Ep. 76: 5 Most Common Mistakes When Healing from Pelvic Organ Prolapse

This week we’re taking a break from FAQs and diving into a subject that can feel overwhelming and discouraging for many folks postpartum and well beyond. That’s pelvic organ prolapse. This is a condition that can be caused by a number of different organs and musculature of the pelvic floor. It’s also one where the severity diagnosis from a doctor doesn’t always match the patient’s symptoms, such as a doctor might call it severe and the patient has minimal pain, or a doctor says that it is mild and the patient is experience severe discomfort doing basic movement. So today we’re diving into:

  • Exactly what pelvic organ prolapse is
  • The most common mistakes I see in healing from a pelvic organ prolapse
  • How to best assess whether you need to take it easy or push yourself a little further
  • and more!

If you found this episode helpful, but you’re still struggling with exactly HOW to mitigate pelvic organ prolapse symptoms and get back to normal pelvic function, I encourage you to check out my free class Revitalize Your Core & Pelvic Floor: The Ultimate Guide to Breathing Techniques.


Welcome back to the Not Your Mama podcast. This is your host, Kelly Bryant, and we are back today getting into the nitty gritty of pelvic organ prolapse. So pelvic organ prolapse is a fairly common diagnosis postpartum. And I think when I see clients who have been diagnosed with pelvic organ prolapse, they often feel like it is a death sentence for their fitness program.

It means that they can’t exercise anymore at all, or that it’s something that they’re going to have pain or discomfort for the rest of their life. That’s not the case at all. And I want to dig into some of the most common mistakes that I see clients make when they have pelvic organ prolapse and in the way that they handle that diagnosis and ideally get back into a full out normal training program.

So all of this applies whether you are postpartum. You know, within the last six months, or if you are years or decades postpartum or even have never had a child, that is much less common with pelvic organ prolapse. First I wanna talk about what is pelvic organ prolapse. Basically, if we were to take a pelvis and turn it sideways, so you’ve got a pubic bone on the left and a tailbone on the right.

Visualize this with me. You’ve got your pubic bone, then you’ve got your bladder, then you’ve got your vaginal canal with your uterus above it, separated by the cervix, and then you’ve got your rectum. In between all of those cavities, you have some connective tissue. There’s lots of muscle, but there’s also just a lot of fascia or connective tissue.

When we have a vaginal birth, or even just from pressure mismanagement during pregnancy, both of those things probably contribute. You can have a pelvic organ prolapse, which is where that connective tissue and muscle has weak points, and that can cause the bladder or the rectum, or the uterus or cervix to kind of sink in, like have a little cave in in the vaginal canal and that can feel like heaviness.

Some people can feel their prolapse, like, you know, if they go to put in a menstrual, you know, a tampon or a menstrual disc or a cup or something like that, they can feel that something is not right. And of course you can also be diagnosed with a prolapse by a medical professional. So sometimes that will happen at the six week follow up postpartum.

Someone will be told right on the spot then that they have a pelvic organ prolapse. Sometimes people go back to the doctor multiple times and say like, something doesn’t feel right. Something doesn’t feel right. Keep checking. And eventually they will get a, a diagnosis. What it feels like is it’s, I’ve heard it described as feeling of heaviness or feeling like the feeling of having a tampon falling out.

So it’s, it is a noticeable sensation. It is not necessarily painful. It is not often painful. I would say most of the time I’m, this is just anecdotally from what I’ve heard most of the time, I would say it’s not painful. It can also be associated with pelvic pain. And we’ll talk a little bit more about pressure management and what that has to do with things, but it can be associated with pelvic pain.

What I want to note here is that a medical professional can examine you and they will often give a, a grade, they will grade the, the severity of the pelvic organ prolapse, but that’s not necessarily indicative of how noticeable your symptoms are. So some people have a more severe pelvic organ prolapse and don’t feel as much.

