Hi friends! Do you have pelvic organ prolapse? Are you worried about being pregnant and having your symptoms worsen? Here are 5 tips to help!
Let’s start by reviewing prolapse. Prolapse is when one or more of the pelvic organs starts to fall (prolapse) into the vaginal canal. Over time this can worsen and they can begin to prolapse outside of the vaginal canal. The pelvic floor muscles span from the pubic bone in the front to the tailbone in the back, forming a hammock, so they play an important role in helping to support the organs from below and reducing prolapse.
Why is this important in pregnancy? The uterus, where the baby grows and develops, is one of the pelvic organs that can prolapse. As the pregnancy progresses, the uterus grows in size and weight which means it requires more support. If there isn’t adequate support we can feel worsening prolapse symptoms.
So what are your options?
#1 Discuss delivery options with your birth provider
Delivery is about teamwork between you, the baby, and your providers. One of the things to discuss with your provider before it is time to deliver is positions you would like to labor and push in. Discuss with them what they feel comfortable with and what your preferences are. Positioning, along with other factors, can impact your pelvic floor and pelvic organ prolapse. You may want to consider adding a doula to your birth team to advocate for you.
If you are experiencing any pain, a pelvic floor therapist can help with deciding which position(s) you want to labor in, too. For example, if you have knee pain getting on your hands and knees might not be the most comfortable position, so your therapist can give you alternatives. The can do this with many different conditions including pain in the back, hips, tailbone, and more. In addition to your comfort during labor and delivery, your therapist can give you different positions to help the baby position itself in the pelvis while opening the pelvis to give the baby space to come out. You therapist will talk to you about different positions depending on what stage of labor you are in.
#2 Learn how to breath and push
There are several different pushing techniques during delivery. A few include: directed pushing, spontaneous pushing, delayed pushing, open glottis pushing, and closed glottis pushing. Talking with your providers is a great way to determine the best way to push for your individual circumstances, but some techniques like closed glottis pushing and directed pushing can put excess strain on the pelvic floor and pelvic organs and worsen symptoms. Learn about the different techniques and practice before the big day.
#3 Perineal Support
Perineal supports are items that we can wear that lift from the outside to help increase the forces from below. This can be tight clothing like spandex or specialized garments, like the myPelvic Bra, designed specifically to support the pelvic floor. For many people, supports are the missing link for heaviness, pressure, and leaks when they are active.
#4 Pelvic floor muscle training (PFMT)
Training the pelvic floor muscles to both engage well and relax well can help them to function better and decrease symptoms during pregnancy. The muscles will be strong to support the weight of your growing uterus and learning to relax those muscles will help during delivery. Studies have shown that performing PFMT during first time pregnancies has been shown to shorten the first and second stages of labor (from the start of contractions to pushing). (Du, 2015). Along with helping to speed up delivery, research suggests PMFT during pregnancy does not increase the risk of having a perineal tear or requiring an episiotomy or instrument-assisted delivery. (Du, 2015)
#5 Avoid constipation and straining
Constipation and straining can be hard on the pelvic floor muscles and make prolapse symptoms worse—especially when we are straining. This can be difficult in pregnancy due to hormonal changes and common supplement or medications that are prescribed in pregnancy (e.g. an iron pill). The goal is to have soft poop that slides out easily (think of a squishy banana). Making sure you are consuming enough water and fiber and getting enough exercise is crucial to helping the digestive system and avoid constipation. Constipation can be the result of many causes, so if you are struggling speak with your providers and consider seeing a pelvic floor physical therapist of occupational therapist.
Pelvic floor physical therapists and occupational therapists can be great resources when dealing with pelvic organ prolapse. They can help address many of the issues above in addition to optimizing function of your pelvic floor and surrounding muscles to keep you pain-free and keep any symptoms or prolapse to a minimum while pregnant. You can ask your provider for a referral to one near you, or find one at www.mypfm.com/find-a-pt.
Ready to learn more about pelvic health? Here are some helpful resources:
Order myPelvic Bra perineal support
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
Watch our YouTube playlist on Pregnancy and Your Pelvic Floor and Prolapse and the PFM
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
Sign up for our email newsletter!
Visit our Instagram page for more on pelvic health.
For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources. At myPFM Academy you’ll find courses like:
How to Help Prenatal Clients Prepare for Birth with Melissa Stendahl, PT, DPT
The Big Event—Empowered Pushing with Chantal Traub, CD (DONA), CCCE, LCCE
Second Stage Labor: Baby, Body, Breath with Chantal Traub, CD (DONA), CCCE, LCCE, Certified Health Coach, Doula, Childbirth Educator
References
Du Y, Xu L, Ding L, Wang Y, Wang Z. The effect of antenatal pelvic floor muscle training on labor and delivery outcomes: a systematic review and meta-anaylsis. Int Urogynecol J 26, 1415–1427 (2015). https://doi.org/10.1007/s00192-015-2654-4
Written by Emily Reul, PT, DPT