Pregnancy puts your body through a lot of changes, both physically and emotionally. Though your body heals during the postpartum period (the period after childbirth), it does not go back to what it was before conceiving. And, as everything feels so different, especially for first-time mothers, this time can be overwhelming. The health of your pelvic floor may be one of your prime concerns during this transition.

Pelvic organ prolapse is one of the common complications occurring after childbirth. It is a condition that occurs when the supporting tissues of the pelvic organs are stretched and weakened. As a result, pelvic organs like the uterus, bladder, or rectum might slip from their original position and protrude out of the vagina. This article will explore the precautions you need to take during pregnancy and postpartum that can reduce the risk of pelvic organ prolapse.

Symptoms and treatment of prolapse during pregnancy

Pelvic organ prolapse is uncommon during pregnancy but not impossible. Commonly, such a condition during pregnancy is associated with vaginal infection, cervical ulceration, and preterm delivery. Other risk factors that increases the risk of pelvic organ prolapse during pregnancy may include:

• Multiple childbirth
• Vaginal delivery
• Instrumental delivery
• Connective tissue disorders
• Obesity
• Age

The symptoms of pelvic organ prolapse during pregnancy include:

• Heaviness or a feeling of dragging mass in the vaginal region
• Difficulty in holding urine (urinary incontinence)
• Frequent urge to urinate
• Pain during sex
• Pain in the lower back

Treatment options for pelvic organ prolapse during pregnancy usually include approaches to minimize obstetrics risks. Typically, devices like vaginal pessaries are inserted to help provide the necessary support to the pelvic organ. Antenatal corticosteroids are given to manage the health of the baby if needed. Fungal infection associated with pelvic organ prolapse is treated using medication.

Symptoms and treatment of prolapse after birth

Childbirth can increase the risk of pelvic organ prolapse, especially uterine prolapse. The physical stress of pregnancy and childbirth can weaken the pelvic floor tissues causing the uterus to slip through the vaginal canal. Postpartum prolapse of pelvic organs is more common in women with multiple childbirths. It is typically characterized by:

• A feeling of constant pressure in your pelvis
• Feeling as if you are sitting on a ball
• Mass coming out of your vagina
• Difficulty with urination or defecation
• Chronic constipation
• Low back pain
• Painful sexual intercourse
• Bleeding with intercourse
• Discomfort while walking

Pelvic organ prolapse after giving birth is typically managed by self-care and non-surgical approaches like:

• Kegels exercises to strengthen the pelvic floor muscles
• Estrogen replacement therapy
• Wearing a pessary
• Avoiding heavy lifting
• External support belt/brace 

In case the condition has progressed to a more advanced stage, you might need surgical treatment, such as:

• Hysterectomy: A surgery to completely remove part of or the entire uterus. However, this option should not be considered for women who want to have children in the future.
• Uterine suspension: This surgery is performed to move the uterus back to its normal position with the help of mesh or sling devices.

Precautions to take while pregnant with pelvic organ prolapse

Pregnancy with pelvic organ prolapse can be hard. The risk of complication can be reduced by: 

• Preventing constipation: Drinking plenty of fluids, eating high-fiber foods, etc., can help improve bowel movement and prevent the prolapsed organ from advancing to a more severe stage.
• Avoid heavy lifting: Lifting heavy objects can increase the risk of complications.
• Control coughing: Chronic cough or bronchitis can cause the pelvic organ to droop down from its original position. Managing cough can help reduce the risk.
• Practice Kegel exercises: Being consistent in doing Kegel exercises before, during, and after pregnancy can help strengthen the pelvic floor muscles. 

What effects does pelvic organ prolapse have on pregnancy?

Pelvic organ prolapse can cause complications during different stages of pregnancy. In the antepartum period, complications like preterm birth, abortion, urinary tract infection, and acute urinary retention can arise. It can be fatal. During childbirth, it can lead to complications like:

• Cervical laceration
• Obstructive labor
• Hysterorrhexis (rupture of the uterus) at the lower segment of the uterus
• Fetal death
• Death

Pelvic organ prolapse can cause postpartum hemorrhage and puerperal infection after childbirth.

Recommended self-care methods for pelvic organ prolapse during pregnancy

Following certain self-care measures can help manage pelvic organ prolapse or uterine prolapse in pregnancy, such as:

• Exercises such as Kegels to help strengthen the pelvic floor muscles.
• High-fiber foods and lots of fluids to avoid constipation
• Avoiding too much straining during bowel movement
• Avoid heavy lifting
• Control coughing
• Losing weight
• Quit smoking

Prolapse Left Alone

Pelvic organ prolapse left untreated will most likely worsen over time. Prolapse cannot heal on its own and symptoms may persist and become more severe. Although pelvic organ prolapse is not fatal, it interferes with the daily lives of many women around the world. Simple tasks like standing, walking, sitting, and urinating becomes difficult to do. Please consult a health professional as soon as possible if your suspect that you have pelvic organ prolapse. 

Using FemiCushion for prevention and treatment of uterine prolapse during pregnancy

FemiCushion is medical device that help support pelvic organs like the uterus and prevent any prolapsed organs from bulging through the vaginal canal. It consists of a soft silicone cushion that is placed against the vaginal opening to gently hold the prolapsed organ in its place and prevents it from protruding out. FemiCushion is recommended over pessary use during pregnancy. The reason being is because pessaries are inserted into the body which produces a higher risk for infections that can affect the baby. FemiCushion is a natural and non-invasive treatment which does not come with the risk pessary devices have. Please consult with your doctor before beginning in any treatment during pregnancy to discuss the risks and benefits.

We hope this article has helped you understand the risks and complications associated with pelvic organ prolapse during pregnancy and after childbirth and how it can be managed.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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