Before I had my third son, I was pretty sure I had a handle on this whole birth and postpartum [1] thing. I knew giving birth was messy. I knew I would feel like I had run three back-to-back marathons. And I knew my body would feel uncomfortable and foreign [2] to me as it healed. I'd been through this before, and I felt confident there wouldn't be any surprises. As is often the case when we think we've got it all figured out, I was wrong.
At about two weeks postpartum, I reached down to wipe after using the bathroom and felt a bulge. I let it go at first, thinking I was still swollen from delivery, but over the next few days, I also noticed some unusual pelvic pain and pressure that I didn't remember from my previous births. I knew something wasn't right, so naturally, I turned to Google to diagnose my symptoms. (Please don't do this, just call your doctor).
I typed in "bulge vagina after giving birth" because I honestly had no idea what was happening or if there was even a name for it. The results brought me to the term "prolapse," a medical condition I had never heard of before in my life. This confirmation offered a few brief moments of relief, but that comfort quickly passed as I dug deeper into the search results. Over and over again, I saw stories from women who lived with the discomfort of prolapse [3] for years or women who needed surgery to repair their prolapse. Let's just say, it didn't sound promising.
My ob-gyn confirmed my suspicions and told me that I had a bladder prolapse, also called a cystocele [5]. He did offer some good news — because I was so newly postpartum, my symptoms could resolve on their own [6]. If my symptoms didn't get better (or got worse), I would probably need surgery to repair my pelvic floor. I had also read that seeing a pelvic floor physical therapist was an option, so I asked my doctor if he thought it could be helpful. I won't say he brushed it off, but he didn't seem too enthusiastic about the potential benefits. I knew that I wanted to avoid surgery at all costs, so I called up a local physical therapy practice, went over my symptoms, and made an appointment.
The most common causes of prolapse are "constipation, vaginal deliveries, repetitive straining, and/or an underactive pelvic floor."
I was beyond nervous for that initial meeting because I had no idea what to expect, but I actually learned so much about my body just in that one-hour-long appointment (certainly more than I did from my doctor). My PT started with an internal exam to check my symptoms and pelvic floor function [7]. She had me do a few Kegels so she could observe whether I was contracting the correct muscles. Turns out, I wasn't. After the internal exam, she used an external ultrasound device to view my pelvic floor and abdominal muscles. My transverse abdominis muscle [8], the ones that should engage during a Kegel, weren't moving at all. I had a lot of work ahead of me.
The PT spent the rest of our session teaching me how to properly engage my pelvic floor and sent me home with "homework" in the form of therapy exercises that I needed to do each day. Our subsequent sessions followed a similar schedule. She taught me new (and more difficult!) exercises at each of my eight sessions and occasionally used the ultrasound machine to verify I was doing everything correctly. Once I graduated, I had no prolapse symptoms at all. I continue to do at least a few pelvic floor exercises daily and always work them into my workout routine when I go to the gym [9].
Now, I talk about pelvic floor health with anybody who will listen. True, this is my personal story with prolapse, but pelvic floor health is something that I think we all need to be aware of. I spoke with Emily Bickers, DPT, OCS [11], a physical therapist specializing in pelvic pain and dysfunction, to get a little more information on who is most at risk for prolapse, when to get checked, and what we can all do to ensure proper pelvic floor function.
"Prolapse is caused by [12] anything that increases intra-abdominal pressure in males and females," Bickers told me. The most common causes of prolapse [13] that Bickers shared with me are "constipation, vaginal deliveries, repetitive straining (i.e. lifting heavy weights, performing deep squats, or pushing and pulling heavy loads), and/or an underactive pelvic floor." Many of these have nothing to do with giving birth, leaving both men and women at risk. This risk can be reduced by "properly training the pelvic brace (the coordination of pelvic floor contraction and co-activation of the transverse abdominis and proper diaphragmatic breathing) to regulate intra-abdominal pressure."
"Just like any other muscle in the body, if you don't use it, you lose it."
This, of course, is something best learned from a physical therapist. Even in the absence of symptoms, Bickers believes everyone can benefit from incorporating pelvic floor exercises into their routine. "We all know we need to strengthen our 'core' [14], but we often forget that the pelvic floor muscles are a main component. Just like any other muscle in the body, if you don't use it, you lose it," Bickers said. If you aren't having any symptoms, you may choose to incorporate pelvic floor exercises on your own, but knowing what I know now, I would suggest to anyone that it can't hurt to be evaluated. Some practitioners will refer patients to a pelvic floor specialist after giving birth or after surgery involving the abdominal region, but Bickers also recommends that anyone with "symptoms of pelvic pressure, sensations of something 'falling out,' urinary incontinence, and/or a bulge that can been seen or felt," see a specialist.
With three kids, it is difficult for me to find time to do pelvic floor exercises daily. I make the time, though, because I know it is the best way to keep my symptoms at bay and maintain my pelvic floor health. Sometimes all I can manage are some Kegels while I am feeding the baby or sitting at a stoplight, but when I can make it to the gym, I spend at least 10 minutes just working on the exercises I learned in physical therapy. As Bickers reminded me, the goal is to implement the pelvic brace consistently into daily living where it becomes second nature. It takes patience and consistency, but it is worth the effort.