How Prolapses Can Effect Your Mental Health

As some of you may know June is Pelvic Organ Prolapse (POP) awareness month, so we thought it would be a good idea to highlight how prolapse and mental health are linked as not many people are aware. Statistics from Women's Health matters show that 68% of women who have been diagnosed with POP have also been diagnosed with anxiety and 64% with depression.

The lack of support that women are offered when it comes to pelvic prolapse often contributes to their anxiety, a decrease in self-esteem, vulnerability and even self-loathing as well as feelings of depression.

Did you know that if a woman suffers bladder leaks after childbirth that her chances of developing postnatal depression go up by 50%? Not acceptable when if provided with the education needed many women could avoid POP.

Pelvic organ prolapse is common affecting a staggering 50% of women. Some women will be unaware of this until the prolapse is noticeable and or incontinence happens or via an internal exam.

Mild pelvic organ prolapse often causes no symptoms and does not always require treatment. Although prolapses are not life-threatening they can cause a great amount of pain and discomfort both physically and mentally.

What is Pelvic Organ Prolapse?

A prolapse occurs when the pelvic floor muscles are weakened and the pelvic organs can bulge (prolapse) from their natural position into the vagina. Sometimes the prolapse can be so severe that it can protrude from the vagina.

Pregnancy and childbirth place a lot of stress on the pelvic floor. Women are at increased risk if their baby was large, they had an assisted birth (forceps/ventouse) or their labour was prolonged.

Straining on the toilet (IBS for example) can cause weakness and overstretch
Previous hysterectomy (the top of the vagina is supported by ligaments and muscles. If these supports weaken, a vault prolapse may occur)
Chronic coughing
Heavy lifting causes an increase in pressure on your abdomen resulting in pressure on your pelvic floor muscles
High impact exercise
Age
Obesity
Family history of prolapse
More common particularly after the menopause as the hormone oestrogen is significantly reduced if HRT (Hormone replacement therapy) is not used

The 4 Main Types of Prolapse:

1. Anterior vaginal prolapse (cystocele) The bladder bulging into the front wall of the vagina. A dropped or prolapsed bladder occurs when the bladder bulges into the vaginal space. It results when the muscles and tissues that support the bladder are weakened.

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2. The womb bulging or hanging down into the vagina (uterine prolapse)

When the uterus hangs down into the vagina, eventually, the uterus may protrude outside the body. This is called a procidentia or third-degree prolapse.

3. The top of the vagina (vault) sagging down (vault prolapse)

This happens to some women after they have had surgery to remove their wombs.

4. The bowel bulging forward into the back wall of the vagina (Rectocele posterior vaginal prolapse)

A rectocele is not the same thing as rectal prolapse. A rectocele is when the tissues between the rectum and the vagina weaken, causing the rectum to bulge into the vagina. In severe cases, protrudes out of the vaginal opening.

Rectal prolapse is a protrusion or prolapse of the rectum through the anal opening.

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Grades Of Pelvic Organ Prolapse

Classified on a scale of 1 to 4 to show how severe it is, with 4 being a severe prolapse.

0 being no prolapse.

Grade 1 being halfway to the hymen

Grade 2 being to the hymen

Grade 3 being halfway past the hymen

Grade 4 is maximum decent

As all seen in the image below from (www.ncbi.nlm.nih.gov)

Grade 1

Grade one is considered a mild prolapse. Being where the bladder only slightly shifts from its original position. With a grade one, it is possible to reverse the prolapse symptoms by doing pelvic muscle exercises.

Grade 2

Grade two vaginal prolapse is where the uterus or vaginal walls have dropped further into the vagina and the bulge can be seen at the vaginal opening. Grade two symptoms can also be reduced through supervised pelvic floor physical therapy significantly, enough so that they can avoid surgery.

Grade 3

Grade three vaginal prolapse is where most of the uterus or vaginal wall has fallen through the vaginal opening. Grade three of vaginal prolapse symptoms can also be reversed and more often than not it can still be done without the need for surgery. Grade three can still be treated with a supervised pelvic floor exercise routine.

