If you have pelvic organ prolapse and you’re wanting to expand your family, the thought of getting pregnant and giving birth can feel very daunting.
There is little research on pregnancy following a prolapse diagnosis. However, limited literature suggests that it is the first birth that causes the damage versus subsequent births.
This study looked at the difference between women giving birth vaginally once versus twice+. It aimed to assess levator ani injury and anal sphincter tears. It’s worth a read.
Research aside, a worsening of prolapse symptoms may (but not always) be experienced during the first trimester. The worsening of prolapse symptoms during pregnancy could be down to a number of factors (outside of your prolapse!):
- Morning sickness creates a sudden and uncontrollable change in intra-abdominal pressure. This can fatigue your pelvic floor (morning sickness also makes you feel rubbish!)
- Tiredness and lack of motivation for your usual pelvic floor related activities. This might include pelvic floor strengthening exercises or management techniques for prolapse symptoms so try and carve out a little time to continue these.
- Stress and anxiety around pregnancy and the future. Particularly if there has been a previous miscarriage(s), conception has taken a long time or the pregnancy is a result of IVF.
- Progesterone can cause constipation which can put additional pressure on the pelvic floor. You may notice you are having to strain on the toilet so some extra care around bowel habits can be useful.
It’s also worth noting that an increase in your prolapse symptoms may also depend on how symptomatic you were prior to pregnancy and if you are prone to flare ups around hormonal shifts, tiredness, stress and activity levels.
The second trimester often offers some relief from general pregnancy symptoms (and prolapse symptoms, particularly if asymptomatic pre-pregnancy). There is often less morning sickness or nausea and the reassurance of a 12-week dating scan and 20-week anomaly scan to help ease anxiety that the pregnancy is viable.
As the baby grows, there is the potential for interrupted coordination and lengthening of the core and pelvic floor muscles. You may find it harder to use your pelvic floor and core muscles to support everyday tasks such as lifting other children or exercise. Including some pelvic floor specific work can be helpful here!
Anxiety around birthing, labour and recovery may also lead to increased symptoms or a focus on (old or previous) prolapse symptoms. However, each pregnancy and birth is different and prolapse doesn’t need to stop you from having another baby.
Navigating prolapse during pregnancy can also influence how you want to birth your baby, particularly if you feel how you birthed was a factor in developing prolapse (eg assisted birth or episiotomy). An open and honest discussions with your partner, midwife and care team are super important – they are all here to support you and your voice matters!
In my experience of working with clients pre, during and post pregnancy, whilst symptoms may come (and go) in pregnancy, many birthing people go on to have a quicker and more effective recovery because they are better equipped with knowledge and support and how to manage prolapse symptoms.
Here are some of my top tips for prolapse symptoms in pregnancy
- Arrange to see your pelvic floor physiotherapist or chat through some areas for you to focus on during pregnancy
- Keep moving, even if gentler than pre-pregnancy; movement is awesome for the body as well as the mind
- If you have been asymptomatic prior to pregnancy, revisit what worked for you – self care is often huge as are toileting habits, relaxation, time for reflection, good nutrition & hydration
- Know that if symptoms are present, they may not be here forever and do not determine the grade of your prolapse
- Consider your birthing options and be open with your birth partner, midwife and care team early on about your fears (and also your hopes)
If you are pregnant and navigation pelvic organ prolapse, please have a look at the Positive POP Framework for exercise and pelvic organ prolapse. You can find it here
Oher useful studies: