What to do if I have a prolapse?

Prolapse can be a scary concept, mostly because a lot of women don’t really know what the term really means.

TLDR: It can distressing but more so if you don’t understand what’s going on and there is so much to be done that can alleviate your symptoms.

So firstly: what is it?

It normally happens in the vagina, the organ that links the vulva on the outside up to the cervix at its top. On either side of the vulva sit the bladder and the bowel where everything is held in place by connective tissue (fascia) and supported from the base by the pelvic floor muscles. Childbirth can cause trauma to the pelvic floor muscles thereby changing the way support happens, and hormonal changes, as we age, can affect this and the fascia that’s held everything where it needs to be over the years.

A prolapse is when the fascia becomes more lax and, normally, either the front or back wall of the vagina begin to feel less supported and become more mobile and there is a sensation of something pushing into the vaginal region. Some women describe a sense of heaviness or dragging that they especially notice when they are washing themselves in the shower, when they sit down or by the end of the day everything just begins to feel a bit worse. Symptoms can fluctuate according to your menstrual cycle and how active you’ve been which can feel both disconcerting and reassuring.

How bad is it that I have a prolapse?

The statistics imply that (at least) 1 in 3 women will suffer from symptoms of prolapse. Mostly, but not exclusively, these are women who have undergone a vaginal birth and we know that those who have had an instrumental delivery or a large tear and more likely to experience symptoms at some point in their life. Some women experience fear and discomfort when they recognise things have changed, but many women manage their symptoms once they know what’s happening. Once we have some knowledge it can be hugely empowering to know that things aren’t necessarily going to get worse.

When can it be diagnosed after childbirth?

Women will often have many sensory changes to their vulva and vagina in the few weeks and months after child birth but this doesn’t necessarily mean that you have a prolapse. The body will undergo natural recovery over the few months post partum and, with good nutrition, hydration, sleep and restorative exercise, changes can be transformative over a few months. So if you’ve been diagnosed with a prolapse at 6 weeks I’d urge you to think about your healing journey and not expect to be feeling the same symptoms a few months from then. If every woman could have access to a thorough pelvic floor assessment after her delivery we would have a population of confident women knowing how to care for their bodies in the post partum phase and beyond.

How do you diagnose a prolapse?

The best way is for a pelvic health expert to have a good old look at the vaginal tissue to ascertain how the muscles are coordinating together and how pressures are being managed. In reality this means lying on a plinth while someone has a look and a gentle feel of the tissues and any scarring that a woman has before getting her into a standing position and doing the same. It can be useful to do this whilst moving – squatting and lifting weights give us a good idea of exactly what is happening and allow for an individualised exercise programme.

Will it just get worse as I get older?

There is absolutely no reason that this should happen. A significant proportion of women who haven’t felt any prolapse symptoms for many years after childbirth become menopausal and wonder why things begin to change at this point. The reason is that hormone levels are changing and, unless we strive to maintain it, as we age our ability to maintain muscle mass decreases. Women in this phase of life can find it hard to prioritise their own health and if they don’t actively work their pelvic floor muscles, alongside all the other muscle groups, then the support of the whole system may be lessened. As long as we know how to manage pressures we can prevent things worsening. Just having a prolapse does not mean you have to wrap yourself in bubble wrap and disengage from any fun activities like sex, walking long distance or lifting weights, it just means you have to learn to manage it – speak to a pelvic health physio about what this can mean for you specifically.

What makes prolapse worse?

Things that increase intra abdominal pressure like straining on the loo or lifting heavy without a good baseline of fitness, especially if we have a history of vaginal birth. Changing hormone levels through the menopause don’t help, especially as feelings of dryness or discomfort can feed into how we feel about a prolapse. Exercise is so important to women as we age; we can’t stop exercising and stay fit and strong, but it’s important to know how to exercise specifically for you. Most of us are going to die of cardiovascular disease and so the last thing we want to do is minimise our potential to work out because we’re worried about a prolapse. Women who don’t exercise and expect to feel the same way they did 20 or 30 years ago may need to readdress their priorities, despite this often being a real challenge.

What can I do to improve my symptoms?

Learning how to support your system during fitness, working into old scars, having good bowel habits, managing hormone levels with HRT and vaginal HRT, intra-vaginal devices or external support garments can all be useful. There’s so much we can do to reduce the symptoms of prolapse and neither stopping exercise and sex are helpful or necessary.

I don’t have a prolapse, how can I prevent myself from getting one?

If you have concerns about your pelvic health then seek advice on what sort of exercise you could be doing to support yourself as best you can. If you’re lifting heavy (maybe caring for a relative or lugging large pots around a kitchen or garden?) then you could be at risk if your muscles aren’t coordinating or strong enough. You may need to learn how to ameliorate the effects of pressure on your system and discuss ways to make your bowel habits easier, preventing straining and the associated problems that causes. Do have a pelvic health assessment to learn about your body and give you some strategies to embrace the coming decades in the best health you can be in!