Pelvic organ prolapse (POP) can feel like a daunting diagnosis. And combining pregnancy with existing prolapse may deepen your concerns…
Is prolapse during pregnancy safe—for both you and your baby?
Will your POP get worse?
Will your pelvic floor ever recover?
It may help to know that millions of people experience POP. And plenty of them have perfectly healthy pregnancies and babies!
So let’s talk about how to navigate prolapse during pregnancy.
First… Can You Get Pregnant with Pelvic Organ Prolapse?
The short answer is yes. Prolapse alone doesn’t cause fertility challenges. Especially if your prolapse is mild, you might not have any issues conceiving or carrying to term!
Still, if you suspect you have a prolapse, have a chat with your health care provider right away.
Depending on a number of factors and the specific type of prolapse you have (uterine, bladder, rectum), a pregnancy with existing prolapse may be at greater risk of miscarriage. And, the more advanced your prolapse, the more severe the challenges may be during pregnancy. Some people even experience life-threatening complications for them and their baby.
I’m not sharing this information to frighten you, but only to stress the importance of having a candid conversation with your doctor. It’s likely they’ll want to keep a closer eye on you as you grow that baby.
Here’s another important consideration: While you certainly can get pregnant with an existing prolapse, getting there might be a little trickier. That’s because prolapse can make penetrative sex painful or difficult. Go easy on yourself.
The Pregnancy-Prolapse Cycle
Pregnancies and prolapses can go hand-in-hand. All that extra pressure during pregnancy, labor, and delivery can strain your pelvic floor muscles and make them more prone to weakness.
But pregnancy isn’t the only risk factor for prolapse. Chronic constipation, straining, genetics, and menopause can all contribute to POP.
At the very least, pregnancy may worsen POP symptoms, which is why most providers advocate for treatment prior to additional pregnancies. Your providers can help you figure out what’s best for you!
(Pssst! There’s lots of ways to prevent pelvic organ prolapse during pregnancy. It’s not inevitable! Check out my free resources to see more.)
Vaginal Delivery and Pelvic Organ Prolapse
Having POP does not alone necessitate a Cesarean section.
How someone gives birth—vaginally or via C-section—actually has little bearing on the severity of POP symptoms or the worsening of prolapse. All of that has far more to do with the amount of pressure your pelvic floor endures during the pregnancy itself.
So let’s talk about how to relieve some of that pressure!
4 Tips to Manage Pelvic Organ Prolapse During Pregnancy
#1 Consult your provider.
I can’t stress this enough. A pro, like a pelvic floor physical therapist, can do a physical examination to diagnose and treat plenty of common pelvic floor issues, including pregnancy with existing prolapse! They can also give you key recommendations for how to keep those muscles in tip-top shape throughout your pregnancy and beyond.
#2 Use a support device.
Your pelvic floor PT might recommend some internal or external devices to give your pelvic organs the extra support they need. Often, pregnant people with POP benefit from the use of a pessary—a silicone device that sits inside the vagina to keep your organs in place.
Other devices that offer support for prolapse include:
#3 Exhale with exertion.
Pay attention to your breathing during everyday movement. For example, most people hold their breath when lifting, pushing, or working out, which increases pressure on the abdominal muscles and pelvic floor.
Instead, when exerting any effort, minimize that pressure by exhaling. Exhaling with exertion decreases the pressure on your pelvic floor and the risk of pelvic organ prolapse.
#3 Poop properly.
Straining while pooping can put serious pressure on your pelvic floor, which can worsen prolapse symptoms. I highly recommend the Squatty Potty to get your muscles in prime pooping position and decrease pressure on the pelvic floor muscles.
Another great way to have healthy #2’s is to avoid constipation. And while constipation is a pretty common pregnancy woe, there are things you can do to help! Try these tips to keep your bathroom trips running more smoothly:
- Eat a high-fiber diet, including veggies, fruits, and whole grains.
- Use the bathroom when you need to, rather than waiting or stalling.
- Stay on the toilet only as long as you need to.
- Choose a food-based prenatal vitamin to avoid constipation related to synthetic iron.
- Drink lots of water.
- Ask your doctor for a pregnancy-safe stool softener, fiber supplement, or magnesium recommendation.
And for those #1’s, don’t push your pee out. Just sit and let the flow of urine begin on its own.
5 Exercises for Pregnancy with Existing Prolapse
Any quick Dr. Google search might tell you that Kegels and other strengthening exercises are the way to fix a pelvic organ prolapse. But here’s the truth: In folks with POP, I see as much pelvic floor muscle overactivity as I do pelvic floor weakness. That means it’s equally important to work on relaxation as it is to work on strength.
#1 Diaphragmatic Breathing
Diaphragmatic breathing, or belly breathing, is unquestionably good for your pelvic floor and core. Often, though, we focus primarily on filling our lower belly as we inhale—which can put additional pressure on the pelvic floor and worsen symptoms of prolapse.
So when you practice belly breathing, think about expanding all the way around—not only into your low belly, but also into your ribcage and mid- and upper-back.
#2 Kegels in Quadruped
Kegels can be helpful for preparing your body for childbirth. In the case of POP, you’ll just want to practice them in a position that minimizes the pressure of your internal organs on your pelvic floor—namely, on your hands and knees. Beyond that, be sure you’re practicing Kegels correctly to get the most benefit from them.
#3 Modified Bridges
Bridges are good for your butt, and they’re gentle on your pelvic floor, even if you’re experiencing prolapse. When you’re pregnant, you’ll want to make one small modification: Practice with a pillow under your hips.
Lie on your back with your knees bent and your feet flat on the floor. Contract your pelvic floor muscles and lift your butt off the pillow until your hips are in line with your knees and shoulders. Hold for three seconds (exhale!), then gently lower down.
While you’re pregnant, limit lying on your back to 1 or 2 minutes. If you feel dizzy, lightheaded, or nauseous, turning onto your side will help relieve symptoms.
# 4 Puppy Dog Pose
As I mentioned, strengthening and relaxing are equally important for POP. This pose offers a nice deep stretch to help release pelvic floor tension.
Start on all fours, with your knees together. Gently walk your fingertips forward, while keeping your thighs vertical, and let your chest relax toward the floor. Lift your hips gently toward the ceiling. Relax in this position for 3-5 breaths.
Listen to your body! If this stretch feels uncomfortable, take a break.
#5 Take a load off.
I realize rest isn’t technically an exercise, but in the case of POP, it counts—because standing for long periods of time can increase discomfort. Especially as your pregnancy progresses, being on your feet puts more and more pressure on your pelvic floor muscles. So strike a good balance between activity and rest.
We’re here for you.
Feeling a little lost on your pregnancy journey? Check out my free resource “5 Myths We’ve Been Told About Pregnant Bodies” and get a quick look at what you can really expect while you’re expecting.
Sources and Further Reading
Iglesia, C. (2021, December). 5 things I wish all women knew about pelvic organ prolapse. ACOG. Retrieved from https://www.acog.org/womens-health/experts-and-stories/the-latest/5-things-i-wish-all-women-knew-about-pelvic-organ-prolapse
Mohamed-Suphan, N. and Ng, R. (2011, October) Uterine prolapse complicating pregnancy and labor: a case report and literature review. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22037938/
Vargas, B., et al. (2022, July) Management of pelvic organ prolapse during pregnancy: Case report Retrieved from https://pubmed.ncbi.nlm.nih.gov/35607457/
