How do you cope with your prolapse?
This week I received the following email from Lisa (NZ) who had just been told her bladder prolapse is worsening.
Lisa’s email really highlights the emotional impact of prolapse on many women. She’s kindly given me permission to share her email with other women.
Here’s Lisa’s email
Hello Michelle. I have found your website and products very useful as I come to grips with a prolapse as a 35 yr old after childbirth. I particularly found the blog you did on emotional impacts helpful.
Today I came away from a Drs visit feeling very depressed, hearing that my cystocoele has worsened after birthing my second baby. Treatment options were invasive and I didn’t want surgery, as here in NZ they still use that awful mesh.
It occurred to me that what I wanted from a medical professional was not to hear how bad it was and how my vagina has been so ruined by birth that drastic surgery is needed, but that I can still live a happy life managing symptoms via lifestyle.
I have felt aged well before my time (feeling like I have a post-menopause body even though I’m only in my 30s) and frightened of doing everyday actions like lifting my baby or a basket of washing. I have also felt extremely unattractive and frightened of being intimate with my husband in case everything “falls out.” But I’m even more frightened of surgery risks, invasive procedures and arduous recovery. It has surprised me how much of my identity as a woman was connected to my vagina, but then I realised I can still be the same person even if I have a prolapse.
Please could you do a blog post saying that it’s okay to choose lifestyle treatment, it’s okay to live with a prolapse, it doesn’t have to steal a woman’s sparkle or what makes her important to the people who love her. A woman’s family will still love her even if she can’t jump or run, and her husband will still find her attractive even though her body has changed after birthing children. Although lifestyle changes will be made, living with a prolapse needn’t ruin your life or take away your self esteem.
Lisa thank you very much for sharing your feelings and fears.
I know that many women feel exactly the same way that you do. I have no doubt that your email will help other women reading here too.
I’m keeping my response general and applicable to women of all ages with some special consideration for younger women with prolapse too.
I hope this blog gives you some ideas about how to keep your sparkle Lisa.
The following information is not intended as individual medical advice. This content is provided as general information only. Please speak with your medical practitioner or health care provider for individualised treatment information about your condition.
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How to Cope With Your Prolapse
It’s natural to have strong feelings after being diagnosed with a prolapse. Most women have feelings ranging from shock and disappointment about what’s happened to their body through to anxiety about their future living and coping long-term with their prolapse.
Unfortunately emotional support for women with prolapse is usually very lacking and women are expected to carry on and deal with what’s often delivered by the health professional as a matter of fact clinical diagnosis.
Women are rarely asked how they are coping emotionally with their prolapse or offered counselling support to help them day to day.
There are 2 ways of helping to cope with a prolapse diagnosis:
- Understand prolapse
- Examine fears related to prolapse
To improve coping and change feelings from fear and sadness to happiness and contentment we need to examine our fears. If you can examine, understand and challenge your fears you’ll be better able to see where they come from, why you hold onto them and whether or not they’re worth holding on to.
Understanding our fears can help us to shift our inward focus and move forward feeling more confident and happy with our body and the prolapse management decisions we make.
What is a Prolapse? Seeing Your Prolapse for What it is
Prolapse is another word for a hernia or bulge.
A vaginal prolapse results from a physical injury or strain.
Hernias occur in different parts of the body. A hernia occurs when our elastic tissues overstretch (just like overstretching a piece of elastic which no longer recoils back into position having been stretched). Our elastic tissues include our skin and tissues that wrap around our organs, joints and muscles.
Different types of hernia (or prolapse) can occur including:
- Inguinal hernia where the intestines bulge or prolapse through the abdominal wall
- Mitral valve prolapse where one of the heart valves bulges into the upper chamber of the heart
- Spinal disc prolapse where material inside the disc bulges out of the capsule surrounding the disc (shown right)
- Pelvic organ prolapse where one or more pelvic organs (e.g. bladder) bulge into the wall(s) of the vagina
You can see that many different parts of the body can prolapse or bulge.
Why the stigma associated with pelvic organ prolapse?
Why are women with prolapse so hard on themselves?
Does a man beat himself up about having an inguinal hernia?
How to Cope With Your Fears About Prolapse
Lisa I’d like to start by examining some of the prolapse fears you describe.
It’s normal to have fears about prolapse. When fears about prolapse bring us down, it’s useful to examine our fears to see where they come from, why we hold them and whether they’re actually worth holding on to.
It’s often hard to face our fears.
Let’s take a look at each of the fears you describe in turn to see whether they are based on fact and worth holding on to.
Fear 1 – Being Old Before Your Time
Prolapse only happens to older women right?
Prolapse is frequently related to aging and the body breaking down over time.
It’s a myth to that only mature women suffer from prolapse – women of any age can have a prolapse.
Pelvic organ prolapse tends to occur in increasing frequency with the onset of menopause and beyond as the pelvic tissues weaken however young women suffer from prolapse from causes completely unrelated to ageing.
Many factors increase the risk of prolapse in young women including:
- Family history of prolapse
- Hypermobility (caused by very flexible tissues)
- Very tight pelvic floor muscles that can’t relax and stretch during vaginal delivery
- Large babies
- Forceps delivery
- Constipation and straining
Hypothetical question: Do you think that a young female athlete who sustains an inguinal (groin) hernia from heavy lifting is old before her time? Or alternatively do you think that she’s put in a mighty hard effort in her chosen pursuit?
How is this different from a woman who sustains a prolapse from childbirth?
Facts: Women of all ages can have a pelvic organ prolapse. Prolapse may be completely unrelated to age.
Fear 2 – Everyday Activities will Make my Prolapse Worse
If you’re told your prolapse is worsening or after prolapse surgery it’s only natural to feel worried about everyday activities making it worse.
Your everyday activities may actually have very little to do with prolapse worsening.
A scientific review1 examined the physical restrictions given by doctors after gynaecological surgery and found that there was no quality evidence to support many of the activity restrictions given to women after their surgery. The authors of this review state that activity restriction causes harm and sedentary behaviour carries many risks to health and wellbeing.
It’s very important to keep active and exercise regularly living with prolapse problems for your physical and mental health as well as keeping your body strong to manage your prolapse long-term.
Protect your prolapse from worsening during everyday activities by:
a. Doing regular pelvic floor exercises
Pelvic floor exercises won’t fix your prolapse however keeping your pelvic floor in the best possible shape will reduce your risk of prolapse worsening over time and may improve your condition.
b. Wearing a Vaginal Pessary
Pessaries are under utilised in women of all ages, especially in young women.
Pessary support should be offered to women with symptomatic prolapse to help them manage as an alternative to surgery when appropriate.
A pessary can reduce prolapse symptoms and assist pelvic floor exercises. Some pessaries may actually improve prolapse conditions.
It can feel like a weight off your mind if you’re not constantly reminded about prolapse symptoms, especially when you’re trying to lead an active life including caring for young children.
There are numerous pessary options that may help you manage your prolapse better and allow you to carry on with your everyday activities. You may like to speak with your doctor or see a Pelvic Floor Physio to discuss getting fitted with a pessary.
c. Using Safe Lifting and Carrying Technique
Being a young mum involves a lot of physical work. Use safe lifting techniques, get your partner to do the heavy lifting and make safe lifting practice a part of your life.
d. Exercising With Pelvic Floor Safe Strength & Fitness Workouts
The stronger your body is, the better your pelvic floor and prolapse will be able to withstand the pressures associated with everyday activities.
Pelvic floor friendly exercises will help you exercise safely and reduce prolapse symptoms.
e. Avoiding Constipation and Straining
Manage your bowels well with appropriate diet, bowel emptying technique and avoid straining.
Facts: Sensible everyday activities are unlikely to suddenly worsen your prolapse. Appropriate exercise helps your overall health and helps you manage your prolapse long-term.
Fear 3 – Feeling Unattractive & Frightened of Intimacy
Why is there such a sense of body shame associated with a pelvic organ prolapse?
Does a bricklayer feel a sense of shame about his spinal disc prolapse? It’s the same kind of injury – just a different body part.
