Prolapse after birth
It’s a term that strikes fear into most women's hearts. No one wants to hear the words 'womb' and 'prolapse' in the same sentence. But the good news is that prolapse doesn't have to be the end of the world (or your sex life)
What is prolapse after birth?
Prolapse following childbirth usually means one of your organs has bulged down into your vagina. This might be the womb, bladder or bowel. In rare cases, more than one organ can prolapse at once.
The uterus is often affected because, during pregnancy, the muscles and ligaments that usually hold it in place are softened by pregnancy hormones and so no longer do their job so well. A difficult labour and birth can further weaken these muscles, leaving the womb vulnerable to slipping down into the vagina. (Don't worry; this sounds more extreme than it feels in reality.)
A womb (uterine) prolapse can vary in severity from mild (stage one) to severe (stage four). In milder cases the cervix drops slightly into the vagina. In very severe cases the entire womb is outside the vagina. This is known as procidentia and is thankfully not common.
How do you know if you have prolapse after birth?
You might see a bulge or a lump either inside or protruding from your vagina, but there are other signs too…
Symptoms of prolapse can include
- A dragging feeling or sensation of heaviness in your genital area and/or higher up in your abdomen
- Discomfort or loss of sensation during sex
- A feeling of something ‘being’ in your vagina, like you’re sitting on a ball
- Urinary problems including leaking urine, needing to go to the loo more frequently, or feeling as though your bladder isn’t completely empty after urinating
It’s also possible not to have any symptoms, and prolapses are sometimes only picked up during routine checks such as smear tests.
Is pelvic organ prolapse painful?
It can be, but usually it's just really uncomfortable. Many women describe a heavy ‘dragging’ feeling in their pelvis, and if any organs have prolapsed right outside of the body then that will obviously make both sitting and moving around uncomfortable, too. Often, the sensation gets worse as the day goes on and is worst in the evening. But remember, some women don't even know they have a prolapse until it's spotted during a smear, so for some, there's no discomfort at all.
When should you see a doctor about prolapse?It happened to me after my second baby. Luckily it fixed itself and I've never had incontinence or anything like that. There are plenty of ways to deal with them so I'd say try not think the worst.
As with anything, you should see your doctor as soon as you suspect a problem, i.e. if you notice a lump in or around the vagina, or if you have any of the symptoms listed above.
The doctor will want to do an internal exam and may ask you to lie on one side in order to get a better look. They may use a speculum, too. Don’t worry too much about the exam. It’s no more uncomfortable or embarrassing than a smear test and is over quickly.
How do you manage the discomfort of post-partum prolapse?
Rest will help, mainly because you’re working against gravity that way, so put your feet up as much as you can. Frankly, if you're putting up with prolapse, it's someone else's turn to wield the Hoover. Lying on your back with your feet on the floor and your knees bent often helps a bit with vaginal discomfort. Using cold packs can help to reduce the feeling of heat and swelling, too (wrap ice packs in a cloth though – don’t go applying anything frozen directly to your nethers).
Can a prolapse correct itself?
Prolapse won’t ‘just go away’ but in mild cases, a few simple measures you can take at home should help a prolapse to repair itself. These might be as easy as small lifestyle changes such as doing pelvic floor exercises, losing weight and treating constipation.
What is the treatment for prolapse?I've had grade three uterine prolapse for nearly 10 years (since I was 26). I'm not having a repair for various reasons. The prolapse is managed well with two ring pessaries, though, and I see my gynaecologist every six months.
Treatment depends very much on how mild or severe the prolapse is.
In mild cases, the simple lifestyle changes described above will be all that a doctor advises (weight loss, pelvic floors, and preventing constipation).
In cases where the prolapse is a little more serious and is causing difficulties or discomfort, you may be offered vaginal pessaries. These are small latex or silicone devices which are fitted into the vagina by a gynaecologist, where they support the vaginal wall and pelvic organs. They’re a good option if you don’t want to have surgery or for women pre-menopause, as they allow you to conceive again. Hormonal treatments with oestrogen are also available but are only suitable post-menopause or for those certain they don’t want any more children.
If the prolapse is severe or other options haven’t worked, surgery might be offered. There are several different surgical procedures, but the most common one for younger women who may still want to have more children is surgical repair. This involves lifting and sometimes stitching pelvic organs into place or strengthening the tissues that support the organs. It’s done under general anaesthetic and you’ll usually need six to 12 weeks off work afterwards. If you know you will want to try for more children in the future, sometimes doctors will suggest putting this off until after any subsequent pregnancies just in case the prolapse returns after another baby. The surgery is straightforward but no one needs to go through that twice.
Is vaginal mesh a safe treatment?
Vaginal meshes were used for some years to repair prolapse. Many women had excellent results from them but many also reported complications including permanent incontinence and damage to nearby organs. For that reason, treatment using vaginal mesh was suspended back in 2018, other than for use in research programmes. If you do have one as part of a research programme, NICE recommends that you are monitored regularly for any side effects or complications.
If I’ve had a prolapse before is it more likely to happen in further pregnancies?
If you have a weakness there already, it is more likely to happen again, though it doesn’t mean it will. Women who have had several babies (especially if they were heavy) are also at greater risk. And if you have a family history of problems with connective tissues, you also have a greater chance of being unlucky on the prolapse front.
Doing all you can to prevent it (see below) will help, and if you think you feel the prolapse returning, let your doctor know as soon as possible.
Can you prevent prolapse?
You can’t protect yourself against it happening for sure (though by all means try any hexes and charms at your disposal) but there are things you can do to lower your risk of prolapse after childbirth:
- Maintain a healthy weight
- Eat plenty of fibre and get enough water to prevent constipation, which is a risk factor
- Avoid lifting anything too heavy
- Avoid ‘bouncing’ type exercises too soon after birth, such as trampolining, and some exercise classes. Even running too strenuously soon after birth can have an effect
- Do regular pelvic floor exercises to strengthen the muscles and ligaments
- Try to avoid coughing too hard and look after yourself if you get a cold so it doesn’t turn into a bad cough. Definitely quit smoking, if you do, as that can exacerbate coughs also
What Mumsnetters say about prolapse
“I had two vaginal births with big babies and quick final stages of labour. The gynaecologist told me that prolapse tends to happen if you have these things, and naturally already have weak connective tissue (which is genetic). He said that pregnancy and birth makes a prolapse happen if you are predisposed to it because of your connective tissue, but that it could have happened in later life anyway, even if I'd never had children.”
“I prolapsed with my first birth. Had a natural delivery with DC2 two years later and it didn't make it worse. Two rounds of surgery and everything is repaired.”
“Mild prolapses can definitely be improved with diligent exercising. I saw the gynaecologist yesterday for a review (I have a moderate bladder prolapse) and they said at my age, 35, exercises nearly always help immensely and fix the problem, as the muscles are very responsive. I have been seeing a physio and saw improvements in only a few weeks. It always worsens when I have a cough/stomach bug, then goes back to how it was, and the physio said this was normal.”
To chat to others who have been there, head to our Childbirth Talk topic.