Do you know you have a pelvic floor?  I’m going to get very personal in this post, but I think it’s so important to share these things with other women.  I was SHOCKED when it happened to me.  I had no idea to expect this and got very little information about how to prevent it or what to do about it when it happened.

After my second baby was born, I developed a prolapse.  My second baby was large and I had a precipitous labor, both thought to increase the risk of prolapse.

What is prolapse?

We have a few organs that share space with our uterus, and all are at risk of prolapsing when the muscles and ligaments that support the pelvic floor are damaged or weak.  This means that the uterus, bladder, urethra, and rectum hang further down and can put pressure on the vaginal wall from the inside and even cause a visible external bulge.

When this happened to me, I was about 2 days postpartum.  I had already passed a HUGE clot the size of a softball.  I had to fish it out of the toilet and photograph it next to a quarter so I could show my midwife. Ew. She decided to come right over.  The next day, again on the toilet, I felt something protruding from my body and thought it was another huge clot.  But it did not come out and when I felt it, I could tell it was part of my body.  I panicked.  My midwife examined me and told me that it was a prolapse and that I needed to stay in bed for 2 weeks to prevent further damage and try to heal.

After 2 weeks, I saw a pelvic floor physical therapist and she helped get my strength to a good level.  That helped a lot, but I also had a lot of damage to the ligaments that could not be fixed.  So, I still have a few issues.  I sometimes get a feeling of pressure or heaviness down there.  Stuff is definitely nearer to the opening then it used to be, pee accidents happen, and pooping is different because it’s hard to feel and control the movement.

I recently got to meet an amazing local physical therapist who feels very passionately about pelvic floor health. Rachel Madera has a mission to spread awareness about pelvic floor issues so that people can know that there is treatment, and in hopes of preventing disorders.

What I have here is a list of ideas from Rachel for prevention and treatment related to pregnancy and birth.  If I could go back, I would FOLLOW THIS ADVICE!! 

During pregnancy

• Avoid straining during bowel movements .
• Ensure you are drinking enough water to have easier bowel movements (at least 50-80 oz/ day).
• Use either a Squatty Potty (you can buy these all over now) or a stack of books at your toilet to prop your feet on so that your thighs are above the level of your hips. This positioning helps to assist the pelvic floor in relaxation.
• Perform deep breathing instead of straining during bowel movements.  Straining will exert even more pressure downwards on the pelvic floor and which already works very hard with the increased weight of the baby.
• Use good sleeping habits, buying a body pillow and putting it between knees AND ankles to keep neutral pelvic alignment
• Use good lifting strategies to prevent excessive torque on the pelvic bones, especially during a time of increased hormones and joint laxity. This includes a neutral spine, shifting your weight back to your heels to bend at the knees and hips instead of the low back when you bend.
• Getting in and out of the bed by log rolling can assist in keeping your pelvis stable, and reduce the risk of DRA (diastasis).

Postpartum

Here are some things to do immediately postpartum and beyond to support healing and help prevent pelvic floor disorders:

• WEEK 1: stay in bed WEEK 2: stay on bed  WEEK 3: stay near bed
• Try not to lift more than the weight of your baby. Allow your organs to heal.  If bleeding stops and then returns, you have done too much.
• Continue to perform log rolling to get in and out of bed.
• Do not perform any crunches or sit ups to avoid any further separation of the abdominals if there is separation.
• Perform 3 kegels per day (breakfast, lunch, dinner) that can start immediately postpartum.
• Be mindful about how you are lifting and bending to pick up your new baby, all the postural recommendations matter even more at this phase!
• Use good support for breastfeeding (i.e. pillows) to bring your baby to you instead of the other way around.
• It is not recommended that you get back to running or vigorous exercise immediately once cleared at 6 weeks. It took 10 months to grow a baby, and your body to make those slow changes.  Your organs are still healing and just went through a very traumatic experience. Start with gentle walking and body weight exercise so your body can adapt to changes, and help catch dysfunction early. For example, prolapse or leakage.

What does physical therapy for the pelvic floor look like in the event that self-care doesn’t prevent all dysfunction?

• Following delivery, many women suffer from urinary leakage. If at 6 weeks you are still noticing symptoms of leakage, ask your care provider for a referral to physical therapy (PT).
• Pelvic floor PT is a standard of care in other countries immediately postpartum. You can ask your OBGYN or midwife for a referral just to be evaluated and PREVENT risk of future dysfunction.
• Kegels are not the correct treatment for everyone. You never know which camp you are in until you get assessed by a Pelvic floor PT.
• A Physical Therapist assesses alignment, posture, strength of core, hips, back and pelvic floor as well as range of motion. They can assess the pelvic floor both externally or internally (usually vaginally).  They are trying to get the best information about how the muscles are working in combination with other areas of your core and pelvis. Sometimes strengthening is indicated.  Manual therapy and relaxation work might also be indicated if the musculature is so tight that it doesn’t contract and relax properly.

Thank you to Rachel Madera at Sullivan Physical Therapy in Austin, TX, for taking the time to share this great information.

I hope this helps someone!  I’ve seen some variation in the statistics, but it’s probably safe to say that 40-50% of women who give birth will experience some level of prolapse that causes noticeable symptoms (even after Cesarean birth).  That’s A LOT!  And most of us never hear about this before it happens to us.  Also, there are certain circumstances that can increase that risk.  Some of the more common include:

• precipitous (very short) labors,
• very long labors
• prolonged pushing during labor
• connective tissue disorders
• forceps delivery
• large baby

So, especially if you experience any of these, take extra care in healing and LOVE your pelvic floor!

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Joyful Beginnings