Grade 4

Grade four of vaginal prolapse is where the uterus is completely out of the vagina. This only really occurs after childbirth or gynaecological cancer treatment. That does not mean it will always occur for everyone after childbirth or gynaecological cancer treatment. They are just the main course of grade 4. Grade four vaginal prolapse symptoms can also be treated, however, this is often done with surgery. Pelvic floor exercises can be tried but are not guarantee results.

Symptoms And Causes Of Pelvic Prolapse

Some of the causes of pelvic prolapse have been covered above but here we will look into them in further detail.

Some symptoms of Pelvic Prolapse are:

Having a feeling of heaviness around your lower tummy and genitals
A dragging discomfort inside of your vagina
Felling as if there is something coming down into your vagina
Feeling or seeing a bulge or lump in or coming out of your vagina
Discomfort or numbness during sex
Problems peeing - feeling like your bladder is not emptying fully and constantly needing to go to the toilet. Even leaking a small amount when coughing or sneezing

If you suffer from pelvic prolapse you may not suffer from all of these symptoms and the symptoms will not be the same for everyone. Sometimes pelvic floor prolapse can show no symptoms and can only be found via a cervical screening.

Some causes of Pelvic Prolapse are:

Pregnancy and childbirth - especially if you had a long, difficult birth or if you have given birth to a large baby
Getting older or going through the menopause
Being overweight
Having long-term constipation or a long-term health condition that causes severe coughing or straining
Having a hysterectomy
A job that requires heavy lifting

Health conditions that could also cause pelvic prolapse are:

Joint hypermobility syndrome
Marfan syndrome
Ehlers-Danlos syndrome

Again pelvic floor prolapse does not only happen to those with any of the above causes and can happen to any person. The above cause is just what leads to someone being more prone to pelvic floor prolapse.

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How common is pelvic organ prolapse after childbirth?

The surge of hormones in your body due to giving birth leads to your pelvic tissue becoming soft and more pliable. As your baby gains weight throughout pregnancy and to prepare for birth your pelvic muscles work harder to support the weight. This strain along with the stretching and pushing of childbirth can cause the pelvic floor to weaken.

According to studies from (www.drjohnmacey.com) 35% of women who have recently given birth suffer symptoms of pelvic floor prolapse. While prolapse is more common for those who have given birth that does not mean it is destined to happen.

Can You Get Pregnant With A Prolapsed Uterus?

Uterine prolapse is a common gynaecologic condition that is rare during or before pregnancy. Uterine prolapse deliveries are estimated to be about 1 in 10,000 to 15,000 deliveries.

While falling pregnant and carrying a child is not impossible or unheard of with a prolapsed uterus it is rare and will require extra monitoring during the pregnancy as well as a c-section to ensure a safe delivery for both the mother and child.

Mental Health Effects Of Prolapse

Although prolapses are treatable they can be mentally debilitating as well. We talk about the effects mental exhaustion can have on us in our previous blog. (Mental Exhaustion)

Pelvic floor prolapse and incontinence issues can take a huge toll on your mental health impacting a lot more than others may realise. Firstly there is the sex side. Pelvic floor prolapse can lead to sex being uncomfortable and sometimes the thought of the discomfort may lead to heightened anxiety

The embarrassment and associated anxiety that you may feel out in public if you leak unexpectedly. The overwhelming feeling of dread may even lead to you not wanting to leave your house when not needed. Not wanting to take part in events with friends as they may not understand the discomfort and anxiety you feel in fear of bladder leaks. Therefore, you end up isolating yourself to save the embarrassment. Exercise is also an issue. Many women give up exercise because of bladder leaks.

This is why it is so important that women are educated from a young age on their pelvic floor, why it is so important and how to do Kegels correctly.

Opening up the conversations helps to break down the taboos and will encourage more women to seek the help and support that they deserve. Again, with education, many women can help to avoid prolapses.

So, if you do have bladder leaks and feel you may have a prolapse please don’t ignore it. The earlier you start to treat it the better the outcome. For most women, pelvic floor therapy and Kegels can make a massive difference.