Dealing With 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.

Prolapse is when one or more of your pelvic organs shift out of place. Sometimes only a little movement inside can cause a lot of bothersome symptoms, yet other women can see and feel a large bulge or protrusion without any bother. It is a complicated condition and you will need advice from your GP or a specialist physiotherapist to understand fully what is going on for you.

If a Pelvic Organ Prolapse (POP) occurs as a result of childbirth, it is often referred to as a postpartum prolapse. This condition arises when the muscles and tissues supporting the pelvic organs are weakened or damaged, causing one or more organs to bulge into the vaginal canal. Prolapse is now commonly categorised based on the part of the vaginal wall affected: front wall prolapse, back wall prolapse, or apical prolapse. 

Front Wall Prolapse

A front wall prolapse occurs when the front wall of the vagina weakens, allowing the organs it supports to shift downwards. This may involve the bladder, traditionally referred to as a cystocele, which causes the bladder to bulge into the vaginal canal. In some cases, the urethra, the tube that carries urine out of the body, may also descend, a condition previously called a urethrocele. When both the bladder and urethra prolapse together, this is often referred to as a cystourethrocele. Symptoms of a front wall prolapse may include a sensation of heaviness or pressure, difficulty emptying the bladder, or urinary leakage.

Back Wall Prolapse

A back wall prolapse occurs when the posterior vaginal wall loses support, leading to the protrusion of either the rectum or the small bowel. When the rectum bulges into the vagina, this is traditionally referred to as a rectocele. It can cause symptoms such as difficulty with bowel movements, a sensation of fullness, or discomfort during intercourse. Less commonly, the small bowel may descend into the space behind the vagina, a condition previously known as an enterocele. Enteroceles often occur alongside apical prolapse or following certain surgical procedures. Back wall prolapses may also contribute to a feeling of incomplete emptying of the bowel.

Apical Prolapse

An apical prolapse affects the top of the vaginal canal and may involve the uterus or the vaginal vault. Uterine prolapse occurs when the uterus descends into the vagina, often causing a sensation of heaviness, pelvic pressure, or visible bulging at the vaginal opening. In individuals who have undergone a hysterectomy, the top of the vagina (or vaginal vault) can lose its support and collapse, leading to what was previously known as a vaginal vault prolapse. This type of prolapse is significant as it affects the overall support structure of the vagina and often occurs in combination with front or back wall prolapse.

Experiencing a postpartum prolapse while recovering from childbirth can be overwhelming, particularly during an already challenging time as a new parent. However, it is important to know that this condition is more common than many realise, and effective treatments are available. We are here to provide support and reassurance, helping you regain confidence and comfort as you recover.

What Causes a Prolapse After Childbirth?

The primary cause of prolapse is a change in the support structures of the organs. This includes their ligament and fascial attachments as well as the pelvic floor muscles supporting them from below. There is no single cause of the problem, rather layers of events occurring that change the support system. Some are in your control but many are not.

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 area.  Hormones and the weight of the growing baby change the elasticity of all the tissues.  Pelvic floor muscles and abdominal muscles stretch and there can be weakening and scar tissue through the birth process.  

Other risk factors include:

• A particularly heavy baby
• A complicated vaginal delivery
• 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
• Being overweight or obese

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:

• A feeling of pressure or a dragging feeling inside the vagina.
• A visible bulge near the entrance of the vagina, or a bulge that you can feel deeper inside the vagina.
• Leaking urine when you cough, sneeze or pick up your baby, as your bladder reacts to pressure caused by the prolapse.
• Alternatively, you may feel as though your bladder is never empty, leaving you with a frustrating feeling that you always need to ‘go’ (urgency) or need to go more often (frequency).
• If your bladder has shifted out of place in the presence of a prolapse, it can make it more difficult to empty it completely.
• You may be struggling to empty your bowel fully (constipation) or you might find it difficult to control your bowel urges.
• Lower back or pelvic pain.
• Pain or difficulty having sex.

It is typical for prolapse symptoms to fluctuate day to day or to notice that symptoms 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. 

Depending on the type and severity of your prolapse, your options include surgery, lifestyle changes, using an electronic pelvic toning device, or even doing nothing.

Every woman is unique so there is no one- size-fits-all solution to prolapse. It’s all about finding out what works for you. We encourage you to treat and manage your prolapse with every aspect of life in mind; from toilet habits, to exercise, to sex.

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.

However, it’s important to know that prolapse will never just go away on its own. If it’s affecting your life now, you should consider taking steps to manage and treat prolapse as soon as possible.

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.

Sources

Brown. (1997). Journal of the National Medical Association. Cervical prolapse complicating pregnancy. [online] 89(5), p 346-348. [viewed 13/12/2024]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2608164/

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 13/12/2024]. Available from: https://www.nice.org.uk/guidance/ipg584/chapter/3-The-procedure

Women's Health Concern. (Reviewed 2024). Prolapse: Uterine and vaginal [online] Women's Health Concern, 2024 [viewed 13/12/2024]. Available from: https://www.womens-health-concern.org/wp-content/uploads/2022/12/21-WHC-FACTSHEET-Prolapse-NOV2022-B.pdf