Is Your Vagina Falling Out?

Your vagina may be in the process of sliding out right now. Or not. Don’t freak out.

Women know that pregnancy can cause stretch marks, that labor can cause tearing, that our bellies and thighs and boobs will probably shift shapes and sizes, but NO ONE TALKS ABOUT THE POSSIBILITY OF YOUR VAGINA FALLING OUT!

It doesn’t literally disconnect from your body, but with a serious prolapse, the walls of the vagina and the cervix can sit outside the body, like an inside out sock.

Here’s the kicker: Prolapse isn’t rare. Rates of prolapse are hard to estimate, but the lifetime risk of needing an operation is about 11%, so we can assume the prevalence is higher than that since not all women will need or decide upon surgery. That means the rate is at minimum 1 in 10 women, probably more. AND NO ONE TALKS ABOUT IT!

Most women with prolapse do not have grade 4—the type that protrudes completely—so saying your vagina is falling out isn’t entirely fair. You may have a grade 1, 2, or 3 prolapse at this moment without knowing what to look for. If you have a grade 2 or 3 you probably know something is wrong “down there” but may not know what.

WHAT IS PELVIC ORGAN PROLAPSE

If you haven’t already, say hello to your pelvic floor. Come back when you’re done.

Pelvic Organ Prolapse (POP) is when the bladder, uterus, vagina, rectum, or small intestine begins to prolapse, or fall, from its normal position.

Whether you will get a prolapse depends on many variables, such as how you gave birth, your age, your genetics, your habits, and your luck. I won’t go into all the details because it could fill a book.

THE TYPES OF PELVIC ORGAN PROLAPSE

• Rectocele: This is when the rectum prolapses and pushes against the back wall of your vagina.
• Cystocele: This is when the bladder prolapses and pushes against the front wall of your vagina.
• Enterocele: This is when the small bowel prolapses, usually the result of a hysterectomy.
• Uterine: This is when the uterus prolapses, weakening the front and back walls of the vagina.
• Vaginal Vault: This is when the top of the vagina falls towards the vaginal opening. As with an enterocele, hysterectomy often precedes it.

WHY DO THE ORGANS PROLAPSE?

Anatomically, the organs prolapse when their support networks are weakened or damaged. Remember, these support networks include muscles and connective tissues.

WHAT ARE THE RISK FACTORS?

Ignore causes. Causes are hard to pinpoint. If you have prolapse, finding the one cause is unhelpful. You probably didn’t have one cause.

You can’t recognize or modify causes, but you can address risk factors. Keep in mind, most women with prolapse have multiple risk factors.

SOME OF THE MAIN RISK FACTORS INCLUDE:

• Childbirth: Cystoceles are commonly associated with childbirth. If you pee yourself every once in a while and had difficult, long deliveries with tearing, you should get yourself checked out. Even though women who have never been pregnant can have prolapsed organs, mothers’ organs slouch more often than that of non-mothers. A vaginal birth increases the odds compared to a c-section, but a c-section can’t prevent it, so don’t demand a c-section if you are trying to out run prolapse.

• Menopause: This is a complicated risk factor. Sometimes, prolapse gets better after menopause — go figure — but often it doesn’t. It depends on the type of prolapse, your other risk factors, your tissue quality, etc… We do know estrogen decreases during menopause, and estrogen is important for strong muscles and tissues. Many women who experienced vaginal trauma won’t see the repercussions of that trauma until they go through menopause, but don’t assume if you have prolapse that it will automatically get worse after menopause. Speaking of estrogen, if you are nursing, your estrogen levels are low, but this doesn’t mean you should stop nursing if you suspect prolapse any more than you should stop aging.

• Hysterectomy: The uterus is part of the pelvic organ support structure. Removing it can upset the balance.
  Obesity: Unsurprisingly, obesity doesn’t help. In fact, some studies suggest obesity increases your chances of prolapse as much as birthing big babies does.

• Genetics: Ask your mom, grandmother, and aunts if they have or had POP. If they do/did, you are not predestined, but it is a risk factor. If you feel weird asking them, I suggest reading The Vagina Monologues to get you in a vagina-centric frame of mind.

• Strenuous Physical Activity: Exercise is a risk factor. Yep. Pause, and take that in. I’m talking to you marathon runner, crossfit enthusiast, weight-lifting strong momma. While you are helping your heart, you might be hurting your vagina. Indeed, any (too) heavy lifting can contribute to prolapse. Great news for moms of babies and toddlers who lift heavy loads ALL DAY LONG.

CHECKING FOR PELVIC ORGAN PROLAPSE

If you are wondering if your vagina is slouching, first, stop freaking out. Even if it is, you’ll be okay. Prolapse isn’t life threatening. You have treatment options if you have it. And lots of women have it, so swat away any feelings of embarrassment.

Then get out a handheld mirror and take a look. If you can see a bulge, you should schedule an appointment with your doctor. Also, ask yourself these questions:

• Do you feel pressure in the vagina or pelvis?
• Does sex hurt?
• Do you feel pain or pressure in your vagina that resolves when you lie down?
• Do you have recurring urinary tract infections?
• Do you leak urine?
• Do you have difficulty emptying your bowel or bladder?
• Do you suffer from constipation?
• Do you have trouble keeping a tampon or menstrual cup in?
• Does anything else seem “off” down there?

Having these symptoms doesn’t mean you have prolapse, but you might. Not having these symptoms doesn’t mean you don’t have prolapse. And having some of the symptoms, but not others, could mean you do or don’t have prolapse. Clarity thy name is not prolapse.

The most obvious symptom is a bulge, so take a look. If you suspect you have undiagnosed prolapse, refrain from seeking internet advice and go see your doctor.

WHAT YOU SHOULD DO INSTEAD OF FREAKING OUT

First, go see your doctor. The following are some of the options you might be given:

• Physical Therapy: If your prolapse is mild to moderate, you might be sent to physical therapy to learn pelvic floor muscle training and other movement modifications.
• Pessary: If your prolapse is troublesome, but you are not ready for, or not a good candidate for surgery, you might be fitted for a pessary, a kind of vaginal brace to hold things up.
• Estrogen: If you are post-menopause and your estrogen is low, you might be given an estrogen cream.
• Surgery: And if you are experiencing discomfort that affects your life, you will want to consider surgery.

Personally, pelvic floor muscle training and awareness of breathing patterns, as well as general physical fitness, have been adequate. But I’m fairly young (33 as of this writing) and have three young kids, so even if I had been offered surgery, I likely would have delayed it.

However, I have multiple risk factors (childbirth factors, genetics, heavy lifting, among others), so, who knows, maybe later I will need surgery. Maybe not. I like knowing my options. I definitely won’t live uncomfortably in my body if I don’t need to. I suggest you don’t either.

I read about postnatal bodies. I write about postnatal bodies. I move my postnatal body. I mother three little bodies who made my postnatal body. I over-think everything. And I like it. You can read more on my blog Mother Figure or like me on Facebook.