Some people have no official diagnosis and yet they feel it quite often and it is cumbersome in their life. So, A pelvic organ prolapse, like I said, can be associated with pelvic pain. Sometimes people have both. It can also be associated with urinary incontinence, and that’s because a pelvic organ prolapse is a pressure mismanagement issue where you’ve got, you know, the connective tissue and the muscles of the pelvis have weakened or have weak spots, and that can happen as a result of postural habits that we have had maybe much longer than just the pregnancy and birth, which is kind of the, where it gets more severe and becomes more obvious. And so that can be, you know, maybe someone has been walking with their back a little bit more arched and more pressure into the front of their pelvis or maybe they tend to sit back and tuck under and therefore they’ve got lots of pressure toward the rectum, toward the tailbone. And so all of that is pushing pressure toward the front of the pelvis. There can be lots of things that contribute to pelvic organ prolapse beyond just like an immediate the trauma in childbirth, though that is typically when it becomes more severe.

I say all of this because often we think of pelvic organ prolapse, or I hear clients think of pelvic organ prolapse as being a weak pelvic floor issue, and that may not be the case. It may be that you’ve got a weakened part of the pelvic floor or some weakened connective tissue, but other parts of the pelvic floor that are way too tight and restricted.

And so we don’t want to, with a pelvic organ prolapse, just go right into lots and lots of kegels. We want, ideally do a more thorough evaluation of the pelvis and figure out are there places where there’s a lot of restriction and you might do all the kegels in the world, but until you kind of loosen up this other area, you’re not gonna be able to manage pressure effectively.

And I mentioned all of that because I wanna note that you may fix a pelvic organ prolapse and still have other symptoms or vice versa. Ultimately you are not a series of diagnosis, but one functioning person, and we want to treat the issues that you are having on any given day. So I’m gonna jump right on in to the first and perhaps most common mistake that I see with pelvic organ prolapse, which is relying on an official diagnosis to tell you that something is wrong, or to tell you that something is healed.

So we don’t want to, you know, have discomfort, feel like something’s wrong in the pelvis, and go to the doctor and be told that everything’s fine, and therefore carry on doing things that are maybe contributing to that discomfort. If you are having a feeling of heaviness, this is what I tell my clients all the time.

If you’re having a feeling of heaviness, if you’re having symptoms that are associated with pelvic organ prolapse, there’s no harm in just acting like you have pelvic organ prolapse. So when I go through my programs, I give some additional queuing around that. We might have certain things that you avoid and you can take those modifications even if a doctor hasn’t told you that you have a pelvic organ prolapse.

And on the flip side, we also have people who are diagnosed with a pelvic organ prolapse, but have no discernible symptoms. And so I hate to see someone limit themselves and do less and become, in fact, less fit because they’re very frightened of this issue that they can’t feel right. Isn’t that kind of scary?

It’s like if someone says, oh, there’s something wrong with you and you can’t feel it now, you can’t trust yourself to know what to do or what not to do, so I don’t. I mean, obviously it’s helpful like from an insurance perspective in getting the referrals that you may need to go to pelvic pt. It is very helpful to have an official diagnosis, but it’s just one small component of the whole.

You need to pay attention to what your symptoms feel like over time and what your symptoms feel like in particular movement to decide for yourself what is or isn’t wise for you to do. And that applies as well to the urinary incontinence that I mentioned, or to pelvic pain where, yeah, maybe you go back and your pelvic organ prolapse is healed and the doctor sees no issues.

But if you’re still having pain, then we still want to kind of pursue that a little bit further. So we don’t wanna just rely on a diagnosis either to tell you that there’s nothing wrong when you feel like something’s. Or to tell you that there’s something wrong with you when you don’t feel like there’s anything wrong.

You can rely on your own physical sensation, and if you’re a little bit earlier postpartum, that’s the only time that I would maybe question it, right? If you had significant trauma to the pelvic floor, maybe tearing or an episiotomy and you had lots of stitches, then you may not have as much innervation and you may not actually be able to feel what’s going on.

But if you are further postpartum and you can feel sex, and you can feel any other kind of penetration and you can engage your pelvic floor and release your pelvic floor, and you have awareness of all of that sensation, then I would not, then I would trust myself. I would trust my own perception over a particular score or grading of the severity from a doctor.

And I’m gonna talk about that a little bit more in a moment. But for now, I wanna jump onto our second common mistake, which is not considering all possible treatments. So as a first course of action, someone who’s had a pelvic work and prolapse diagnosis. Really should try to get to a pelvic floor pt.

So you want someone who does internal work and who is going to take the time to work with you and talk through your symptoms and help give you tools that you can use on your own. Yes, you’re probably gonna have rehab oriented exercises that you do on your own over and over again. They’re probably gonna be boring, probably gonna be pretty repetitive.

But you should also see that you are progressing, that it’s not just the same exercises over and over again. And that should be a conversation between you and your therapist. If you are not seeing that progression, then you may need to look elsewhere. Either find another provider or add on something else, like one of my programs to make sure that you are actually moving into doing the things you wanna be able to do, right?

Maybe for you that’s running, maybe for you, that’s jumping on the trampoline with your kids. Maybe it’s just being able to squat down and stand up without feeling like your insides are gonna fall out your vagina, whatever it is for you. You should make sure that you’re getting a pelvic floor PT who is actively working with you.

It’s not gonna be overnight change, but actively working with you over time to make progress and focus on the things that matter to you in managing your symptoms. That said, I think we often think that exercise-based therapeutics are the only solution. And there is such a thing as a pessary, which is a manual device that helps to kind of hold things where they belong.

It’s inserted vaginally And they are often like fitted for an individual and that can be very helpful. And I think sometimes I talk to people who don’t want to go that route for a a reason like feeling like it’s cheating or feeling like they should be able to fix this other ways. I think you should try your very best to fix it other ways.

I think you should give rehab exercises, three, six, even 12 months to work. But if you’ve been doing your prescribed exercises, you’ve been working with an expert, you’ve been really doing the work, and you’re not seeing progress, and you’re not able to do the things that are important to you, know that there are other options, and talk to your ob gyn about them and make sure that you’re really being offered everything that’s available to you and that the solution that’s provided is one that suits your lifestyle because you are the one who has to live in your body for the next many decades.

The next common mistake that I see is only doing safe exercises in a postpartum program and vice versa, right? Not doing or doing all safe exercises no matter what, right? Just like I was saying a little bit earlier, we always wanna rely on our physical sensation to tell us what is and isn’t safe. And that often starts with just building a baseline awareness of what the pelvic floor is feeling. Like I said, if you’ve had trauma to the pelvic floor, it may take some time to even be able to feel.

I can feel my pelvic floor released. I can feel my pelvic floor. Once you’ve got that baseline down and you know what your pro prolapse symptoms feel like, then you wanna be allowing the pelvic floor to, to release and engage throughout whatever exercise you’re doing. And you want to, over time, slowly and progressively in a safe way, introduce exercises that were previously not safe.

So, yeah, right out the gate, you probably don’t wanna be doing big, heavy, full range of motion squats, but at some point, because that’s, again, bending, you know, squatting down can make people feel like their organs are gonna fall out. But at some point, squatting should become part of your program because squatting is a normal physical movement that we have to do in our bodies and our life.

So we wanna make sure maybe you’re starting a squat to bench with no weight, squatting down to a chair, standing up, engaging, releasing the pelvic floor, engaging the pelvic floor, feeling subtle control of the pelvic floor. So releasing the pelvic floor doesn’t mean I gave up. I completely let go of it. I can’t feel anything.

It means I can feel that my pelvic floor is lengthening to allow me to sit down and back, but I can still hold some tension there. Right? So that might be where we start with a squat. And over time you may add depth and you may add weight. Similarly with. You might, every now and then you have to just try.

What does it feel like if I add a little bit of impact here? Nope. Doesn’t feel good. Okay. It does feel good. It feels good for three reps of a squat jump, but not after that. Okay. How do I, how do I modify a squat jump, or whatever the exercise may be? What’s a, a lighter way that it’s still in, you know, rapidly engaging.

It’s doing that kind of power focused movement where, you know, a squat jump is rapidly engaging the pelvic floor as you go up and managing pressure as you come down. Can I do that just quickly? Going from a squat up to my tiptoes and dropping back down with speed that may be, you know, not actually jumping up.

That may be a way to toy with managing pressure through a jump. You have to try in order to tell if it’s still a no-no exercise for. And should you be doing that at six weeks postpartum if you have a sensation of heaviness in the pelvic floor? No. No, absolutely not. You should give yourself a reasonable amount of time to heal. But if you are, again, 6, 9, 12 months postpartum, you’ve been doing rehab exercises regularly, you are seeing progress. Then yeah, absolutely. It’s time to start introducing some impact and seeing how it feels and backing off if it feels like too much, that’s all there is to it. At some point you have to just feel it out and try.

Fourth common mistake that I see with pelvic organ prolapse, assuming that change is linear and only goes one way, this is honestly, this is a mistake that I see with every possible injury that people are recovering. It’s like, well, I got better last week.

Why am I not getting better still this week? Or, I’m not seeing any progress. Any progress, any progress. And then there’s this enormous leap. That’s how change in our body goes. It’s, it’s not linear. It’s not, you know, you don’t get back out exactly what you put in. You put in and you put in and you put in and you put in and then you get, you get some out.

Or sometimes you make lots of progress and then you stall for a long time. And that can be really hard emotionally. This is where it’s very helpful to have a coach, to have someone who’s telling you like, it is worth it. It is working. There’s nothing wrong with you. Your body is gonna adapt when it’s ready to.

There is also the other side of that, which is that sometimes we actually backtrack. Sometimes we’re doing really, really, really well and then we backslide, and that may be backsliding because something happened, right? Where it’s like, oh, well I went on vacation and I didn’t do my exercises, or I, you know, I moved and I was carrying a bunch of heavy boxes and I was set back for three weeks.

Like that happens. That does happen because we’re a real person who lives a real life. And sometimes it’s just, it feels like it falls from the sky and there’s no reason for it, and we don’t know why we’re backsliding, and that doesn’t mean there’s anything wrong with you. It just means you have to keep putting one foot in front of the other, keep showing up, and it will progress again.

Many of my clients with pelvic organ prolapse are not aware that their symptoms may change with their cycle and change with their postpartum hormones. So sometimes pelvic work and prolapse just seems to resolve. A year or two postpartum when hormones kind of get back to normal levels again. Or some people may find that their pelvic organ prolapses basically feels non-existent three weeks out of the month.

But leading up to and right at the beginning of their period, it is very obvious. That makes perfect sense with a cervical prolapse, cuz you know. The cervix is opening, the uterus is kind of like emptying. There’s a lot of cramping that’s happening, happening in the uterus. So there’s all this pressure downward.

I mean, of course it makes perfect sense logically that we would have more prolapse symptoms, but also the connective tissue, the, the, the tension and the connective tissue changes throughout the cycle. So even if you have a bladder prolapse or a rectal prolapse, those symptoms can change due to your cycle.

Even. Even though it doesn’t seem like it should have anything to do with the cervix.

And then finally, the last common mistake that I see is believing that there is going to be a place where the pelvic organ prolapse is cured forever, and that’s never gonna change. Now it’s nice of course to have that ideal of I am one day going to be completely symptom free, and that does happen for some people, but hand in hand with that idea of like expecting change to be linear and to never backslide, I find that it’s helpful to understand that your body is constantly changing and while your pelvic organ and prolapse symptoms may completely go away for quite some time, they also may come back.

And that doesn’t mean that anything’s wrong. It doesn’t necessarily mean that you’re starting back from zero. It may just mean, oh, hey, I need to bring some awareness back to doing my rehab exercises again, or having more mindfulness of my breathing patterns and my posture. It can be that simple. It’s okay if your symptoms change.

If they return after being gone for a little while or dormant for a little while. It’s not the end of the world. It just means, oh, hey, let me, let me think about what’s going on. Maybe there’s hormonal changes around post-menopause, and we want to just keep in mind things are changing all the time. You have the skills, you’ve healed it once, you’ll continue to heal it again, and your body is resilient and it wants you to be healthy and functional.

When we see those backslides, when we think that it’s been gone for a long time, then comes back, you know, five years later, that’s not the end of the world. It’s just your body saying, Hey, I need a little bit of attention on this area. Let’s focus on this again. If you’ve been diagnosed with pelvic organ prolapse or you are currently pregnant and you’re thinking about, you know, what are some of the things I should be aware of?

I hope that this has been really helpful. I hope that you find the resources that you need and if you ever have trouble finding resources or don’t know where to turn next, I’m available and I’m always happy if you wanna reach out to me at Kelly Bryant Wellness on Instagram or Facebook. Everything that I do as far as courses and programs is in the show notes if you want more assistance with exercise that is mindful of pelvic organ prolapse.

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