Somehow in contemporary society a woman’s sense of physical and sexual appeal can be tied up with some mythical notion of the ‘perfect vagina’.
Some women feel so insecure about their vagina and the appearance of their labia they undergo painful expensive Labioplasty surgery to feel OK about themselves. Granted this is different to prolapse however it demonstrates the quest for some idealised kind of norm when really there isn’t one.
The statistics tell us that 1 in 2 women who’ve had a vaginal delivery will have some form of vaginal prolapse, so why isn’t prolapse openly discussed as ‘the norm’?
What about the attributes that really matter?
- Empathy for others
- Sensitive enquiring mind
- Capacity for nurturing
- Sense of humour
- Love, care and support for your family and friends
- Generosity …
Aren’t these the things that contribute to our personal appeal and desirability as a partner?
Why do we consider ourselves unattractive and undesirable if our vagina isn’t as perfect as the day we were born or measuring up to some idealised kind of norm?
Is it because at some deeper level that having a prolapse makes us doubt our ability to sexually please our partner?
Where is the evidence that a woman with a prolapse is not sexually arousing or fulfilling to her partner?
It may be useful to acknowledge the elephant in the room and discuss your fears with your partner. Tell your partner you’ve been feeling vulnerable and unattractive because of your prolapse.
Ask your partner how they feel about your prolapse and whether or not they’re bothered by it during intimacy.
The possible answers are likely to be:
- Hasn’t noticed your prolapse (unless he’s a gynaecologist)
- Hasn’t noticed your feelings about your prolapse
- Feels rejected and confused owing to your lack of interest in intimacy
- Feels turned off by your prolapse (a highly unlikely option)
It’s most likely that your partner loves you for who you are; a woman who has bravely endured pregnancy and childbirth and now carries on the partnership in helping to raise your children.
Would you want to be with shallow Hal who rates your physical desirability on the pristine perfection of your vaginal anatomy?
Does your partner’s intimate anatomy determine his/her sexual appeal for you?
A mature sensitive and caring partner loves you for the woman that you are. Perhaps don’t underestimate what attracts your partner to you.
How to Improve Sex With Prolapse
Will your partner notice you have a prolapse during intercourse?
No – unless it is very severe and protruding from your vagina your partner is most likely to be completely unaware of your prolapse. A prolapse can be difficult to detect even with an internal examination especially when the woman is lying down.
Is sex with a prolapse safe?
Yes – in woman with mild to moderate prolapse consensual sex with a prolapse is quite safe. Sex actually pushes the prolapsed vaginal walls upwards (temporarily) towards the previous resting position. In women where the prolapse is advanced and protrudes from the vagina sex may not be possible.
How to make intercourse more comfortable with prolapse:
- Choose missionary position (woman lying underneath) to control the depth of penetration
- Use a small pillow under the hips to tilt the pelvis back and reduce the size of the vagina (and prolapse) which may increase sensation for both partners
- Try side lying with your back to your partner to control depth of penetration
- Use a good quality lubricant
- Take your time during intercourse
Fact: Sexual appeal just like physical attractiveness is a social construct. Whether or not we choose to be defined by what others think is desirable is entirely up to us as individuals. Your partner is most likely attracted to you for the person that you are.
Fear 4 Risks of Prolapse Surgery
It’s normal to feel fearful of surgery, especially vaginal surgery which is carried out on the most intimate sensitive area of the body.
Whether or not to have prolapse surgery is an individual decision and can be very be difficult to make.
Prolapse surgery has risks like any form of surgery. Pelvic surgery can increase the risk of some major complications associated with anaesthetic and the surgical process along with post operative problems. Many gynaecologists now perform prolapse surgery without mesh to reduce the risk of complications.
The decision to proceed with surgery can be fairly straight forward if the prolapse is severe enough and the potential benefits outweigh the risks. Sometimes with very severe prolapse, a woman’s poor quality of life means there’s little option but to have surgery.
Alternatively many women find that conservative management with pelvic floor rehabilitation and/or using a vaginal pessary gives them good quality of life and they decide against surgery.
