What Causes Pelvic Organ Prolapse? Maybe It's the Ants in Your Pants
I'll be the first to say that the recommended six weeks of activity restrictions after having your baby can be HARD. So many moms, myself included, just want to feel better and feel like ourselves again. That can look like getting back to running, CrossFit, hiking, or whatever physical activity it is that makes you happy. And if you know someone who is into running or another similar activity, you know how difficult it is to get the ants in their pants to calm down and for them to take a break from their favorite activity. You gotta watch yourself if you tell a runner not to run! (IYKYK)
But what if I told you that the future of your pelvic health depended on you resting after childbirth? Whether you had a c-section or a vaginal delivery, your pelvic floor has been through the ringer with pregnancy and delivery. Let's take a look at two moms in similar situations. Spoiler: they've got ants in their pants about getting back to activity.
Meet Missy: Running enthusiast
Missy is pregnant with her first child. She's been a runner since her early teens and has yet to stop running. Missy has done marathons, triathlons, and thinks it would be amazing to run an ultra marathon someday. She refuses to let pregnancy get in the way of running and continues to run throughout her entire pregnancy. In her third trimester she starts to have some pelvic pain, which is a common complaint to hear at this point in pregnancy. Her OB-GYN tells her this is normal and it will go away after delivery. Despite all the running, she goes past her estimated due date and her OB-GYN brings her in for an induction. She has the whole kit and caboodle of hospital interventions including pitocin, an epidural, and coached pushing. As a result, she pushes on her back and sustains a 3rd degree tear. The physician sews Missy up and sends her on her way, recommending that she wait the typical six weeks for vigorous activity and intimacy with her husband.
Missy has ants in her pants though and can't stay away from running. The day she gets home from the hospital she's out taking walks with her husband, baby, and the dog. Two weeks later she's doing a light jog, and she's back to running consecutive miles by her six week postpartum visit. She notices she has a lot of pressure and pain in her pelvis with running that lasts for several hours and sometimes even into the next day. Missy is also brave enough to feel around down by her vaginal opening one day while sitting on the toilet and notices that things feel a little different different down there, sort of soft and squishy coming out between her labia, but it doesn't hurt so she stops investigating. All in all, Missy doesn't think much of all of this. She did just have a baby after all, so it's probably normal, right?
Well, the pain doesn't go away and she suffers with pain 'round the clock for the next several years until she finally hooks up with a pelvic floor physical therapist who tells her she's likely struggling with pelvic organ prolapse, among other things. Missy works with her for the better part of a year to reduce her pain and get her pelvic floor functioning optimally again.
Let's meet our other mom.
Meet Nina: Martial arts fanatic
Nina has been involved in martial arts her whole life. She's dabbled with various arts, but most recently has been interested in Brazilian Jiu Jitsu (BJJ). She's pregnant with her second child and has trained through both pregnancies. Only problem is that with this second pregnancy, she's been put on pelvic rest and activity restrictions for placenta previa since 30 weeks. There is no BJJ for Nina for the final six weeks of her pregnancy. Because of this placenta previa, she needs a c-section and undergoes the surgery at 36 weeks.
The surgery thankfully proceeds without complication, but getting back to simple tasks like walking are incredibly difficult. The hospital doesn't seem to think anything of it though and just provides Nina with an abdominal binder and tells her it will get better with time. Nina does her best to be active when she gets home, but she is much more restricted after this delivery compared to her previous vaginal delivery. However, she's a determined woman and is adamant about taking a daily walk. She's also up and moving all day, often while baby wearing her new bundle of joy. Her toddler needs her attention and having her hands free is a must! When her six week postpartum visit comes, her OB-GYN tells her that she's cleared to return to activity. Nina is ecstatic and is so very ready to go back to her BJJ classes. She shows a little bit of temperance and waits until she's about eight weeks postpartum, but the ants in her pants get the best of her and she goes back earlier than she knows she should.
