Almost seven years ago, I lay in bed with my snoozy newborn on my chest, and googled “why does it look like a little ball is coming out of my vagina?”. In the weeks prior, I’d been reassured by my midwife that the pelvic pressure I was experiencing was “quite normal” following a vaginal delivery. I was reminded of what a big deal it is for a baby to make its way out of a body, even in a “textbook labor” like mine. I was told that the area still had a lot of swelling, and that I simply needed to be patient as my body healed.
Spoiler: The problem wasn’t my patience but a society that’s historically de-prioritized and dismissed women’s health and maternal wellbeing.
I hadn’t minded being the last one of my newly postpartum friends to break the protective bubble of my quiet home. I’d actually loved the idea of a slow postpartum transition, inspired by cultures with traditional practices for nourishing and supporting the new mother and baby through the fourth trimester.
But at almost four weeks postpartum, the ache hadn’t subsided and I felt an entirely foreign vaginal bulging sensation any time I was on my feet. I finally began to question the reassurance I’d been given.
As a 2nd year doctoral student in clinical health psychology, I knew the risk of consulting doctor google. But what’s a newly postpartum mother supposed to do when her provider tells her, “Everything is fine!” and she knows it is not? (To be fair, I also searched google scholar ;)).
Over the weeks and months that followed, I learned that in the process of bringing our tiny perfect human into this world, I sustained a pelvic floor muscle injury (levator ani avulsion) and had developed pelvic organ prolapse. I’ve since learned that I am not alone, and there is so much I know now that I wish I knew then.
What is pelvic organ prolapse?
Pelvic organ prolapse is a condition in which one of the pelvic organs (bladder, rectum, or uterus) drops down from their “normal” position due to injured or weakened pelvic floor musculature and connective tissues. This can create a bulge near the vaginal opening. Many describe the sensation as like “a tampon falling out.” Other symptoms can also be things like pelvic pressure/heaviness worse with prolonged standing, urinary or fecal incontinence, splinting for bowel movements, aching low back pain. Despite rarely being discussed, postpartum prolapse is present in approximately 30% of postpartum people.
I was given the advice to permanently limit heavy lifting, “learn to love gentle walking”, and “come back for surgery when you’re done having babies”. As a former high-level athlete these words were devastating to me. I had imagined long hikes with my baby in a carrier and family bike-packing trips.
What I should have been told is that pelvic floor symptoms are multi-factorial and benefit from a whole-person approach (i.e., not just kegels or immediate referral for surgery). For some, this could look like addressing tension, practicing diaphragmatic breathing, and un-learning societally-conditioned patterns of holding in one’s belly. For others, symptoms will benefit from dietary changes such as increased fiber and water intake to reduce constipation. This complexity can feel overwhelming at times but it also means we have so many potential tools to use. If one approach doesn’t work well, we still have so many options.
Instead, my prolapse diagnosis and the way it was framed (by both social media and the majority of the providers I saw) completely destabilized my sense of self and my vision for my future.
I had felt well-prepared for sleep deprivation, adjusted rhythms, and loss of freedom over my schedule. I was not prepared for a muscle torn from bone or a bladder trying to escape.
I remember sitting on the floor late one night as my daughter slept in her bassinet beside me, poring through the multitude of pregnancy and childbirth books I’d collected, with tears streaming down my face. “Did I just miss this?” I wondered, “How did I miss this? My whole life is changed by something I didn’t even realize was possible.” In fact, I did not miss it. In fact, it was not included in any of my pregnancy books or childbirth class or even the pelvic floor prep workshop I’d attended.
I felt blindsided, broken, and betrayed.
I allowed those feelings to fuel action, and I began to push back against the societal stigma surrounding birth-related pelvic floor injuries and conditions. I decided not to keep it a secret, just like I hadn’t ever felt the need to keep my bike racing injuries a secret. I refused to inadvertently perpetuate – through my own shame-induced silence – the idea that our job as women and mothers is to quietly accept the impact of under-addressed and underfunded health issues.
