Prolapse Prevention begins early

With 50% of baby boomer women affected by varying degrees of pelvic organ prolapse (POP) and ultrasound studies showing unexpectedly high rates of mild to moderate prolapse in young and/or asymptomatic women, it’s important to address what can be done to change POP outcomes for younger as well as baby boomer women. Studies show prolapse is directly affected by race (increased prevalence in Caucasian women), mothers age at first baby, quality of collagen, prior pelvic surgery, retroverted uterus, lifestyle habits, pregnancy and birth trauma.

The advice in this article shares some everyday advice women can use to reduce the likelihood of POP, which insidiously affects the quality of life in many women.

  • Posture – slumping in sitting, standing or walking has been shown to shut down the action of pelvic floor and core supporting muscles. Lengthening the spine (up through the crown of the head) and maintaining a ‘Tall’ posture switches on the automatic activity of pelvic floor and core muscles.
  • Easy elimination – keeping the stools soft prevents bowel straining, which damages pelvic floor supports and sets the scene for POP.
  • Treat allergies or chest infections early to avoid prolonged coughing or sneezing causing repeated downward pressure on pelvic organs.
  • Engage in a suitable level of exercise for your pelvic floor muscle control. Pelvic floor friendly exercise programs build core stability without over whelming pelvic floor control.
  • Control your waist measurement – excessive abdominal weight holds two different risks. Firstly, excess abdominal weight creates more intra- abdominal pressure, forcing pelvic floor muscles to work harder to provide support. Secondly, a diet high in calories and saturated fat creates an acidic bodily environment, which is associated with higher rates of incontinence.
  • Eat foods rich in lysine and vitamin C to promote healthy collagen. Skin doctors describe sugar as being the ‘enemy of skin’ as it promotes wrinkles (loss of collagen). Studies show poorer quality collagen is associated with POP.
  • Be aware of lifting correctly (spine straight, bottom out) and limiting the weight lifted to prevent straining internal supports and promoting POP.
  • Learn and train local pelvic floor muscles for a quick, strong, holding action. Use the 'knack' before coughing, sneezing or lifting.
  • Speak with healthcare providers about trialing a vaginal pessary support before surgery is considered. Hysterectomy and pelvic repair surgery is a precursor of POP in some women due to the nerve and blood vessel damage sustained during surgery.
  • Discuss the use of vaginal lubricants or suitability of oestrogen cream or tablets to combat dryness and loss of muscle tone.
  • Use orgasm to promote blood flow and muscle contraction and release pleasurable hormones.

I’ve been collecting birth stories from clients and workshop attendees for years. Women’s personal, descriptive birth stories clearly show ongoing pelvic floor dysfunction (associated with POP) in mothers who had pre birth pelvic floor issues and where interventions were necessary. Fortunately I have almost equal numbers of positive birth stories, which typically describe thoughtful birth and pelvic floor preparation.

Pregnancy and post birth are times when optimal posture, regular suitable exercise and specific preparation for labour, birth and recovery are pivotal to POP prevention. The following advice is specific to new mothers.

  • Use soluble fiber to overcome the constipating effects of iron supplements. Avoid bowel straining.
  • Continue with moderate aerobic exercise if still comfortable – swimming is ideal for most women right up to birth. Prenatal yoga with experienced instructors improves strength and postural control while practicising relaxed breathing.
  • Wear pregnancy support garments to protect pelvic joints and avoid prolonged sitting and standing to minimize leg swelling.
  • Vaginal and pelvic heaviness during pregnancy may benefit by having a vaginal pessary fitted to help support pelvic organs and prevent strain.
  • Lengthen the spine into a ‘Tall’ posture to engage pelvic floor and core muscles.
  • Sit ‘Tall’ to give baby more room to move in the abdomen and present in the optimal position for birth. A slumped posture encourages baby to turn and present in a posterior birth position.
  • Practice pelvic floor exercises as research shows women with stronger pelvic floor muscles may have a shorter second stage of labour. Pelvic floor problems before and during pregnancy are strongly associated with post birth incontinence.
  • Research the effects of birth interventions and birth positions on pelvic floor trauma. Studies show higher rates of pelvic floor muscle damage when interventions, poor positions and forced pushing as used.
  • Prepare the pelvic floor for birth with perineal massage or use the Epino device after 35 weeks of pregnancy to reduce pelvic floor damage in first time mothers.
  • Urge directed pushing during labour allows the vagina to stretch and accommodate the baby’s head. Early forceful pushing has the potential to shear the inner layer of vaginal muscles apart from the outer muscular layers, leaving the mother with prolapsed tissues. 
  • Immediately post birth, protect the pelvic floor and pelvic joints, reduce abdominal muscle separation, control posture and compress pelvic organs by wearing support garments.
  • Combine ‘Tall’ posture with easy pelvic floor exercise programs to strengthen from the inside out before resuming other forms of activity.
  • Avoid lifting and running until the floor and core have strengthened to restore dynamic pelvic/trunk stability and until pregnancy weight gains have reduced. Walking, swimming, postnatal yoga and physiotherapist led exercise classes improve core and general muscle strength. 
  • Ideally women should not return to running until after breastfeeding has ceased or after periods are regular.