POP Goes the Body
What Just Happened?
POP, pelvic organ prolapse, is a possibility for almost any woman who has just given birth. It can be a very scary event - you're fine and then, POP! Your inner organs (some or just one) begin falling out of your body. Your bladder, uterus, the vagina or the rectum can become subject to removal. However, knowing what is happening and why can make dealing with it a little bit easier.
The pelvic region has two exit points, the vulva and the rectum. When the internal spaces connected to these exit points come under the extreme stress of giving birth, muscles and tendons that hold everything together internally can become weakened. Since the support for the internal organs is weak and limited the prolapsed of one or more of these organs occurs.
The Work of the Muscles and Tendons
Each organ in the pelvic region has its own connective tissue that stabilizes it in the pelvic floor. All of the muscles and connective tissue in the area work together to create a stable and strong floor or box that exerts more pressure upward than the weight of the abdomen exerts downward (think: Atlas holding up the world). This system is not something we have to focus upon. The cooperation of muscle, tendon and bone to hold the organs in the body is just what the body does, without our mental involvement. The muscles remain in a contracted state, never fully relaxing, and hold things together.
Why POP Occurs
During the intense and extreme pressure of childbirth, sometimes the muscles are stretched beyond their capacity and they tear. There may be some nerve damage to the muscle control system which then causes the muscles to relax too much. The result is a movement of internal organs. The ligaments, which were never designed to hold the kind of weight now being exerted upon them, hold things together for a while but eventually they, too, will give way. A ligament that is stretched or broken by the effort of the baby's head coming through the canal compromises the muscle and the organ associated with it cannot be held in place any longer. The muscles hold the organs up against the pull of gravity and the ligaments keep them arranged in their proper places, keeping space between them. Weight, obesity and age are all contributors to pelvic organ prolapse. It can also be something that runs in families. A woman who has a family history of prolapse is at higher risk for it than a woman who has no history in her family.
How POP Presents - The Symptoms of POP
POP presents in a wide variety of ways. When a bladder begins to fall, it puts pressure on the front wall of the vagina. This is called a cystocele and is the most common of organ prolapses to occur in pregnancy. Since the organ can't fit through the urethra, which becomes blocked by the bladder, pressure from it pushing against the vaginal wall can be felt.
When the rectum falls against the back wall of the vagina (rectocele), a strange pressure in the back half of the body can be felt. The rectocele causes a blocking of bowel movement. A piece of the rectum may find its way out of the anal opening, which remains strong, or a small space may have opened between the vagina and rectal wall that allows a small piece of rectum to move into the space.
Now It's Really Getting Serious
Although all of these are very uncomfortable, it is more concerning when organs actually begin to appear outside of the body, as in a vaginal, rectal or uterine prolapse.
When a vaginal prolapse occurs, pieces of the vaginal wall can be seen or felt protruding from the birth canal. If the uterus has prolapsed, it is possible to see the actual cervix coming out. An anorectal propapse presents with a large lump of tissue protruding from the anus during or after a bowel movement. This tissue does not remain in place when pushed back in.
Regardless where the tissue is protruding from or where the pressure is felt, a prolapse requires the immediate care of a physician. There are different ways to treat POP, which we'll discuss in another article.
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