Every few weeks, I see a woman in my clinic who is extremely distressed about what’s suddenly happening to her body and often on the verge of a breakdown as I ask about her story.
Her story goes something like this. She gave birth a few months ago and, like a good patient, went to her 6-week postpartum appointment. Her doctor told her that her perineal stitches had healed and that she was good to go back to normal activity. She asked her doctor about the weird heaviness she felt in her pelvis, but she was assured that she was just tired and it would go away.
She returned home and, to get back to her life, signed up for a 5K in two months. The postpartum had left her feeling disconnected, so she was eager to feel like herself again. While running and training for her race, she suddenly felt a strange pressure in her lower abdomen. It felt like something was slipping out of place. Confused, she went to the toilet and looked down at her vagina.
Only to find the unspeakable horror of a grape size tissue hanging out of her vagina. What is THAT? She thought.
She rushed to the emergency room but was told that it was not a medical emergency and that she should call her OB/GYN. She called her obstetrician, who was not available for three weeks. After spending a torturous three weeks with this tissue hanging out of her body, she finally got her diagnosis – “Pelvic Organ Prolapse.”
Her doctor referred her to see a urogynecologist. After waiting another six weeks to see this specialist, she was told she had two options. She could either choose to have surgery to tie her organs back in place or see a pelvic floor physical therapist.
With a 4-month-old baby at home and what felt like a lifetime of tears, she decided to see a pelvic physical therapist.
She ended up in my clinic. “HELP! my vagina is falling out,” she said, tears flowing down her face.
And while this is what I most often see happening in an alternate universe (a maternal health haven), this woman’s story would play out differently.
After giving birth, she would be seen within the first six weeks by a medical practitioner. She would be referred (like all new moms) to a pelvic floor physical therapist to screen for pelvic floor weakness and aid in postpartum recovery.
Instead of feeling alone, miserable, and lost, she would be in my office at seven weeks postpartum. I would educate her on how to build the foundation of her core and pelvic floor back after the ordeal of pregnancy and labor. I would also screen her for pelvic organ prolapse and educate her on strategies to help her healing body.
With proper supervision, training, and a graduated return to activity, she would never be caught off guard by her diagnosis. She would start pelvic floor strength and coordination training before attempting a run. She would feel stronger with each passing week and spend this precious time bonding with her new baby instead of spending it fretting and agonizing over her seemingly fragile body. She would eventually return to her passion, running, without any symptoms. Instead of living with fear and distrust of her body, she would live with confidence and build resilience in her body.
Pelvic organ prolapse is a condition where one or more of the pelvic organs (such as the bladder, uterus, or rectum) drop down from their normal position and press against the wall of the vagina (or sometimes droop down outside the vagina). This can happen when the muscles and tissues that support the pelvic organs become weakened or damaged, causing the organs to slip out of place.
Symptoms of pelvic organ prolapse can include :
- A feeling of pressure in the vagina or pelvic region
- A bulge or lump in the vagina
- Incontinence (leakage of urine or feces)
- Difficulty with bowel movements
Even in the best of circumstances, organ prolapse is a difficult diagnosis to cope with. Still, unfortunately, most women in the US are left to their means until, one day, it all comes crashing down (the vagina).
It is estimated that a fair percentage of women have some degree of organ prolapse during the initial postpartum weeks. The pelvic floor (the muscle inside the pelvis supporting these organs in place) gets stretched out and weaker during pregnancy and birth. This muscle (and the body in general) needs support and specific exercises to build strength back.
When women aren’t given this support and education, they often return to physical activities (like running), which are too hard on this healing tissue. They are caught off guard when organ prolapse, leaking, or pain symptoms worsen during workouts and blame themselves for hurting their body.
In many European countries, like France, every woman who gives birth is referred to pelvic floor physical therapy to recover from childbirth and protect her body from long-term deficits. It’s standard protocol. They never have to ask for the care they deserve. It is built into the system and is covered by insurance.
The system in the US, on the other hand, is built to do the bare minimum for women giving birth. Even when they do all the right things, women in the US receive trivialization of their symptoms and reactive medical help.
Not only do we fail our mothers in providing them with financial support through paid parental leave, but we also fail them in providing the right medical support in such a crucial phase of life. Unsurprisingly, pelvic organ prolapse surgery and the economic burden on the healthcare system is one of the highest in the US when compared to the rest of the developing countries.
Stories like this one are far too common in my clinic as a pelvic floor physical therapist. Seeing new moms go through preventable trauma and misery is heartbreaking.
If you are pregnant or a new mama, ask your doctor or midwife to send you to a pelvic floor physical therapist to screen for weakness and aid in recovery. Know exactly what’s going on in your body and have a plan for recovery. Devote time and attention to the part of your body that has undergone so much to nurture your baby.
What should’ve been the job of the healthcare system is your responsibility as a birthing person; to advocate for preventative care to ensure your long-term health.
