Frequently Asked Questions
What is a prolapse?
A pelvic organ prolapse is where one or more of your pelvic organs shifts into the vaginal canal. The degree at which this happens varies. The organs involved can be the bladder, urethra, uterus, small intestine, or rectum. The rectum itself can also prolapse out through the anus. Prolapses happen because there is a loss of support for these structures. They are supported by pelvic floor muscles and fascia from below and by ligaments from above.
How common is prolapse in the postpartum population?
POP is extremely common in the postpartum population and studies report 50%-90% prevalence! Interestingly, only 3-20% are symptomatic. This means that many women have POP and have no idea. Being diagnosed with a pelvic organ prolapse is not a life sentence, though it can feel that way. There are multiple ways that healing can occur and many women become asymptomatic.
Few studies examine women in the early post-partum period however in a 2014 study of 202 women who were examined 1-4 years post-partum 90% had a cystocele, 89% a uterine prolapse, and 70% a rectocele. 65% of these women had a grade 2 on the POP-Q staging exam and none had a 3 or greater. Interestingly, 80% were asymptomatic! The mean age of this study was 31.2yrs (Durnea, 2014).
Swift et al examined 477 women aged 18-82. 4% had no prolapse, 45% had grade 1, 48% grade 2, 3% grade 3.Barber et al (2013) in a systematic review found that POP was present in 50% of women examined in the general population. Only 3-6% were symptomatic. In 2002 Hendrix et al reported that the rate of uterine prolapse was 14.2%, cystocele was 34.3% and rectocele 18.6% in 16,616 older women.
I was recently diagnosed (or I think I have a prolapse), what should I do now?
Don’t panic.
You are not alone in this journey. There are many other women who have been through this and who are willing to help you.
Take some deep breaths.
Everything is going to be ok. Deep breathing will help you regulate your nervous system and calm you down in times of stress.
Schedule a doctor appointment.
Preferably find a urogynecologist. This is the doctor who specializes in prolapse and will be able to give you a detailed diagnosis and help you with treatment options. If there isn’t one in your area seek out a gynecologist who is well versed in prolapse.
Schedule an appointment with a pelvic floor physical therapist (PFPT) / physiotherapist.
These PTs often have long waitlists so even if you haven’t gotten a referral from your doctor yet, you can still schedule an evaluation with the PFPT. Check that the office is in network with your insurance.
Rest
Get those hips up on a pillow. Put your legs up on a wall while laying on your back. Try not to lift anything too heavy if you can help it. Get some help taking care of children if you can.
GET OFF GOOGLE!
There is a lot of misinformation regarding postpartum prolapse on the internet. Much of the information available pertains to older women with POP because the research in the postpartum population is lacking.
How do I find a pelvic floor therapist?
Search on one of these two resources for registered PFPTs in your area.
https://pelvicrehab.com/
https://aptapelvichealth.org/ptlocator/
If you find someone locally who is not on this list, it doesn’t mean they are not a qualified therapist; they just haven't registered to be on the list!
You can also call your doctor and ask for recommendations in your area. Another option is to simply do a Google search.
A few important pieces of advice:
- Call the office and make sure that the therapist is in network with your insurance. Many clinics also offer cash rates.
- Make sure that the pelvic floor therapist will perform an internal examination. Some PTs claim they are pelvic health specialists but they do not have training in internal examination and treatment.
What types of prolapse are there?
Many doctors will diagnose you with a prolapse but might not tell you the details. You might also hear the terms “anterior wall” and “posterior wall” prolapse. These are general terms for something more specific!
Cystocele (Bladder): the bladder shifts into and down the vaginal canal from the anterior wall
Rectocele (Rectum): the rectum shifts into and down the vaginal canal from the posterior wall
Urethrocele/(Urethral): the urethra shift into the vaginal canal from the anterior wall, or the urethra protrudes out of the urethral opening. Enterocele (Small Intestine): the small intestine shifts down into the vaginal canal from the superior wall
Uterine Prolapse: the uterus and cervix shift down into the vaginal canal
Rectal Prolapse: the rectum descends through the anus
What are the different grades of prolapse?
Different doctors will use different systems to grade a prolapse. This is one reason you might have received differing grades from multiple providers.
The Pelvic Organ Prolapse Quantification (POP-Q) System
This method uses reliable techniques which can help demonstrate change over time from the numerous measurements taken. The measurements are taken with a special speculum while lying on your back and with a maximal bearing down effort. If a point drops to the hymen it measured as 0cm, if it stays higher than the hymen it is recorded as a negative and if it protrudes past the hymen it is recorded as a positive. All measurements are recorded in centimeters using a ruler or tape measure.
The stage or grade of the prolapse is then determined by the organ’s relationship to the hymen while bearing down.
Grade 0: No movement, no prolapse
Grade 1: Movement is noted but does not progress past 1cm above the hymen
Grade 2: The organ descends to between 1cm above the hymen and 1cm below the hymen
Grade 3: The organ descends more than 1cm below the hymen but no more than 2cm
Grade 4: Vaginal eversion has occurred or the organ is more than 2cm past the hymen.
Baden-Walker System
The BW System is commonly used by physical therapists and gynecologists. It is less specific than the POP-Q meaning that disagreements may occur between different practitioners. The prolapse is observed during maximum bearing down while lying on your back. A finger is often used to visualize where the prolapse descends in relationship to the hymen. The grades given are the same as mentioned above with the POP-Q however they are not measured with a device.
Did I cause my prolapse?
NO! You did not cause your prolapse.
From a clinical perspective prolapse is viewed as an injury that occurs due to improper pressure systems and ligamentous stretching over time. In other words, multiple repeated microtraumas that add up to a larger trauma at some point.
Think of it this way. You slept poorly. You spilled your coffee. Traffic sucked on the way to work. Your lunch order was wrong. Then you get home, and your partner or child says one wrong thing and you snap. Small things throughout your day added to you having larger outburst that evening. If your day hadn’t been so shitty, you would have had a lot more patience when you got home.
These microtraumas with prolapse can be pregnancy related, postural and breathing changes, ligamentous laxity from hormone changes/heavy uterus, pushing, assisted delivery, clenching of the abdomen postpartum as a protective mechanism, repetitive lifting, physical activity, etc. etc. etc. On top of this genetics play a huge role. Moral of the story is that these things add up.
For those of you who can pinpoint when the shift occurred, I find it hard to believe that the activity you were doing at that moment was the sole contributing factor. I think more likely that things had added up and your body tipped the scale at the point. It probably would have occurred later down the road for you regardless because you already had experienced those previous microtraumas.
I know it is so hard to change our mindset about this. Trust me. I have gone over what I did immediately postpartum and questioned my labor and delivery – and I know better! I know your mental health can really be affected by this diagnosis. Mine was too. Let’s work towards having grace for ourselves as we learn to heal from prolapse.