FEBRUARY 2016 UPDATE: I recently came across a fantastic visual aid for those of you who are wondering what prolapse looks like! Before reading on, CLICK HERE. Check out the images and videos, and then come back to my blog to read my post. Kudos to ACOG for putting together such a great visual aid. Remember, click here to take a look and then come on back!
I received the following questions — both related to prolapse — within a few days of one another. The first is from H.J. She writes:
“When I was reading your book, something stuck with me. When you described your mild pelvic organ prolapse, you said that you grabbed a hand-held mirror and to your dismay you realized that you had it. I’m worried because I had a rough labor with my daughter who is now four. She was actually born with forceps. It was so painful and I could feel the tearing. I’m worried that it messed everything up “down there!” But I’m confused. Maybe it’s naive of me but I went to look at my lady bits with a hand held mirror and I had no idea what I was supposed to be looking for… Can you help? What does prolapse look like?”
If you do a search for pelvic organ prolapse images on google, you’re going to be shocked. Most images that pop up portray extremely ADVANCED prolapse; prolapse that requires surgical intervention. Images that portray mild to moderate prolapse are harder to find, although you can click here for simple and clear illustrations of grades 1-3 cystocele (bladder prolapse).
If you think you might have prolapse, then schedule a consultation with your gynecologist or with a women’s health physical therapist. Here’s a link to a women’s health PT locator to help you find a provider in your area. These practitioners can give you a solid diagnosis and direct you to the next best steps. However, IT’S REALLY IMPORTANT TO KNOW YOUR OWN BODY, so I definitely encourage you to check yourself, first.
Wash your hands. Sit comfortably on a toilet, or on the floor with your hips and knees bent. Make sure you’re in a well-lit room, or grab a flashlight. Gently part your labia (the outer and inner “lips” of your vulva) and use a handheld mirror to look inside the vaginal canal. Do you see anything? If you see a “bulge” that protrudes to the level of — or outside of — the vaginal entrance, then you probably have pelvic organ prolapse (which could be a prolapsed bladder, uterus, vaginal vault, or rectum). Make an appointment with your healthcare provider for further evaluation.
If you DON’T see a significant bulge, then gently bear down. You can try coughing (without contracting your pelvic floor first) and see what happens. If gently bearing down and/or coughing produces a bulge, then you might have mild-moderate pelvic organ prolapse. Finish by checking the same things standing up. After all, we live our life in upright positions… Not lying down on an examination table! It’s important to check for prolapse in functional positions such as sitting and standing.
As for specifics about what prolapse looks like, please note that for all women there will be “texture” on the inside of the vaginal canal. You should note wrinkled or “ridged” looking reddish-pinkish tissues (this is called vaginal rugae). This is okay and totally normal! It’s also normal to feel/see your vaginal wall descend SLIGHTLY when and if you experiment with bearing down or coughing. However, it is NOT normal to see a golf ball-like bulge that goes to the level of — or protrudes out of — your vaginal opening.
Real quick… Wondering about “grades” of prolapse? The following (italicized text) is reproduced from WebMD:
Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina.
- Grade 1 (mild): Only a small portion of the bladder droops into the vagina.
- Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.
- Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
- Grade 4 (complete): The entire bladder protrudes completely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele). (See Reference 1)
The second question is from J.M. She writes:
“My mother-in-law has a prolapse and her doctor gave her a device a lot like a diaphragm, but no exercises! Do you have any recommendations for her?”
It’s great to hear that your mother-in-law was prescribed a PESSARY (the diaphragm-like device that essentially keeps the prolapsed organ in its rightful place), but it’s a bummer that she wasn’t also provided exercises!
In my book, I address prolapse specifically, and the “inner core energizer” exercise routine (in the book) would be perfect for her to do while using/wearing her pessary since it strengthens ALL of the core muscles.
In the meantime, please have your mother-in-law do the following:
- Take a look at this blog post (click here) to learn more about prolapse
- Have her do some bridge exercises and corkscrew kegels to “wake up” her core muscles
- Encourage her to watch the 30-minute interview linked in the picture below. In this interview, I discuss prolapse and how we really need to talk about it and take it “out of the shadows” as far as something women understand and seek help for!
1. Prolapsed Bladder, WebMD. Retrieved from http://www.webmd.com/women/guide/prolapsed-bladder. Last accessed May 7, 2015.
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*NOTE: This website in general, and this article specifically, is for general information and educational purposes only. It is not intended to diagnose or treat any medical condition, but rather to understand what options are available. Please seek the advice of a physician to properly diagnose your symptoms.