In young women prolapse surgery has additional considerations:
- The risk of prolapse surgery failing increases in younger women (the repair has to last a lot longer than for a mature woman)
- The desire to have more children needs to be weighed up
- Recovery is challenging with young children to care for
The longer surgery can be deferred the better for many young women. Surgical advances may mean that in the future prolapse surgery may even be performed robotically using minimally invasive techniques. Having surgery now won’t prevent your prolapse from becoming severe in your lifetime and prolapse in young women can recur..
Fact: Prolapse surgery carries risks and some young women may benefit from deferring surgery for as long as they feel comfortable doing so.
Fear 5 Arduous Recovery After Prolapse Surgery
Recovery from prolapse surgery is a healing process just like recovery from any form of surgery. Pain relief in this day and age is usually well managed and most women feel quite comfortable during their hospital stay and beyond.
While recovery from prolapse surgery isn’t necessarily arduous, it’s definitely more challenging for women who don’t have the capacity to rest during recovery. Rest is vital for ensuring good healing and avoiding postoperative strain.
All women undergoing prolapse surgery need the support of family and/or friends with the physical day to day running of the house.
Young women caring for children need additional support to allow them to rest so they can heal well and recover.
Fact: The first prolapse surgery needs to be the best surgery. Prolapse surgery outcomes are optimised with good rest during the recovery process.
Worst Case Scenarios for Your Prolapse – Can you Cope?
This next exercise can feel confronting and may be undertaken with the help of a counsellor or trusted support.
Ask yourself what the very worst thing that could happen to your related to your prolapse is fears and whether or not you can deal with this event.
Some examples of worst case prolapse scenarios:
- Your prolapse protrudes out of your vagina
- Your partner tells you you’re physically unattractive and undesirable
- Your prolapse worsens and you need to have prolapse surgery at a future date
Think about each of these scenarios and consider each in turn (maybe not all at once).
How would you cope? Would you break down completely or would you be wiser and stronger for the experience?
Examining worst case scenarios can help us realize that we can cope very well with many of life’s unwanted events, prolapse included. This activity may help to reduce the size of the problem and help us deal with problems that may seem insurmountable.
Monitor Your Thinking About Your Prolapse
Negative thoughts about ourselves and our bodies can easily spiral and become habitual when repeated over time.
Being mindful of your thoughts related to your prolapse can be a helpful management strategy and this doesn’t mean berating yourself for thinking about your prolapse.
Rather, being mindful involves noticing when you think about your prolapse or have negative thoughts related to your prolapse.
You may choose to label your negative thinking for example “there’s that prolapse thinking again” every time you notice related thoughts. Sometimes just the process of noticing negative thinking can stop your thoughts from spiralling.
A mindful approach to your prolapse thinking takes practice. It can really help you change the way you see yourself and avoid negative self talk from becoming ingrained.
Key Points for Coping With Your Prolapse
It’s normal and natural to have fears associated with a prolapse. Many women their lose self confidence and have poor body image as a result of having a prolapse.
Things you can do to cope with your prolapse so that you feel happy include:
- Analysing your fears
- Staying physically active
- Managing your prolapse symptoms really well (you don’t need reminders)
- Managing and supporting your growing family
- Feeling confident in the person that you are
- Being open and discussing your feelings with your partner
- Feeling supported by your partner and significant others in your life
- Feeling comfortable with your prolapse management choices (surgical or non-surgical)
- Practicing being mindful of prolapse-related thinking
Examining our fears helps us understand why we think the way we do about prolapse and can help us realise sometimes our fears are not always based on facts. This process can help you cope with prolapse and move forward feeling a whole lot happier with your body and your life.
ABOUT THE AUTHOR, Michelle Kenway
Michelle Kenway is an Australian Pelvic Floor Physiotherapist. Michelle lectures to health professionals and promotes community health through her writing, radio segments, online exercise videos and community presentations. She holds dual post graduate physiotherapy qualifications in women’s health and exercise.
1Nygaard I, Hamad N and Shaw J. (2013) Activity Restrictions after Gynecologic Surgery: Is There Evidence? Int Urogynecol J. May; 24(5): 719–724.