The #1 Habit Change That Could Make Your Prolapse Better
Fifty percent of women have some level of pelvic organ prolapse. Whether a bladder prolapse (cystocele), prolapsed urethra (urethrocele), rectal prolapse (rectocele), small bowel prolapse (enterocele), or prolapsed uterus, the good news is, even if you already have one, in most cases, it’s reversible!
And while a lot of online searches and even some practitioners will sing praises to kegel exercises, those are just the tip of the iceberg…and may not even be what you need at all.
In this post, I'm sharing some things that you may not even realize you’re doing that can greatly impact prolapse:
What is Pelvic Organ Prolapse?
How to Tell If You Have a Prolapse
Symptoms of Prolapse
My Experience With Pelvic Organ Prolapse and the Trouble With Getting a Diagnosis
Your Pressure Management System
Lifestyle Habits That Affect Your Pressure Management System
The Number 1 Habit Change That Could Make Your Prolapse Better
In this post, I’m going to be sharing the top lifestyle strategies that I see affect women (including myself) and worsening prolapse symptoms that can be changed and make a huge difference in decreasing symptoms and reversing prolapse. So if you have a prolapse and are looking for natural, conservative ways to reverse it, or are wanting to prevent prolapse from happening at all, keep reading.
What Is a Pelvic Organ Prolapse?
A Pelvic Organ Prolapse (POP) is a displacement of the organs into the vagina. It’s due to laxity in the vaginal wall which allow the organs, such as the bladder, rectum, uterus, small bowel, or even the urethra to bulge into the vagina. Just to clarify, the vaginal wall is still closed, so the organs are bulging into that space, not actually coming through to the vagina, with the exception of the uterus which is above the vagina so can actually fall into the vaginal vault itself.
It’s super common for women to experience mild prolapse after childbirth - typically vaginal delivery but can also happen after C-section depending on how far labor progressed. Plus just the weight of the pregnancy is the biggest contributing factor vs. the delivery alone. But it can also happen to women who have never given birth, who have had a hysterectomy, with age (lowering of hormone levels), if you’re obese, and even if you’re not super active so have low tone which doesn’t keep things in place.
Other risk factors are connective tissue disorders like Ehlers-Danlos syndrome, chronic cough, constipation, or repeated heavy lifting.
All that to say, you don’t have to be fearful. Just be aware that while prolapse is a common thing that can happen, it that can also be prevented or reversed (by 1-2 grades) with good lifestyle habits and/or pelvic physical therapy, which includes manual therapy, exercises, and lifestyle strategies.
How To Tell If You Have a Prolapse
If you’re wondering if you could have a prolapse, the best way to know for sure is to see a Pelvic Physical Therapist or other skilled practitioner who can test you at rest, when bearing down, and possibly in multiple positions. That’s the best and most comprehensive way to know. An Ob-Gyn, Nurse Practitioner, or Midwife can also check though many just look without testing during bearing down or multiple positions. If that’s the case, it may be missed. So if you’re having symptoms but your provider checked by just looking and says you don’t have a prolapse, go get a second opinion.
You can take a look yourself as well, though it’s not necessarily observable externally. Grab a handheld mirror, and sit in an empty bathtub or propped up on pillows on your bed. Somewhere where you can recline a bit. Use the mirror to take a look and see if you can see anything near the entry to the vagina that wasn’t there before. Without going into a lot of detail, just know that you probably won’t be able to see much just with the mirror, but at least you can get an idea of what things look like “down there” so you can compare from day to day if things change. You won’t be able to see a grade 1-3 bladder or uterine prolapse with this method, but you may be able to see a urethrocele or rectal prolapse.
Symptoms of Prolapse
Another way to be clued in as to whether or not you have a prolapse, and the reason most women seek help, is symptoms. Prolapse can feel different depending on which organ is involved, but these are some typical symptoms that may accompany prolapse:
A feeling of heaviness or fatigue in the vagina (or pelvis/low back) that worsens as the day goes on, if you’re on your feet a lot, and with certain activities (high impact, heavy lifting)
Pelvic or Low Back Pain (or sometimes hip pain) - usually worse at the end of the day
Feeling like something is stuck in the vagina or blocking the opening
Pain with intercourse
Difficulty having a bowel movement - may feel like you can’t empty all the way. May have GI issues or constipation (but not always)
Need to urgently or frequently urinate. May have leakage (urinary incontinence)
Vaginal irritation or pain
Tightness or tenderness in the pelvic floor
It could even feel like a yeast infection
Diastasis recti (not really a symptom but often accompanies prolapse)
One important caveat is that the severity of prolapse doesn’t correlate with the severity of symptoms. There are women with grade 3 prolapse who may not have any symptoms at all. And then there are women with grade 1/2 prolapse who are having all kinds of discomfort. Why would this be so? It probably has to do more with level of tension in the pelvic floor. So say the lady with a grade 1/2 prolapse is really bothered by a lot of pain or irritation in the vaginal area. And although she has a prolapse, she also has a pelvic floor that stays tense most of the time. In fact, once that tension is released, the symptoms can completely go away, even with a mild prolapse still present.