The discussions that followed, with both providers and postpartum people, confirmed that the physical, mental, and social aspects of birth-related pelvic floor injuries are a significant unmet need.
I am not grateful for my birth injury, but I am grateful for the fact that I was well-positioned as a clinical psychology doctoral student to be a part of the solution. Now, seven years later, I’m a licensed clinical psychologist and postdoctoral research fellow. I’m currently leading a 6-session education and coping skills group for individuals with postpartum pelvic floor concerns, and hope to make this resource more widely available in the future.
I wish I could go back in time and deliver the information I have now to that devastated version of myself… that new mother fumbling through the tender transition of matrescence (the transition to motherhood) with the added weight of pelvic floor symptoms, diagnostic uncertainty, physical activity restrictions (largely non-evidence-based), and medical gaslighting.
But in lieu of a time machine, helping others feel less alone and broken than I did will have to do. Here are a few things I wish I had known when I was there myself.
The narratives surrounding prolapse can often fall into unhelpful extremes. You might hear either “this is normal, keep living your life!” or “don’t ever run or lift heavy or you’ll make things worse!” These mixed messages may bring a sense of confusion and fear, and can make it difficult to navigate what you can and cannot do. One of the most helpful things I learned was that the off-limits physical activity list is shorter than we may have been led to believe. It’s not so much what but how. This helped me combat fear of movement, embrace a “lets try” mentality, and ultimately rebuild strength, athleticism, and trust in my body.
Our symptoms are real, but our brains matter too. We can learn strategies to help our brains work for us. These tools can include mindfulness-based practices to begin to re-orient our relationship with physical symptoms, relaxation skills to reduce tension and help our systems feel safe and supported, cognitive behavioral techniques to recognize and challenge unhelpful thought traps, and behavioral strategies to flexibly increase engagement in valued activities even with symptoms in the background. Over time, even frustratingly persistent symptoms can start to be experienced as sensory signals in the background versus an urgent message of danger or imminent worsening.
Pessaries can improve quality of life. A pessary is an internal silicone prosthetic device inserted vaginally to provide additional pelvic support. There are also pessary options specifically designed to help with stress urinary incontinence (urine leakage due to running, sneezing, etc.) They can be a tool that gives a lot of freedom. It doesn’t need to be seen as a source of embarrassment or shame. Think of it like eye glasses or supportive knee braces. A pessary can help people live more fully with less discomfort.
Unfortunately, many people struggle longer than necessary because of misconceptions and stigma around pessaries. I’ve encountered a lot of myths, so here are some important reminders:
- Pessaries can be helpful for all stages of prolapse, not just severe prolapse.
- Pessaries are for people of all ages.
- Pessary insertion and removal typically gets easier with practice and can be self-managed at home.
- Pessaries do not automatically compromise one’s ability to be intimate and can actually enhance it. I don’t know about you all, but I have a much stronger desire to be intimate with my partner when I’m able to engage in mood-boosting, value-aligned activities with fewer prolapse symptoms in the background.
Many need to try several different shapes and sizes to find the optimal fit, so please don’t give up after the first try if you haven’t found an option that provides comfortable support. There are also a number of external support garments that many find to be useful.
You are not alone and resources exist!
- Pelvic floor physical therapy is a great place to start, but provider shortages and long waitlists and lack of insurance coverage are real barriers so there are also other options.
- Bimonthly community group through my Substack for people managing postpartum pelvic floor injuries and conditions, including prolapse.
- Online prolapse course by Margo Kwiatkowsky, a physical therapist and mother of two who experienced prolapse herself. It covers education and rehab/activity progression guidance.
- Follow trustworthy voices in this space such as Julie Wiebe, Carrie Pagliano, and Rebecca Maidansky.
- Before you return to activity post-partum, check out these resources.
I hope some of this was helpful, and please feel free to reach out if you’d like to connect! In addition to my Substack, you can find me on Instagram at @wildmatrescence or email me at [email protected]
