Pelvic Organ Prolapse (POP) Community
Questions for my Wife
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Questions for my Wife

Hi,

I'm writing on behalf of my wife. She gave birth to our beautiful daughter about 11 weeks ago. Unfortunately it was a forceps delivery. She's suffered several complications ranging from severe hemorrhoids to a third degree perineal tear.

But the injury that has us the most worried is her grade 2 bladder prolapse. My wife was in terrible pain up until recently. She's now able to sit up for longer periods of time and the pain is going away. She still has pain and discomfort in the area of her vagina -- especially when she walks. But she's only had a few occurrences of mild urine incontinence, and she's doing kegel exercises under the direction of a physical therapist. Our concerns are whether her bladder prolapse will ever fully recover. Is it possible for her to get back to "grade 0" bladder prolapse, meaning no prolapse? We're also very concerned about future pregnancies. We'd like to have one or two more children, but we're very worried that even if we opt for a c-section that the prolapse will become worse during the pregnancy. So our questions are whether she can completely recover and if it's possible to have more children without causing further bladder prolapse.

My wife is 28 yrs old and hasn't had any major health problems before. This was her first pregnancy. It seems very difficult to find solid, reliable information on postpartum bladder prolapse, so I would appreciate your input as well as any suggestions for what books or resources to study.
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Sorry, how do I erase this? I was trying to post in the "Ask a Doctor" forum.
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I can have administration remove your post if you like, I'll answer your questions to the best of my ability and if you still want the post removed, let me know and I can get word to admin to take it off.

First of all, know that your wife is not alone with sustaining damage to her pelvic floor after forceps delivery; unfortunately this type of delivery can damage surrounding tissues. I'm so glad to hear she is under the guidance of a PT, I am hopeful that the PT is certified in WCS or CAPP, these are women's pelvic floor specialists. Doing Kegels properly will be of great benefit to your wife; they will help  her regain strength in her pc muscle as well as bring blood to the pelvic floor area which will help it heal faster. Doing them properly is important, your wife should be varying sustained and pulsing contractions. It is important to recognize that the tissues need to heal b/4 she can regain pelvic floor health again and that takes time when much damage is done. Another path to investigate is myofascial release therapy; often women who have scar tissue from this type of damage are not able to contract their pc muscle completely because fascial restrictions limit range of contraction. A certified MFR therapist can assist release of these restrictions. Some PTs utilize this type of therapy.

As she continues her Kegel exercises, the incontinence should go away; Kegels are a path that she should plan on adding to her daily maintenance for life just like brushing her teeth. Doing them while on the computer or when stopping at stop signs and lights will enable her to maintain her pelvic floor health; after doing them for a while in one of these patterns it will become habit.

More good news is that by doing Kegels on a regular basis, it helps the pc maintain an "elastic" property which assists the delivery process; that will be of benefit for future deliveries. A C-section is not the answer, every time you cut into the pelvic cavity, you increase risk of scar tissue and weaken abdominal muscle structure which supports the pelvic cavity from the outside. Having a strong abdominal muscle core on the outside and a strong pc muscle on the inside is the best direction women can aim for.

Being aware of the signs and symptoms of POP (there are 5 types, a cystocele-bladder prolapse-is just one of them) is a great step to assist women in recognition of this extremely common, cryptic health issue. I am so happy to hear that your wife is taking a proactive approach and you are on board to help her in any way you can.

Sher

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