Also of note, a grade 1 prolapse is considered to be within normal range. But even though the presence of a mild prolapse may not be of great concern, it would be wise to go ahead and work on balancing the tissues and pressures in order to prevent it from progressing. A prolapse certainly can be prevented from worsening with conservative treatment.
My Experience With Pelvic Organ Prolapse and The Trouble With Getting a Diagnosis
After a particularly difficult birth with my third child, I could decidedly see something different in the vaginal area. At my 6-week checkup, I asked my midwife if it was a prolapse and she didn’t think it was. At that point in time, I had never seen a prolapse and wasn’t trained to do internal pelvic exams yet. So I was relieved that she felt it was normal. (btw, it IS normal to have a grade 1/2-1 prolapse immediately postpartum and things should get back to normal in a few weeks to months). At that point, I went to pelvic floor PT to help support my postpartum healing. She didn’t actually check me for a prolapse (and I didn’t ask her to since I’d just been checked), but we did work on pelvic floor tension release and strengthening which would help with prolapse anyway.
Years later, I attended an internal pelvic therapy course. In these courses, we take turns being both the patient and practitioner. And wouldn’t you know, as we were assessing prolapse, lo and behold, I had one. Not saying it was missed before, because it certainly could have changed over that amount of time, but I hadn’t actually been checked the way we did in the course, so it’s possible it was there all along.
I’m sharing this because it’s a great example to show that there are different methods taught to evaluate for prolapse. So not every practitioner will follow the same guidelines or do it the same way.
So while I didn’t really have symptoms, I knew I’d better work on it because I’m getting to the age where hormones are starting to drop causing there to be less resilience in the tissues, so as that continues to happen, prolapse can worsen if nothing is done about it. No me gusta.
The good news is, prolapse responds super well to conservative treatment! And since the recurrence rate after surgery is 58% just one year later, I’d say it’s worth it to go the pelvic therapy route first. So unless you have a really severe case (not typical), surgery isn’t the best option anyway. Research shows that the best treatment for prolapse is pelvic therapy (lifestyle, exercise, manual therapy) which can reverse the severity of the prolapse by at least 1-2 grades and resolve symptoms completely. (side note: severity of symptoms has no correlation to the grade or severity of the prolapse. Go figure.)
And if you’re dying to know what those lifestyle habits are that I keep alluding to…the wait is over. I’m finally done rambling and will get to the good stuff. ;)
Your Pressure Management System
First, it’s important to understand your body’s pressure management system. As in, how does it keep the organs in place throughout so many movements and activities. Like breathing. When you breathe in, your diaphragm pulls down, opening your lungs so they can take in air. Basically your ribcage opens up like an umbrella - wider at the bottom and narrower at the top. When that happens, your pelvic floor also drops down a bit in response to the pressure from above. This is normal and your pelvic floor is meant to have a bit of give - like a trampoline - so it can move up and down with each breath. Plus all the other things we need our pelvic floor to be able to do.
So when you breathe in and out, your pelvic floor moves down and up too. If you sneeze, cough, or laugh, your pelvic floor should brace just before that happens. If it bulges out, that’s a problem in the pressure management system.
Lifestyle Habits That Affect Your Pressure Management System
Breathing - You probably already guessed that one. Your breathing habits directly affect your pelvic floor. You want to breathe 360 where your rib cage expands all the way around. If it doesn’t, that pressure that would have gone into that spot has to go somewhere else, and the pelvic floor is one of the main areas. Another place is your belly, which is why this is also a risk factor for diastasis recti. Keep in mind that diastasis recti and prolapse go hand in hand. So in many cases if you have one, you’ll also have the other.
