Delivery with prolapse and after

I know that my fans have been clamoring for an update, so sorry it took me so long to get around to it. (I am kidding, I can tell from my stats that I have one or two fans, and no one has been clamoring). Even so, I want this to be out there for other women to find.

Delivery with prolapse

Turns out there’s an upside to prolapse: my labor was only 2 hours, and I don’t recall making any effort to push. So I appreciate my midwives and gynecologist humoring me on the planning for another difficult delivery.

That said, you may find that when your uterus decides to let go, you don’t have time to find a good spot and lay down. The baby just comes. Call 911 as soon as you know you’re in trouble — they’ll walk you and your partner through it, using whatever you’ve got to hand. And if you’re lucky like me, emergency services will be there in 5 minutes.

(Also, she really was and still is beautiful.)

The aftermath

Sadly, the speedy birth doesn’t mean I got off scot free. I have added a rectocele to my prolapse collection, which means vagina collapses in on the rear side too, probably due to more detached muscles. That’s my rectum bulging in to meet my bladder now. Since my OB-GYN says my uterus hangs low too, I’m calling it a hat trick.

Six weeks without a pessary was rough, waiting for the stitches to heal. When I got in for an appointment around 10 weeks, they upgraded my pessary to the 3 inch rather than 2.5.

I was back in physical therapy by week 8, dealing with my back and beginning to work on my pelvic floor.

Luckily, as my muscles recovered (what’s left of them), I could switch back to the 2.5 for normal days and nights, keeping the three for tougher days (carrying kids, walking long distances, squatting or getting on the floor a lot, etc). I can run short distances if I don’t do it very often, but I don’t try jumping. The three inch periodically annoys one of the muscles in my pelvis, possibly the iliacus, but I’m not sure.

Incontinence is better, weirdly, urinary-wise. I hear this can happen due to a kink in the urethra, but at least I don’t have trouble urinating either. So I’ll call that a win.

Fecal is not awesome but could be worse. I did have many episodes very early on where I didn’t quite make it to the bathroom, but I was wearing a pad anyway. No point sweating the weeks after childbirth. Three years and a half years later, I’ve only had a couple of incidents while out of the house, but it wasn’t as hard to deal with as I’d feared. Find a bathroom, clean up and change the panty-liner. Hope to God no one notices how you smell before you find said bathroom.

Menstruation part 2

I put off menstruation as long as possible with breastfeeding, but when that came back, I found the cup no longer stayed in. I really hate disposable pads, from the feel to the noise they make, but it was a relief to just leave the pessary in. I stuck with the big one for my visits from Aunt Flo since the first days of menstruation make my pelvic floor feel achy and weak.

I switched to cloth pads and period underwear, which was very expensive up front, but they’re miles more comfortable. Plus less landfill waste. Washing is kind of a PITA though. Eventually I figured out that I could rinse them, spritz them with a stain-fighter, and wait up 24–48 hours to wash them. (That said, I don’t know if that affects the polyurethane lining long-term.)

How to swim on my period was a hard question. I bought period swimwear, which are probably fine if you’re either not going in the water — or are going straight in the water and getting dressed straight after leaving the water. The gynecologist said that two tampons at once might stay in, but that idea is not up my street.

However, the Thinx “quiz” introduced me to this idea of a menstrual disc, and I looked into it. They’ve got big diameters, like pessaries, so I thought it might stay in. First time swimming, I wore the disc alone. With my tissues flapping around as they do in the water, the disc did not maintain a seal — when I took it out, I found pool water mixed with a little blood. So, the next time, I tried putting in the smaller pessary after the disc. And that worked.

Also, a note about Thinx, two of my three pairs of underwear were defective. I’ve sewn up a leg, replaced a waistband, and left a slash in the inner fabric alone because it’s too high up to be a problem. They’re good paired with pads (they do not hold 2 tampons lol), but they’re too expensive to have these kinds of quality control issues within a year or two of wear.

Long term maintenance

Like most people, I don’t stick religiously to my physical therapy exercises after PT ends. Eventually, I got a bad cold that knocked me way off, loosening my pelvic floor further with all the coughing. I started wearing the big pessary full time. The coughing also damaged my ribs. Having to carry my child on one side for weeks while that rib healed destabilized my lower back. After six months of that, I went back to PT with a different therapist who taught me how to correct my lower back and begin strengthening.

A physical therapist is critical to identifying your particular problems and correcting misalignments. However, for strengthening, I have had the most success with an exercise DVD called Hab-It (also available as a download, which I might have done if I was starting now rather than 2015). The kegel pattern has produced the best gains in strength for me, and I especially like the way that the exercises build to an “advanced” set that only take 13 minutes.

During the pandemic, when I was suddenly at home a lot and up and down off the ground with the kids, I felt saggy a lot. Hab-It really helped me strengthen my muscles so that I could go back to the smaller pessary.

But I also tried doing the Hab-It exercises while my back was misaligned, before post-partum PT the second time around, and it was painful (I stopped, not wanting to damage my back further). I needed to see a PT in person to fix that first.

If you do have difficulty with your lower back, the glute squeezes are especially important. My second physical therapist joked that I have a lazy ass, not taking up its share of the burden supporting my lower back, and training my glutes to do that job has helped me stabilize my back and stay more comfortable on active days.

Surgery

After my second birth, which I intended to be my last child, I began to talk seriously about surgery with the OB-GYN, who specializes in my kind of pelvic floor dysfunction. I was a bit gutted when she said she’d recommend a hysterectomy, but I had a few years to get used to the idea. Silly, isn’t it, when I’d decided I was done having children? And yet somehow fundamental.

The surgery is done now, and I am recovering, which is why I have time to write. So fingers crossed I’ll post more about that before I get swept up in life’s current again.

Posts in this series:

Prologue
Is this normal?
Sometimes you won’t get better
Menstruation
Pregnant with prolapse
Birth plans and prevention
Delivery with prolapse and after