Prolapse After Childbirth
What Types of Prolapse are Possible After Childbirth?
It’s thought that around half of all mothers will develop prolapse symptoms at some point following childbirth. For some, it happens straight away, for others it doesn’t happen until they reach menopause.
If a Pelvic Organ Prolapse (POP) occurs as a result of childbirth, is is then known as a postpartum prolapse. Depending on the organ that prolapses into the vagina, each pelvic organ prolapse has a different name. Follow the links below to learn more about each type of prolapse:
- Cystocele – prolapse of the bladder
- Urethrocele – prolapse of the urethra
- Cystourethrocele – prolapse of both the bladder and the urethra
- Rectocele – prolapse of the rectum
- Enterocele – prolapse of the small bowel
- Uterine prolapse – prolapse of the womb
- Vaginal vault prolapse – prolapse of the vaginal walls
Having a postpartum prolapse at a time when you’re recovering from giving birth and becoming a new parent couldn’t be more distressing. But we’re here to help put your mind at rest and show you that you have options. Plus you’re not alone, a prolapse after childbirth is more common than you think.
What Causes a Prolapse After Childbirth?
All pelvic organ prolapses occur as a result of a weakening in the muscles that hold everything in place within the pelvic area – the pelvic floor muscles. Healthy pelvic floor muscles act like a muscular hammock at the bottom of the pelvis, and along with the strong vaginal walls, help to keep the pelvic organs stable.
Unfortunately, pregnancy and a vaginal delivery can add pressure to the pelvic floor muscles and cause them to weaken and become loose, as they overstretch and cause scar tissue where they try to repair. It can also cause nerve damage to these important muscles. The weight of the baby can stretch them, even if you give birth by caesarean.
Pregnancy hormones also play a role, changing the pelvic floor muscles to make them become more elastic, usually beyond their rebound limits. Helpful for supporting a baby and for giving birth, but not so much for their strength afterwards. <!–– ADD IMAGE[13.0 Diagram of a baby putting pressure on the pelvic floor]-->
Other risk factors that can add to the damage include:
- a particularly heavy baby
- a complicated vaginal delivery, with lots of pushing, tearing and where forceps are used
- an uncomplicated vaginal delivery, which can cause scar tissue and nerve damage to the pelvic floor muscles
- multiple pregnancies and births
- having had previous pelvic organ prolapses
- prolonged and sustained constipation meaning that you have to strain to pass a bowel movement
- a chronic cough
- I xan see my cervix after childbirth
- being overweight or obese
- regularly lifting heavy weights or older children
What are the Symptoms of Childbirth Related Prolapse?
You might begin to develop prolapse symptoms straight after childbirth, or it might take some time. You may also never develop symptoms and have a postpartum prolapse diagnosed during a smear test or other routine pelvic or vaginal examination such as your six-week postpartum health check-up.
If you do experience symptoms, then you may experience all or some of the following, depending on the pelvic organ prolapse you are suffering from:
- urinary incontinence – a constant dribbling of urine that you can’t control
- urinary stress incontinence – an uncontrollable dribble of urine when you cough, laugh, sneeze or pick up your baby
- frequent bladder infections
- frequent urination
- urgent urination
- difficulty urinating
- difficulty inserting a tampon or keeping a tampon in
- lower back or pelvic pain
- pain having sex
- a feeling of pressure in the pelvic area
- a dragging feeling, or a heaviness in the pelvic area
- a visible bulge of tissue protruding from the vagina when you cough or strain, or permanently
- symptoms that get progressively worse on standing or simply throughout the day
How Do You Treat a Prolapse After Childbirth?
There are various treatments for a postpartum prolapse. Which one is best for you will depend on the severity of your symptoms. Many lifestyle changes can be enough to treat mild and moderate prolapses. These include daily Kegel / pelvic floor exercises, maintaining a BMI of less than 30, and avoiding constipation.
To read more about treatments, visit the prolapse treatment page. If you know which pelvic organ prolapse you are suffering from, visit the types of prolapse page for more detailed treatment explanations.<!–– ADD IMAGE [13.1 Diagram showing basic pelvic floor exercises]-->
Brown. (1997). Journal of the National Medical Association. Cervical prolapse complicating pregnancy. [online] 89(5), p 346-348. [viewed 22/03/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608164/
Mørkved, S. Salvesen, K. Å. Salvesen, Ø. Volløyhaug, I. (2015). Ultrasound in Obstetrics & Gynecology. Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery. [online] 46(4), p 487-495. [viewed 22/03/2018] Available from: https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/uog.14891
NICE. (2017). Uterine suspension using mesh (including sacrohysteropexy) to repair uterine prolapse, 3 The Procedure [online] National Institute for Health and Care Excellence, 2017 [viewed 22/03/2018]. Available from: https://www.nice.org.uk/guidance/ipg584/chapter/3-The-procedure
Women's Health Concern. (2015). Prolapse: Uterine and vaginal [online] Women's Health Concern, 2015 [viewed 14/03/2018]. Available from: https://www.womens-health-concern.org/help-and-advice/factsheets/prolapse-uterine-vaginal/