Managing Pressure to Prevent Prolapse

…And Other Pelvic Floor Dysfunction

What do pressure, pelvic organ prolapse, and a tube of toothpaste all have in common? Stay tuned. 

It is critical that you learn to “blow before go,” as Julie Wiebe, expert physical therapist in women’s health, explains, in order to better manage your pressure in order to decrease your risk of developing a prolapse. Specifically, intra-abdominal pressure. This refers to how much pressure is in that canister we talked about in “A Better Way to Breathe and The Right Way to Kegel.

Imagine if you take a deep belly breath in and fill yourself full of air, and you continued to hold that breath while you exerted. “Exertion” is anything that requires any sort of effort. #Momlife means that this exertion could be lifting your upset 35 pound toddler flailing on the floor at the grocery store or simply rolling over to get out of bed after recently having a c-section. Yep, all of that air in your canister must exert pressure somewhere, and typically, it finds our weakest points. 

In the post-partum woman, this is especially concerning because being postpartum puts the following two body structures at highest risk for compromise:

1.) Pelvic Floor — what supports your pelvic organs.

2.) Linea Alba — what connects your rectus abdominis muscles.

More information to come on #2, and how a compromised linea alba leads to Diastasis Recti, in a future post.  Today, let’s focus on the first concern. What could happen if extra pressure from above (i.e. breath holding) is pushing down on your pelvic floor muscles below?

Consider a tube of toothpaste. Let’s pretend the cap on the toothpaste is your pelvic floor (the bottom of the canister mentioned above). If you try to roll up the tube from the other end as if you were trying to get the very last bit of toothpaste out and onto your brush, but you didn’t realize that the cap isn’t twisted on tight, you could end up with a mess. The toothpaste could squirt out all over the counter because the cap didn’t do a good job of managing the increase in pressure of you pushing on the tube as you rolled it up.

Or consider this. If the tube of toothpaste falls onto the ground before the lid got put back on, and you accidentally step on the tube, toothpaste may spew out all over floor. 

Now, shift gears to thinking about the anatomy of your own body. If your pelvic floor muscles aren’t strong and functional (i.e., the lid to the toothpaste isn’t on tight), and you hold your breath while you crunch up to get out of bed newly postpartum or don’t breathe properly while you pound on your pelvic floor over and over again while jump roping, cycling, or running, your pelvic floor is going to feel that pressure. You could leak urine out just like the toothpaste spilled out or, even worse, it could lead to your pelvic organs being pushed down and eventually feeling like they may be falling out if your pelvic floor muscles aren’t able to counter-balance the pressure coming from below. 

This is called a pelvic organ prolapse.

What might it feel like to experience a pelvic organ prolapse?

You may feel or see a bulge when you wipe after going to the bathroom, or if it’s more pronounced, you may notice it when sitting on a chair. It may be painful. It may be related to urinary or fecal incontinence. There may be a feeling of pressure or discomfort, aching, or general fullness in the pelvis. This pressure often gets worse with standing, coughing, or later in the day especially if you’re standing or on your feet a lot. You may have problems inserting tampons or with painful intercourse. (1)

What is actually happening to your body if you have a prolapse?

The pelvic floor muscles and tissues that are supposed to support the pelvic organs like a hammock can become weak or damaged.  For a better review of this hammock, refer to “What is the Pelvic Floor and Why Should I Care?”  The pelvic organs include the bladder, uterus and cervix, vagina, and rectum. A prolapse happens when the pelvic muscles and tissues can no longer support these organs, causing any of them to drop down or press into or out of the vagina. (2)

https://www.acog.org/Patients/Patient-Education-Videos/Pelvic-Organ-Prolapse?IsMobileSet=false

Refer to the American Academy of Gynecologist website to see videos that demonstrate what is happening anatomically during a pelvic organ prolapse.

As a postpartum women, you are inherently at a higher risk for the incidence of prolapsing because pregnancy and vaginal delivery are the most commonly cited risk factors. The steps of carrying the weight of a baby throughout pregnancy, laboring to bring the baby through the birth canal, and pushing the baby into the world all combine to weaken the pelvic floor and create conditions for a prolapse.  The greatest risks of prolapse are from delivering babies bigger than 8 ½ pounds, having a prolonged second stage of labor, using forceps, episiotomy, sphincter tear, large fetal head, or being age of 40 years or greater at time of first delivery. Even moms who have a C-section are at risk. (3)

Many women want to believe that having surgery such as the popular mesh sling is the only way to “fix” this concern. In reality , 58% of women had prolapse reoccurrence after surgery. (4,5) The encouraging news is that physical therapy can help you manage your prolapse non-operatively oftentimes (3).

In physical therapy, you  will be taught how to properly activate the muscles that support these pelvic organs. You need to ensure that you are breathing out (exhaling) and contracting your pelvic floor muscles (engaging) before you do anything that may seem challenging or require exertion.

A simple way to remember this sequence is by using the 3 E’s to Exhale, Engage, and then Execute. The exhale (blowing air out) and engagement (contracting your pelvic floor) needs to be relative to the task at hand, or what you want/need to execute. For example, lifting your 3-month-old likely won’t require the magnitude of exhalation and engagement as deadlifting 150 pounds.

By learning how to properly manage the pressure intra-abdominally, you may be able to prevent a prolapse from occurring or possibly prevent one from getting worse. Refer to “A Better Way to Breathe and The Right Way to Kegel” for more information on the effect breathing has on your pelvic floor. Even better, go visit your local women’s health physical therapist to learn more personalized strategies just for you.

Implementing the 3 E’s on a daily basis can help you move better to decrease harmful pressure on your pelvic floor to ultimately mom better.

Also, I need apologize if this post ruined the thought of toothpaste for you. But on the contrary, maybe it will be a gentle reminder, or better yet, motivation, to do your kegels each night. 😉 

Resources:

1. https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279110/

  1. Saunders K. Recent advances in understanding pelvic-floor tissue of women with and without pelvic organ prolapse: considerations for physical therapists. Phys Ther. 2017;97:455–463.
  2. Whiteside, James L. Risk factors for prolapse recurrene after vaginal repair. American Journal of Obstetrics and Gynecology. 2004. Volume 191, Issue 4, p. 1533.1538.
  3. Salvatore, Stefano, et al. Risk factors for recurrence of genital prolapse. Obstetrics and Gynecology. Oct 2010. 22(5):420-424.

2 thoughts on “Managing Pressure to Prevent Prolapse”

  1. I distinctly remember the day I learned that this could happen (female organ prolapse). I was horrified and thought it couldn’t be true. I took to google…sure as the world! And it only further horrified me (and this was well before my being married and having a family time).
    I SO wish more was being done to educate, assess and get on the front end of this sort of stuff. Proactive is almost always better than trying to fix something after the fact. Thanks for helping to spread awareness!!

    1. Through becoming a mother myself, I’ve learned that Google is a horrifying place to search anything medically related…especially this kind of thing. You should know better! 😉

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