Pregnancy with Existing Prolapse
If you’re experiencing pregnancy with existing prolapse, you’ve come to the right place. I’m here to tell you everything you need to know about how to navigate pregnancy, manage prolapse, and optimize your pelvic health.
Understanding Prolapse and Pregnancy
What is prolapse, and how does it affect pregnancy?
Pelvic organ prolapse is the descent of one or more pelvic organs into the vaginal canal. Structures that typically prolapse include the uterus, bladder, and rectum, and less commonly the small intestine.
Prolapse is staged from one to four with one being the least severe and four being most severe. A stage one prolapse is barely descending into the vaginal canal, while a stage four prolapse is protruding externally.
Stage 0 : No prolapse demonstrated
Stage 1: Prolapse, but definitely inside the vagina
Stage 2: Prolapse, but at the entrance of the vagina
Stage 3: Prolapse, but definitely outside of the vagina
Stage 4: Full organ eversion outside of the vagina
Stage three and four uterine prolapse require the most care during pregnancy to keep the uterus from protruding outside of the vagina.
Stage ones and twos are often the most symptomatic, though.
Types of prolapse during pregnancy (uterine, bladder, rectal).
A uterine prolapse is a prolapsed uterus, a cyctocele is a prolapsed bladder, a rectocele is a prolapsed rectum, and an enterocele is a prolapsed small intestine.
Let me give you a simplified visual:
The uterus is the highest of the bladder, rectum, and uterus
The lowest point on the uterus is the cervix
The vaginal walls connect the uterus to the outside of your vulva (like a slide for your blood to come down when you are menstruating)
The bladder sits in front of the vagina
The rectum sits behind the vagina
Now, imagine if the uterus is prolapsed, causing the walls of the vagina to slacken, how the bladder and/or rectum could prolapse as well.
Symptoms of prolapse in pregnant women.
The main symptoms of prolapse are the same for pregnant women as they are for not pregnant women, but uterine prolapse symptoms may be intensified during the first and third trimesters due to increased weight of the uterus and hormonal changes.
The most common symptoms pregnant women report by trimester include:
First trimester:
Heaviness
Incontinence
Urinary retention
Constipation
Second trimester:
May still experience the above, but symptoms improve
Uterus begins to lift upward so appearance of prolapse may improve
Vomiting also typically reduces, which puts less strain on the pelvic organs
Third trimester:
Heaviness – uterus grows significantly so appearance may worsen
Hemorrhoids
Sleep difficulties can lead to worsening of symptoms
Incontinence & constipation may continue
Postural challenges will increase
Managing Prolapse During Pregnancy
Safe exercises to manage prolapse while pregnant
Big oof – basically “it depends.”
For lower staged (1-2) prolapse, continuing your current exercise regimen with proper breathing & core and glute activation should be safe but as always run this by your own provider first. For higher staged prolapse, I would recommend working with a pelvic floor PT early in your pregnancy and consider a pessary for support if your provider feels you are a good candidate.
For managing prolapse during pregnancy I like to consider three things:
Core and pelvic floor muscle recruitment to support the organs
Thoracic and ribcage expansion to allow the uterus to grow upwards more rather and down
Pelvic floor relaxation to allow for proper pressure management
Easy, tangible ways to build this into your daily exercise routine looks something like this:
Make every exercise a core exercise by engaging core muscles & exhaling with the hardest part of the movement
Exhale and engage when you come up out of a squat or deadlift
Exhale and engage when you push up out of a push up or shoulder press
Include thoracic mobility at the end of your workouts
If walking, exaggerate your arm swing as this will increase thoracic mobility
Add a legs up the wall (first trimester) or puppy pose (second or third trimester) to the end of the day to address the pressure and let gravity help your pelvic organs
Tips for reducing prolapse symptoms during pregnancy.
Lifestyle tips for reducing pregnancy include managing constipation, being mindful of posture, and specific vomiting techniques.
Because of where the rectum sits in relation to the uterus and vagina, having daily bowel movements helps tremendously with managing pelvic organ prolapse. Tips for managing constipation during pregnancy include:
Adding magnesium citrate
Daily walks
Eating 20-30g of fiber/day
60-80 oz of water/day
And adding an abdominal massage in earlier trimesters
You can read more about managing constipation here.