Toileting - Do you bear down when you’re on the toilet? Are you constipated often? Both can overload the pelvic floor. A Squatty Potty or footstool can help during bowel movements to take the pressure of the pelvic floor (feet can be down for urination). And for constipation, try eating 1-2 Tbsp of freshly ground flaxseed daily. Plus work on overall gut health.
Bearing Down When Not Toileting - Do you bear down when you’re lifting? Many women do! Instead of bracing the pelvic floor, bearing down when lifting (or coughing, sneezing, laughing, at all times) puts huge pressure down through the pelvic floor. Not good. If you’re not sure if you do this, try coughing. Does your pelvic floor push out or pull up right before you cough? (You can feel with your hand on the outside of your clothing if you’re not sure)
Clothing - Tight clothing, especially around your belly, automatically puts pressure on your abdomen that has to go somewhere. And it’s usually the pelvic floor. Think about a balloon being squeezed in the middle and where that air has to go - either up or down. Another potential pressure-changer is wearing shoes with heels which pitches the body forward and changes the muscle tension all the way up the body. The pelvic floor operates best in neutral position, so if it’s constantly on a tilt, the muscles won’t be balanced and can cause tension and change in pressures. Moral of the story is, wear flat shoes (or no shoes) and loose-fitting clothing around your middle as much as possible.
Posture - your default body position and how you use your body daily will have a huge impact on the pressures in your pelvic floor. Tucking the pelvis and rib thrusting are big pressure changers (also huge factors in diastasis recti), and while it may just be a habit, it could actually be a compensation pattern for weakness or tension elsewhere which signifies a compensation for something deeper.
Speaking of tension, there’s a pretty big tension spot besides the pelvic floor itself that can have a huge impact on prolapse….
The #1 Habit Change That Can Make Your Prolapse Better
Stop. Clenching. Your. Abs.
Namely, your upper abs. Are you an Ab-Clencher? Here’s a way to check. Stand in front of a mirror and pull up your shirt so you can see you belly. Do you have any lines across your belly where you can see you naturally fold when you’re slouching, sitting, or just normally? If so, that’s your tension line. So if you tend to have a lower belly bulge and the upper/middle abs seem flatter - most likely you’re going to have a tension line in the upper/middle ab area.
If you do that, you’re constantly forcing pressure downward into the pelvis and pelvic floor. And if there’s constant pressure being placed on the pelvic floor, it can cause all sorts of issues, not the least of which is exacerbating or causing prolapse.
Try this:
Sit on the floor or in a chair. Put your hands around the lower part of your rib cage. Take a super deep breath and see if you can feel expansion all the way around. Then breathe out all the way - getting out as much air as possible. As you breathe out, press in with your hands around your ribcage to help encourage your ribs to come down and in. Do 5 breaths just like this.
Then relax, breathe normally, and check in with your ribcage to notice difference in how much better it moves with each breath…thus improving your internal pressure management and redirecting a lot of the pressure that would normally be pushed into your pelvic floor, out through the ribcage where it belongs.
Variation: If you’re not getting get expansion in the back of your ribs (you can feel with your hands and/or look in the mirror), go ahead and lean your upper body forward and slightly to the side (kind of “I’m a little teapot” style but not so far to the side). Repeat with the deep breaths as above. In this position, it will really help to direct the air to go to the back of your ribcage. Repeat on the other side for several breaths. Now come back to neutral and try breathing deeply again and notice if you have less tension in your abs (they should release and expand a bit with breathing) and are getting more even ribcage expansion.
Now, for your homework…take note throughout the day if you’re clenching your abs. While you’re putting on makeup, brushing your teeth, washing dishes, sitting at the computer…When you catch yourself doing it, take a deep breath, release it all out, and let the abs go with it. (If you can’t let it go, try the exercise above.) Practice a few more deep breaths to really get some good expansion, relaxation, and to take the pressure of the pelvic floor. It may seem like you have to do this a lot at first, but your body will adapt and relearn what it’s supposed to do if you keep working on it, so you will more naturally keep those abs relaxed over time.
Final Thoughts on Prolapse and Managing Pressures
While prolapse is something to be aware of and is super common, it doesn’t have to be something to fear. While specialized, targeted exercises can help get you back on track and sort of “reset” your system as well as be a tool to help release tension/compensation patterns, there are lots of lifestyle habits that are just as important and will be the key to long-term pelvic floor, core, and overall health.
Take our free quiz to find out how well your pelvic floor is functioning!
Note: For educational purposes only. Not to take the place of or be taken as medical advice.
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