"What does prolapse look like?" and other prolapse Q's

I received the following questions — both related to prolapse — within a few days of one another.

The first question is from H.J.:

"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?"

My response:

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.

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 for the United States. 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.

How to check yourself for prolapse:

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, and have a handheld mirror handy. 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 DO NOT see a significant bulge, but you still think that something feels “off,” or if it looks like something is “out of place,” then gently bear down. You can also 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 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.

What does prolapse look like?

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, see Reference below) applies to prolapsed bladders since this is the most common type of prolapse.

Prolapsed bladders (cystoceles) are separated into four grades. The grades are based on how much the bladder presses into the front vaginal wall. Please note that a prolapsed bladder does not actually protrude through the vaginal wall, it simply presses into it, which is what causes the protrusion or “bulge.”

• 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; often associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele). 

The second question is from J.M.:

"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?"

My response:

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!

If you'd like to learn more about pessaries, here is a blog post with additional information.

I like to think of pessaries as a "sports bra for the vagina." Just like sports bras, pessaries provide lift and support!

It's a great idea for your mother-in-law to exercise while wearing a pessary so that she can strengthen her muscles while her organs are being supported. Consider the following starter exercises:

• Try my beginner core workout and corkscrew kegels to "wake up" her core muscles

• Encourage her to sign up to get the first week of “Lift,” my pelvic support series, for free. It’s a wonderful program that has helped thousands of women reduce — or even reverse — their symptoms of prolapse.

Lastly, know that there are many MYTHS surrounding prolapse! Here’s a look at the top three:

When it comes to prolapse, just know that there is hope, and there is help!

Making positive lifestyle changes and learning some basic pelvic floor and core exercises can help women OF ANY AGE live a more active, less symptomatic life. And even if surgery is required at some point in the future, going into it STRONG and armed with knowledge will make the outcomes much more successful.

If you’re interested in Lift, my at-home program for prolapse, click here to learn more.

Want a sample? Get the first week for free right here!

Reference:

1. Prolapsed Bladder, WebMD. Retrieved from http://www.webmd.com/women/guide/prolapsed-bladder. Last accessed Feb 3, 2021.

*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.