Postural alignment is HUGE when it comes to prolapse too. The pelvis naturally tilts forward as the uterus grows, and often pregnant women exacerbate this by squeezing their glutes and poking their belly forward. Being mindful of this and working to engage core muscles more helps tremendously.
And lastly, because vomiting puts so much pressure on the pelvic floor simple things like squeezing a towel between your knees while vomiting will help recruit the pelvic floor muscles and provide more support while you are puking.
Lifestyle adjustments for a healthy pregnancy with prolapse.
Lifestyle adjustment recommendations include dietary modification listed above (where possible due to nausea) to support daily bowel movements, working hard on sleep hygiene as sleep is often disrupted during pregnancy (this might mean working with a sleep specialist), and considering a pessary or external support garment for increased support in the later trimesters.
Additionally, if you are on your feet a lot during the day, finding breaks to sit throughout the day to give your pelvic floor a break is also beneficial.
Medical Considerations and Support
Pessary management and risks of using a pessary during pregnancy with existing prolapse.
A pessary is a support device that is fitted, sized, and prescribed by an OBGYN or pelvic PT with training in pessaries. Pessaries are like a sports bra for your pelvic organs – they just provide a little extra support but need to be fitted appropriately. You can read more about pessaries here.
There are different types of pessaries with rings and cubes being the most commonly used. Cubes work via suction and are not recommended as first line because of the mucous plug – we don’t want her coming out too soon!
The risk of bacterial vaginosis (BV) is 3.3x more likely for those using a pessary, which is important for those who elect to have a cesarean as opening the uterus with BV can cause pelvic inflammatory disease.
This doesn’t mean not to use a pessary - it does mean you should work with your OBGYN and get swabbed for BV regularly during your pregnancy.
When to consult a pelvic floor specialist during pregnancy
I like to start seeing my patients who are pregnant in the first trimester – let’s get ahead of things!
And if you are pregnant with an existing prolapse, odds are your symptoms are worse during the first trimester, so let’s work together to manage them.
The frequency of visits during pregnancy is similar to the frequency of visits with your OBGYN/midwife - starts out monthly and increases in frequency as your pregnancy progresses.
Treatment options for prolapse during and after pregnancy.
Treatment options for managing prolapse during pregnancy include:
Pelvic floor PT
Pessary
Or a combo of both, ideally
Treatment options for managing prolapse after pregnancy include:
Pelvic floor PT
Pessary
Surgery
Or a combo of the above
If surgery is the route you choose to go, keep in mind the research shows that the best outcomes come from doing pelvic floor PT prior to and after surgery.
Postpartum Recovery with Prolapse History
How to recover postpartum with a history of prolapse.
Rest, rest, rest in the beginning – and by rest I mean put your legs up. Telling you to sleep with a newborn to heal your pelvic floor would be unrealistic, but by all means, do that as much as you can!
I like to recommend breathing exercises in the early postpartum phase - with the goal of trying to connect to your pelvic floor and core again. This might be hard if you’ve never experienced pelvic floor PT and don’t know how to do that so let me encourage you to reach out to your local pelvic floor PT and get that appointment scheduled!
When you feel like it (healing is different for everyone), I recommend starting with body weight exercises and try to be really intentional about breathing and core activation. Breathing is so important as breath holding puts pressure on your pelvic floor and organs and can exacerbate your prolapse.
I believe strength training for moms is also super important because of how physical our role is. And our babies are only getting bigger :(
Preventing worsening prolapse after childbirth.
This is where I believe pessaries come into play for prevention. Once your body is ready for it, I believe using a pessary as support while your muscles relearn how to work is ideal.
This will hold your organs in the place they need to be so your ligaments and other structures can properly heal.
Role of pelvic floor therapy in postpartum prolapse recovery.
An excellent postpartum pelvic floor PT experience specific to prolapse will include individualized care targeting the above mentioned things including:
Proper breathing techniques
Core and pelvic floor coordination
Pelvic floor relaxation
Constipation management
Potential pessary fitting
Strength training
And so much more!
Pelvic floor PT can get you back to living your best life, symptom free so you can play with your kiddos without worrying about your prolapse.
We are currently taking new patients with prolapse in Rockwall, Canton, andSulphur Springs. If you are interested in scheduling an appointment, please request an appointment here and someone from our team will reach out to you to get you scheduled.