Nina quickly realizes that her core muscles were not ready for this endeavor and one day, soon after returning to class, she finds herself experiencing a lot of pressure in her pelvic floor and struggling to hold her bladder while she coughs. This becomes a frequent occurrence over the next few weeks. She confides in a gym partner who mentions that she saw a pelvic floor therapist after the birth of her child and that maybe Nina would benefit from seeing one too. So Nina takes herself in to see the therapist and finds that she's dealing with a pelvic organ prolapse. Nina works with the pelvic floor therapist for several months to address her issue and help her feel back to herself again.
What went wrong?
Well, I'd argue that two major things went wrong for both Missy and Nina.
First, neither one rested appropriately in that immediate postpartum phase. We live in a very busy culture that idolizes the grind. This is translated into the postpartum phase by telling women that they need to get up and be active, take care of their other kids, take care of the house, etc, much to the detriment of mothers. There are many great things about our society, but this is not one of them. Traditionally, women have always taken time after the birth of their babies to rest and heal. And when I say rest, I mean REST. In the bed. No cooking. No cleaning. No caring for anyone other than themselves and their new baby. This period of rest allows for a good breast feeding relationship, bleeding to slow down before asking a mother to expend further energy, and for her internal organs to rearrange themselves again. Stop and really think about this: All of the ligaments and tissues holding up your organs are stretched out in pregnancy. After baby comes out, there's nothing creating that pressure within your abdomen to hold things where they should be. On top of that (or underneath, if you will), there's a pelvic floor that was stretched or even torn during a vaginal delivery and under stress during the entire pregnancy, and it can't do it's job of holding things up very well either. So organs are falling and pelvic floors are not in a state to hold them up well. What exactly do we expect to happen, gravity to give us a pass? Sorry sister, no one is exempt from gravity, not even you. You need to kick your feet up and relax after baby is born.
Second, neither one got the appropriate referral they needed for physical therapy. Missy sustained a third degree tear. This means that she tore through the muscle bellies of the pelvic floor muscles. Do you know what is done after muscle tears and surgical repairs for literally every other muscle in the body?
The pelvic floor muscles are the same type of muscles as your quads or triceps, meaning they are skeletal muscles. Each muscle in our bodies has a unique function, and they are all deserving of the proper rehab if they tear. When torn muscles are not appropriately rehabilitated, it can lead to pain, scar tissue, and dysfunction.
In the case of Nina, she too should have had physical therapy even though she didn't have a vaginal birth with tearing. In acute care hospitals, most patients who undergo major abdominal surgery have a physical therapy consult. But not moms post c-section for some reason. I have many speculations as to why this is, but I'll save those for another day. In my opinion, regardless of the reason, it's unacceptable that moms undergoing major abdominal surgery are excluded from this list. And then you're expected to hold, carry, and care for an infant when your abs don't work and you're in excruciating pain? All the while, you're doing things in a weird way because of the pain and the poor abdominal muscle function and it's causing you to bear down to get things done, which in turn is worsening your pelvic floor situation, putting continual stress on your diastasis recti, and causing you back pain... I could go on and on about all the things that could happen, but I'll stop myself there and just tell you that this all very easily can lead to a cascade of unfortunate events that all stem from a lack of proper care in the immediate postpartum phase.
So what's the point?
It can be very difficult to take things slow once you've had your baby. You've been modifying or restricted for so long and you crave feeling like yourself again. I get it, mama, I've been there. But don't let the ants in your pants get the best of you. Some women are fine to not take that rest after their baby is born, but these women are few and far between. Resting appropriately and getting in to see a PT after the birth of your child (or even better, during your pregnancy) will set you up for getting back to activity you love and have you feeling like yourself more quickly.
Did you know that in Wisconsin, you actually don't need a physician's referral to see a physical therapist? Don't worry about getting your physician on board to write a referral for you, you can just do what you know needs to be done for your health.
If you're in SE Wisconsin, I'd be happy to help you on your pregnancy and postpartum journey. I'm currently accepting new clients. Hit the contact button below to get started today!