"I was four weeks postpartum and visiting with my parents for the weekend with my brand new son. They said those magical words: âGo take a shower and relax, weâll watch him.â Off I went, but as I was getting in the shower, something just didnât feel right. I’d just birthed my first child, so I didnât think too much about it. A few minutes went by and I continued to feel as if I had a tampon in, and it was sitting right in the opening of my vagina. I grabbed my iPhone, turned on the camera, and took a look down there. I didnât know what I was looking at, but just as I thought (or felt, rather), something was sitting right there in the opening and no matter what I tried it wasnât going away.
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After a nerve-wracking call to my midwifeâs office and later, an in-person visit and pelvic exam, I found out that I had a vaginal prolapse. When I first heard this term, I had no idea what it was, how I got it, or what I could do to heal from it. If youâre wondering too, here are the things to know about prolapses.
1. Itâs caused by weakened supportive tissues around the vagina
Before learning more about prolapses, my mind was racing about all the possible things that couldâve caused a prolapse. I knew it had to do with either my pregnancy or birth since Iâd never had any issues before becoming pregnant, but I didnât know exactly what had caused it.
âA prolapse is when the supportive tissue of the vagina loses its strength and is unable to support the organs above (the bladder, the uterus, the rectum),â said Dr. Padma Kandadai, MD, MPH, Director of Female Pelvic Medicine and Reconstructive Surgery in the Department of Obstetrics and Gynecology and Boston Medical Center and Assistant Professor at the Boston University School of Medicine. âThink of the vagina as having three hammocks: a front hammock that holds up the bladder, an upper hammock that holds up the uterus, and a back hammock that holds down the rectum. Whichever hammock becomes weak, the organ sitting above it drops from its position.â
The feeling I mentioned above at four weeks postpartum in my parent’s shower is a common feeling and usually the symptom that prompts women to call their OB. âThe main symptom of prolapse is feeling a bulge or a ball outside of the vaginal opening,â Dr. Kandadai said. âSome women may experience difficulty initiating a urinary stream or emptying their bowels completely, but this generally doesnât happen unless the prolapse is very advanced. Some women may also experience different types of urinary incontinence, but prolapse may not necessarily be the cause of the urinary problems. Some women actually donât feel anything at all.â
2. Theyâre more common than we think
To this day, I donât personally know any other woman who’s had a vaginal prolapse. To be honest, for the last 17 months of being a mom, I have felt very alone and isolated in my experience because it feels like I am the only one this has happened to. While I know that canât possibly be true, women donât often feel comfortable talking about their vaginas, especially when something has happened to them out of the ordinary. I felt some relief learning it’s actually very common.
âSome epidemiologic data suggest that 1 in 4 women have some degree of prolapse, however, the vast majority of those women have no symptoms and no intervention is needed,” Dr. Kandadai said. “About 13 percent of women will undergo surgery for prolapse in their lifetime.”
I was shocked by these statistics not only because that meant several of my mom friends and coworkers are likely experiencing similar symptoms, but it also means there is a large chunk of information being left out from new parenting or pregnancy classes. Mothers and womenâs reproductive physicians and experts need to be having these conversations more so that we can lessen the stigma and embarrassment around these physical health changes.
3. There isnât a clear way to prevent prolapse
In the beginning months, and truthfully even sometimes now, I blamed myself for getting a prolapse after birth. Should I have done more Kegels? Was I picking up items that were too heavy to carry during pregnancy? Did I gain too much weight while pregnant? Did I not push during labor the right way?
I kept going over the nine months before my son arrived and the 36 hours of labor, wondering where it was that I went wrong to cause this. Part of blaming myself stems from not knowing anyone else this had happened to. It can sometimes feel like I did something wrong, while everyone else mustâve gotten pregnancy âright.”
âWhile women who have cesarean sections are less likely to develop prolapse, itâs not definite,” Dr. Kandadai said. “Just the weight of pregnancy can lead to prolapse.â She recommended that women should try to avoid constipation if they can because pushing your bowels is very damaging to the pelvic floor. Taking a daily fiber supplement or even using a gentle laxative can help move your bowels along without straining or pushing too much.
