What exactly is prolapse, and what does it feel like?

At the end of one of my pelvic floor workshop a question that came up was “What does prolapse feel like?”

I’m not going to lie, after I had my first baby 5 years ago I spent a lot of my sleep deprived time on google trying to work this out too!

Despite having an understanding of movement and knowing my body quite well, I felt clueless about what was happening to my pelvic floor. When I started getting a bulging sensation in my vagina I knew instinctively that something was “out of place”, but I had no idea it was prolapse. I also had no idea how common prolapse is.

I felt frustrated and a little bit terrified. What the hell was happening?? I had a C-Section, I thought my vagina would be fine!

Now I think back on this period and feel so frustrated for myself as a new mum, utterly exhausted and feeling so worried about what was happening to my body. Why didn’t anyone talk to me about the possibility of this happening? Why isn't it standard for birth educators and antenatal care providers to refer you to a women’s health Physio during pregnancy and after the birth?

Knowing the stats now makes me even more disappointed for my 2018 self, and all the new mums who are going through this now. Some degree of prolapse is a NORMAL occurrence after birth. Many women won’t even know that any prolapse occurred, and minor prolapse will usually go completely unnoticed unless it causes symptoms down the track. 50 percent of vaginal deliveries will result in some degree of prolapse.

What’s so frustrating to me is that minor prolapse can be kept minor, OR completely resolved by learning how to breathe and move well. Prolapse is often seen alongside an inability to manage pressure well. If women were taught this before giving birth, prolapse would be a lot less scary.

First of all, what exactly IS prolapse?

Generally prolapse is described as the descending or “falling” of the internal organs in the pelvis into the vagina due to muscle/tissue weakness and stretching. There are three main types of prolapse and each is usually graded from Stage 1 to Stage 4.

I’ve recently found the work of Anna Crowle who treats prolapse and the pelvic floor with Myofascial Release therapy, and she theorises that rather than prolapse being caused only by weakness or stretching of the connective tissues, it’s often actually tension in the pelvic floor pulling the organs out of position.

I really connect with this idea, and will explain why shortly.

Cystocele or Anterior Wall Prolapse

A cystocele or Anterior Wall prolapse is the bladder and vaginal wall bulging into the vagina. Usually the muscles and connective tissues support the bladder in place. I experienced this kind of prolapse after both my births.

Uterine Prolapse

Uterine prolapse is the the dropping of the uterus into the vaginal canal. The weight of the descended uterus can put pressure on the other organs in the pelvis and will create a feeling of heaviness and bulging. You may notice the cervix sitting really low, or coming out of the vagina depending on the stage of prolapse. This sort or prolapse is NORMAL immediately after birth. My cervix was basically at the entrance of my vagina.

Rectocele or Posterior Wall Prolapse

With a rectocele prolapse the rectum bulges into the posterior vaginal wall and may cause rectal pain, constipation, a feeling of pressure in the rectum or the feeling that the bowel hasn’t fully emptied.

So what does it feel like?

I had a stage 1 anterior wall prolapse, and for me it felt similar to an air bubble or a tampon that was about to fall out. I felt like I needed to queef constantly. I had a heavy feeling in my pelvis and sex was painful in certain positions (which I know now was actually due to tension). I also felt like I couldn’t fully evacuate when pooing, but have since learned this was also due to tension in my pelvic floor.

After exercise I’d feel really fatigued in my pelvic floor, and I’d instinctively elevate my hips to try to relieve the pressure. I was on the right track here, but I was missing a big piece of the puzzle. My rib cage.

More on that soon!

We need to do better.

What felt most frustrating to me was the lack of information. I had been to see a women’s pelvic health Physio and nothing was discovered re prolapse, nor even discussed. But to be fair, I didn’t have any symptoms at the time. It wasn’t until I went back to my pre baby exercise (because I felt fine) that I started to notice symptoms.

What's also so frustrating is the 'normalising' of not being able to exercise without leaking, not being able to enjoy sex, not being able to jump and play with your kids without leaking because 'you're a mum now and it's just what you have to deal with.'

I remember having these conversations with mums I trained way back in my early 20's when I had no clue that you can actually do a LOT to resolve prolapse and pelvic floor symptoms. They all talked about it as if it was a given of #mumlife.

So, I didn’t start getting symptoms until after the Physio appointment when I returned to my usual workouts. This is what I was mentioning earlier about being educated so that minor prolapse stays minor, or can be easily resolved with the right education on pressure management and better movement patterns.

I would say I'm lucky that I didn’t have any problems with leaking, but my symptoms were still very frustrating. If you've had that vagina bubble/bulging sensation, heaviness, painful sex or just a feeling of disconnection you know what I mean!

Seeing a women's health physio postpartum was a great way to understand what was and wasn't functioning properly, but one appointment doesn't equal problem solved. And in fact the exercises prescribed can sometimes make symptoms worse.

This is where understanding what your pelvic floor actually needs is so important.

After having my first baby I felt totally disconnected from my pelvic floor, and discovering I had an anterior wall prolapse meant I had to figure out what worked for my new post baby body - and that started with literally relearning how to breathe! I could go on for days about breathing but I’m not going to go into that here. If you’re curious about breathing check out my previous post on 360 breathing.

It could be weakness OR it might be tension.

As I mentioned earlier, I really connected with Anna Crowle’s theory that pelvic floor symptoms and POP could be caused by tension pulling organs out of position.

This makes sense to me with everything I’ve learned over the last year. If you imagine your pelvic floor is like an interconnecting web of soft tissue and muscles, what do you think would happen if there is scar tissue pulling on one side of the web? It’d pull everything along for the ride. Right? Or what about constant butt clenching shortening the muscles of the posterior pelvic floor? Stress and anxiety causing clenching throughout the body?

So if you think of scar tissue from episiotomy’s or tearing, C-sections, trauma, stretching from birth - that compromised tissue is going to pull the surrounding structures out of their normal positions.

I know now that I had SO much tension in the back of my pelvic floor from years of gripping my butt - partly due to a tailbone injury years ago, but also because my body was trying to find some stability. I also used to think belly breathing was the best way to breathe, and inadvertently stretched and weakened my core muscles by allowing pressure to push out the front, so that my strategy became glute clenching and dropping my chest to create some compression, aka stability.

Add on top of that two pregnancies and my ability to manage pressure was out the window. My poor glutes were doing ALL the work, and my poor posterior pelvic floor was paying the price.

It's been a process of trial and error, a LOT of re-educating myself, working to find the balance of relaxation/lengthening and strengthening of my pelvic floor. But I’m so happy to report that my Pelvic Floor Physio check up at 15 months postpartum revealed that my prolapse has fully healed.

I’m back to high impact activities like jumping, running and sprinting with no symptoms.

The last 5 years has been a huge eye opener for me, and it’s given me a lot of drive to share what I know to help mums avoid the mistakes I made when it comes to training and the pelvic floor.

I’ll share more on the HOW to soon.

I’d love to know, did you get education about the possibility of prolapse after birth?

Did you see a pelvic health physio during and/or after pregnancy who helped resolve your pelvic floor symptoms?