Condition: Postpartum Prolapse

Postpartum prolapse is where one or more of the organs in the pelvis (the uterus, small intestine, rectum and bladder) slip down from the normal position and bulge into the vagina. In severe cases, these organs may bulge outside of the vagina.

Having a prolapse after birth is fairly common, with one study finding that around 35% of women will experience some degree of the condition postpartum.

The condition is not life-threatening but can cause pain and discomfort, and is generally unpleasant to live with if you experience symptoms.

The pelvic organs are kept in place by healthy pelvic floor muscles and the strong walls of the vagina.

Giving birth vaginally puts pressure on the pelvic floor muscles, which can cause them to stretch, weaken and become loose. As a result, these muscles aren’t strong enough to hold the pelvic organs up as they had done pre-pregnancy, causing a prolapse to occur.

Although more common with vaginal birth, women who have a caesarean delivery can also experience postpartum prolapse due to the weight of the baby pushing down and stretching the pelvic floor muscles during pregnancy.

Pregnancy hormones also play a role in postpartum prolapse as they reduce the elasticity of the pelvic floor muscles. Postpartum prolapse is also more likely if you had to push for a long time, give birth to a large baby, you’ve had multiple pregnancies or births, or if forceps or vacuum are used to aid delivery.

Other factors, such as obesity, having a chronic cough and regular heavy lifting may also play a role.

A prolapse may be noticeable straight after giving birth, or it can take some time to develop. In some cases, you’ll have no symptoms of prolapse at all, and it will only be discovered at a smear test or other routine examination such as your six-week postpartum check-up.

Depending on the type of prolapse you have, you may notice some or all of the following symptoms:

• A feeling of dragging, heaviness or pressure in your pelvic area
• A visible bulge from your vagina either permanently or when you cough or strain
• Urinary incontinence
• Stress incontinence
• Recurring bladder infections
• Frequent or urgent urination
• Difficulty urinating
• Lower back or pelvic pain
• Pain during sex
• Difficulty inserting or keeping a tampon in
• Constipation

These symptoms are often more noticeable when standing and can tend to be less in the morning and worsen throughout the day.

There are a number of treatments available for postpartum prolapse. The most appropriate and effective avenue will depend on the severity of your symptoms.

In most cases of mild and moderate prolapse, pelvic floor exercises and lifestyle changes such as weight loss, stopping smoking, avoiding heavy lifting and treating coughs will be enough to reduce symptoms.

In more severe cases, vaginal pessaries, vaginal physiotherapy or surgery may be required.