While I donât remember having any specific issues with my bowels during pregnancy, I do remember my son sitting quite low in my belly. I felt a lot of pressure in my pelvic area, and toward the end of my pregnancy, I needed to take breaks and sit down more often due to lower back pain and soreness in my pelvic area. As I was nearing my due date, my midwife suggested buying belly bands to help lift my belly a bit to relieve the pressure and weight. While the band did help a bit, I learned sometimes a prolapse is unavoidable because carrying a human in your body for nine months puts a lot of pressure on muscles weâve never had to strengthen before. Iâm trying to accept it wasnât my fault knowing prolapses can happen to anyone.
4. You can still enjoy sex with a prolapse
Sex and intimacy have been the hardest hurdle to overcome since having my prolapse. You often hear moms talk about their bodies feeling a bit foreign to them after giving birth, and my prolapse took that feeling to a higher level. Without getting too personal and graphic (as if we arenât talking about my vagina already), I didnât know how I could enjoy a healthy sex life with something sitting in the opening of my vagina. I also wasnât sure if I could even have sex at all or if my prolapse would cause complications.
âMost women donât have problems with prolapse during sex, because when theyâre lying down, the prolapse slides back in. (Most partners donât even notice!),â Dr. Kandadai said. âMany women avoid sex because they are embarrassed or worried that sex can damage the prolapse and make it worse. Thereâs no need to fear. Itâs very safe to have sex even if you have prolapse.â
Thereâs no need to fear. Itâs very safe to have sex even if you have prolapse.
She was right. I was embarrassed not only about my own body but about what my husband would think about this change. Heâs been nothing but supportive and kind when we talk about my prolapse whether if Iâm having discomfort or Iâm feeling particularly self-conscious when heâs in the mood. While I am grateful he is still interested in being intimate with me as much as he always has been, it is still a personal struggle that I am working on. Many women know and understand if your mind is somewhere else, it is hard to be intimate or enjoy an intimate moment with a partner. Itâs a work-in-progress, and I hope Iâll be able to fully accept this new body of mine one day.
5. You likely donât have to rush into having surgery
Due to this new change in my body, I wanted to immediately reverse whatever was happening in my vagina. During my in-person appointment with my midwife, I asked if surgery was an option. While she said that having surgery to put everything back into place was a possibility, I should wait until I was done having children. My heart sank because I’ve always known I wanted at least two kids, which meant I was going to have to live with this prolapse for a few more years.
âThe difficulty with prolapse is that itâs hard to predict whether it will progress or not, once it becomes symptomatic,” Dr. Kandadai said. “In younger women, prolapse can be very dynamic, particularly postpartum. Thatâs why itâs important not to jump to surgery immediately after deliveries. It can take the body up to one year to completely recoil from all the stretching that goes on.â
So, if youâre not done with family planning yet, I asked Dr. Kandadai what women could do in terms of recovery. She said things like pelvic floor physical therapy and using a pessary are great options. “For older women who have completed their families, we can consider surgery. With most surgeries, the patient can go home the same day. However, there are usually 4-6 weeks of lifting restrictions after surgery.â said Dr. Kandadai.
After my visits with my midwife, I did try a few pelvic floor physical therapy sessions and got a pessary to use. The pessary was pretty uncomfortable for me to use all the time, so I decided to stop using it. The physical therapy sessions were informative, but without any friends or family close by to help with the baby, I struggled to find the time to make the appointments.
I asked Dr. Kandadai what sheâd tell someone who has a prolapse and is feeling confused and unsure of what to do next. âIf you are able to live your life, then itâs probably fine to leave things alone. If itâs bothering you, for example, you donât like the bulge, the bulge is uncomfortable, youâre limiting the activities you love because of it, then you should see a urogynecologist who can evaluate your prolapse and give you your options,” Dr. Kandadai said. “Many women live with prolapse because it doesnât bother them or give them problems. Ask your OBGYN for a referral to a pelvic floor physical therapist. They are amazing resources who can help you with managing prolapse symptoms while youâre trying to figure things out.â