MonthDecember 2014

Let’s talk about prolapse

Prolapse, much like incontinence, is one of those topics which no-one really likes to talk about. But is so important women understand what’s really going on down there! So we’re going to give you the low down on what it is, how to recognise it, and what to do about it if you have end up with a prolapse…

The organs of the pelvis – the bladder, rectum and uterus – are supported within the pelvis by connective tissue (or “fascia”), ligaments and pelvic floor muscles. If these tissues are stretched or torn, and/ or your pelvic floor muscles become weak, your pelvic organs may not be held in place and may bulge down into the vagina. This is called pelvic organ prolapse or POP.

Pelvic organ prolapse is very common. Did you know that up to 50% of women who have given birth will suffer from prolapse? It can also be seen in women who have not given birth and is often associated with straining at stool. Collagen type is also important, and women who are hypermobile (i.e. extra range of motion in a joint or joints) may be predisposed to prolapse.

Women may first notice prolapse when they find a lump or bulge in the vagina and have a sense of dragging or aching. There may be issues with incontinence or difficulty evacuating the bowel. The symptoms are often worse at the end of the day, particularly if you are on your feet all day or doing a lot of bending and lifting. Prolapse often feels better after lying down.

Childbirth is the most common cause of prolapse. When the baby descends through the birth canal, stretching or tearing of the supportive tissue and pelvic floor muscles may take place. However, chronic coughing, a long history of straining at stool/ constipation and heavy lifting, are other factors that can cause prolapse.

Prolapse is named after the organ that has lost its support and is protruding into the vagina. You may hear terms such as urethrocele (when the urethra protrudes into the vagina), cystocele (bladder), rectocele (rectum), enterocele (small intestine), or uterine (uterus) prolapse. However, new terminology makes it easier to understand with terms such as anterior wall (bladder) and posterior wall (rectum) prolapse.

Women are often devastated to learn that they have a prolapse and are sometimes angry that they were not informed about this as a consequence of childbirth. Many have little or no knowledge of prolapse, so education is the key to helping women understand their body and how best to manage it.

Conservative measures such as pelvic floor muscle strengthening, bracing and correct position for defaecation, can help to reduce symptoms of prolapse. Local oestrogen can help with tissue quality in the vagina for women who are breastfeeding or post menopausal. Pessaries, which are a plastic or rubber device inserted into the vagina, can help reduce symptoms of prolapse by supporting the wall of the vagina. Lifestyle changes such as ensuring adequate fluid intake, a well-balanced diet, maintaining a healthy body weight, and avoiding excessive straining, can all help prevent and assist in the management of prolapse. Being aware of safe lifting techniques, bracing before lifting, and avoiding exercises or activities which cause an increase in intra-abdominal pressure are all important as well.

Lastly, surgery may be recommended if the prolapse is significant and not responding to conservative management. In this case referral, to a gynaecologist or urogynaecologist may be necessary – you should speak to your GP about arranging a referral.

We strongly recommended you see a pelvic floor physio if you are experiencing any symptoms of prolapse, as there is a lot that can be done to help reduce and prevent worsening of symptoms. And education is key to understanding any symptoms and being able to take timely and appropriate action.

Sharyn Wappett
B.App.Sc (Physiotherapy)
Member of the Australian Physiotherapy Association (MAPA)
W: Restore Physiotherapy
FB: Restore Physiotherapy on Facebook

Planning your (birth) plan

My yoga teacher used to say, “If you want to make God laugh, make a plan.” Never were truer words spoken! With the best of intentions we often try to plan our lives but we all come to know in time that things often do not go the way we think they will. Even if they head in the right direction, the path can be curvy and often very steep. The only thing which is certain in life, apart from death and taxes, is change. Moment to moment we are in a state of flux. While we must accommodate to this constant state of change, making plans is crucial to ensuring you are heading in the right direction.

Making choices or a plan for your birth can be contentious, where public and professional opinions abound! As soon as you announce you’re pregnant, a barrage of (often unwarranted) comments and questions arise such as: “Are you seeing an obstetrician or a midwife? Are you taking birth classes? Where? Why would you not have an epidural? Oh you’re going all natural, wow you’re brave…” It can often seem endless. Pregnancy seems to somehow make you public property overnight!

In the end though, the choices you make on the birth journey are yours (and maybe your partner’s). This may seem daunting, but it doesn’t have to be. Embracing the experience and making choices from a place of intuition, true desire, with priority for the safety of you and your baby is paramount to a happy birth process. Here’s a few tips to keep the process authentic, awesome and also real:

1. Become empowered, excited and fearless about your birth experience and meeting this new human entering your world. Nurture a peaceful mind – just some of the ways to do this are:

  • utilise the breath
  • get into yoga (if you haven’t already)
  • meditate
  • get hypnosis
  • use visualization
  • use affirmations
  • try massage
  • find some form of movement
  • or anything that will nurture positivity and will see you into labour with a sense of calm and clarity!

This attitude will enhance the effect of the labour hormone oxytocin and will decrease adrenalin (which inhibits oxytocin). YOUR state of mind really counts. Knowing you have this box of tricks with you as you go into labour will be comforting and encouraging.

2. Know that labour and birth is dynamic and sometimes things happen beyond our control. That’s okay! Just nurture your sense of calm and go with it. The universe always has a grander plan. Some things on the plan will change, and other won’t (hooray!).

3. The baby’s comfort and safety are of upmost importance. Don’t lose sight of that through preconceived expectations of an experience. The aim is a healthy baby in your arms.

4. Trust yourself and your body by honing self-love, self-nurture, self-trust. Check your internal dialogue; are you kind to yourself? A little self-compassion can go a long way!

5. Get yourself an awesome birth partner. That is, make sure your chosen one knows their role in the labour/ birth room. Their role should mainly be to nurture you, keep you calm, and to love and support you. They are your advocate and guide (when you may not be able to express yourself fully!). Share your feelings, plans and thoughts with them leading up to the big day

6. Do seek opinions but make up your own mind about your choices. Trust your own instincts. Other women’s birth experiences are theirs – not yours. Your experience is bound to be different. No two births will ever be the same!

7. Aim for a happy and safe birth. Adding words like ‘normal’ or ‘surgical’ to the word ‘birth’ may foster guilt and a sense of being abnormal if it doesn’t all go the way you intended. You’re not abnormal and you won’t be, regardless of the outcome.

8. Try to have continuity of care such as a good midwife or other support person, who can spend ample time with you during your pregnancy and labour. This is the one thing which has been shown to increase your chances of having a birth without intervention. These people keep you centred, nurtured, and they know you and they know what you want.

9. Be careful of online birth forums, as they can scare you and even give you biased and badly written information. Take them with a grain of salt, and if in doubt, check with your midwife or obstetrician.

10. Know that your caregiver has your and your baby’s best interests at heart.

11. Don’t be afraid to do your research about birth and what’s available (medications, alternate positions, interventions, etc). Delve, read, ask and just do what YOU need to.

12. Invest in an awesome child birth education program; one that nurtures a peaceful, positive mindset and combines practical guidance for birth and motherhood. The program should give you useful coping tools as well as evidence based information (without blinding you with the science). NB: You do get what you pay for!

13. GET EXCITED! Embrace this! It’s soon going to be your baby’s birthday!!! A new beginning where love will take on a whole new meaning! <3

Kerrie Adams
Midwife/Lactation Consultant/Yoga Teacher

M: 0430 849 986
W: Nurture Mama
FB: Nurture Mama on Facebook

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