Pelvic organ prolapse (POP) is a condition that can occur after childbirth, particularly during the postpartum period.

It involves the descent or bulging of one or more of the pelvic organs—such as the bladder, uterus, or rectum—into the vaginal space due to weakened or stretched pelvic floor muscles and connective tissues. Prolapse can be a significant concern for postpartum individuals, especially those who have had a vaginal delivery, though it can also occur after a caesarean section. Understanding the signs, causes, and available treatment options for postpartum prolapse is essential for recovery and maintaining pelvic health.

What is Pelvic Organ Prolapse (POP)?

Pelvic organ prolapse happens when the muscles and tissues that support the pelvic organs become weakened or stretched, often during pregnancy and childbirth. This results in the displacement or bulging of one or more of the pelvic organs—bladder, uterus, rectum, or small intestine—into or through the vaginal canal.

There are different types of prolapse based on the organs involved:

  • Cystocele (Anterior Vaginal Wall): Bladder prolapse, where the bladder bulges into the front wall of the vagina.
  • Rectocele (Posterior Vaginal Wall): Rectal prolapse, where the rectum bulges into the back wall of the vagina.
  • Uterine Prolapse (Cervical or Vault Descent): When the uterus descends into the vaginal canal.
  • Enterocele: The small intestine descends into the vaginal cavity.

The severity of prolapse can range from mild, where there are no noticeable symptoms, to moderate or severe, where prolapse may cause a visible bulge or significant discomfort.

Signs and Symptoms of Postpartum Prolapse

Pelvic organ prolapse often develops gradually, and the symptoms may be subtle or become more apparent over time. Common signs and symptoms of postpartum prolapse can include:

  • A Sensation of Heaviness or Fullness in the Pelvis: This feeling occurs because the pelvic organs are not supported properly and may begin to descend or bulge into the vaginal space.
  • Vaginal Bulging or Feeling of Something “Falling Out”: This is one of the most recognizable signs, where you may feel or even see a bulge in the vaginal area, especially after prolonged standing or physical exertion.
  • Urinary Problems: Symptoms like urinary incontinence (leaking urine), frequent urination, difficulty fully emptying the bladder, or a feeling of urinary urgency can occur if the bladder is affected by prolapse.
  • Bowel Issues: Constipation or a feeling of incomplete bowel emptying may result from rectal prolapse. You may also experience difficulty with bowel movements.
  • Pelvic or Lower Back Pain: Discomfort, pressure, or a dull ache in the pelvic area, especially after prolonged sitting, standing, or physical activity, can be signs of prolapse.
  • Pain During Intercourse (Dyspareunia): Prolapse can sometimes cause discomfort or pain during sexual activity due to the shifting of pelvic organs.

It is important to note that prolapse can range in severity. In mild cases, you may only notice symptoms during physical activity or at the end of the day. In more severe cases, the prolapsed organ(s) may be visible outside the body.

Causes of Postpartum Prolapse

Postpartum prolapse is commonly associated with pregnancy and childbirth. The following factors can contribute to the development of prolapse:

  • Childbirth: Vaginal delivery, especially if assisted with forceps, vacuum, or if the baby is particularly large, can put significant pressure on the pelvic floor muscles, increasing the likelihood of prolapse.
  • Multiple Pregnancies: Carrying and delivering multiple babies can stretch and weaken the pelvic floor muscles, making prolapse more likely.
  • Heavy Lifting: Lifting heavy objects, especially in the postpartum period, can increase intra-abdominal pressure and further strain the pelvic floor.
  • Chronic Constipation or Straining: Difficulty with bowel movements can cause excessive straining, which can lead to weakening of the pelvic floor over time.
  • Age and Hormonal Changes: Postpartum hormonal changes, such as a decrease in oestrogen, can lead to tissue weakening, which may exacerbate prolapse symptoms.
  • Obesity: Increased weight places extra pressure on the pelvic floor, which can increase the risk of prolapse.

Treatment Options for Postpartum Prolapse

The good news is that pelvic organ prolapse is treatable, and many individuals with mild to moderate prolapse can experience significant improvement with proper treatment. The treatment options vary depending on the severity of the prolapse and the symptoms experienced.

  1. Pelvic Floor Physiotherapy
    Pelvic floor rehabilitation is important for prolapse. A trained pelvic health physiotherapist can guide you through exercises designed to strengthen the pelvic floor muscles and improve support for the pelvic organs. These exercises, such as pelvic floor contractions, focus on engaging and strengthening the muscles that support the bladder, uterus, and rectum. Physiotherapists may also use techniques such as biofeedback, manual therapy, or internal pelvic floor assessments to improve muscle tone and function.
  2. Lifestyle Modifications
    Making some adjustments to daily habits can help relieve symptoms of prolapse and prevent it from worsening:
  • Manage Load & Heavy Lifting: Modifying activities that increase intra-abdominal pressure, such as heavy lifting or high-impact exercises.
  • Manage Constipation: Incorporate fibre-rich foods and adequate hydration into your diet to promote regular bowel movements and avoid straining during defecation.
  • Maintain a Healthy Weight: Losing excess weight can reduce the pressure on the pelvic floor, improving symptoms of prolapse.
  • Postural Adjustments: Practicing proper posture, especially when standing or lifting, can help alleviate pressure on the pelvic floor muscles.
  1. Vaginal Pessaries
    A vaginal pessary is a medical device that can be inserted into the vagina to provide support for prolapsed organs. Pessaries come in various shapes and sizes and can be very helpful for individuals with moderate to severe prolapse who may not yet be ready for surgery. A healthcare provider will fit the pessary and teach you how to use it, as well as provide guidance on cleaning and maintenance.
  2. Surgical Intervention
    In cases of severe prolapse, or if other treatments are unsuccessful, surgery may be recommended. Surgery is typically considered a last resort after other conservative measures have been tried, as it carries risks and requires a longer recovery time.

When to Seek Help for Postpartum Prolapse

If you experience any of the following symptoms postpartum, it is important to consult a healthcare provider or pelvic health physiotherapist:

  • A feeling of vaginal bulging or heaviness.
  • Difficulty urinating or bowel problems.
  • Pain during intercourse.
  • Persistent pelvic pain or pressure.

Early intervention is crucial, as it can prevent further weakening of the pelvic floor and improve the overall quality of life. A healthcare provider can assess the severity of the prolapse and recommend the appropriate treatment plan.

Conclusion: Prolapse is a common and manageable condition.

Postpartum prolapse is a common and manageable condition, and with the right treatment plan, most individuals can recover and regain a healthy, active lifestyle. Whether through pelvic floor exercises, lifestyle changes, or more advanced interventions, there are a range of solutions available to improve pelvic health after childbirth. By addressing prolapse early and seeking appropriate care, you can prevent further complications and restore comfort and functionality to your pelvic region.

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