POP, PP vulva, and prostrating on the ground

Welcome CB!

It’s great to have you here. Congratulations on the birth of your baby and I’m sure we can answer your questions.

Yes, prolapse often recedes higher in the vagina when lying down. Stress urinary incontinence is often a first symptom of prolapse. The angle of the urethra changes so that it doesn’t close down against internal pressures as well as when you were younger. The bladder neck is designed to kink like a garden hose when under pressure from above. When its normally sharp angle straightens out a bit as the bladder begins to fall back, that passive sphincter protection is compromised. The good news is, when the bladder falls back even more, it kinks the “hose” off in the opposite direction and your SUI will disappear. You may then have to manage a slightly bigger bulge in the front wall...like most of us. However, the goal of the WW work is to minimize all these symptoms. The hard lump on the back wall is poop. Your rectovaginal fascia is thinned from the births and now you can feel digitally what has always been there. Not to worry.

The bumpy bulge is your vaginal wall - the “rugae” are what make it stretch like an accordion. The vaginal walls do secrete fluid, but frankly I don’t know if it can be seen with the naked eye. It may be your urethra behind that mound or a bit of your bladder. The bladder is soft...since you check your cervix daily, I assume you know its position and what it feels like - hard and muscular. I’m guessing you are feeling the back of your pubic bone, which is right there.

Impossible to tell about the posture without seeing you. But I’m going to take a wild guess that you are pulling into it correctly. Let the posture go when you’re in difficult situations that require you to bend at the waist or whatever. As soon as you’re through, pull back into it. We are very flexible creatures and don’t have to maintain this posture 24/7.

If your mother is prostrating like the man in the photo, she is doing a WW exercise! Her organs have fallen into the hollow of her lower belly and are completely protected. If she can widen her legs and let her belly fall in between them it will be more comfortable and conducive to pelvic organ support. Help her learn how to keep WW posture as she comes onto her feet, but be mindful that an older, deformed (sorry, but I use that word with kindness) skeleton needs slow, careful and gentle work to begin to mould it back into a more natural shape. I think a little WW awareness and a lot of reassurance that her symptoms will probably stabilize will probably help your mom immensely. And I have no doubt you will be just fine.

Wishing you well,

Christine

Well, the urethra is actually the tube that urine moves through. The urethral opening to the outside is the pee hole. The urethra can sag down into that front vaginal wall bulge.

Yes...little does Louise know how much Mother-love she has given me as well. We are so very blessed to have her kind and gentle influence.

I felt unsettled last night after I wrote to you, but needed to go to sleep and could not write more. The way I understand it, your mom is bending over with a hunched spine. This straightens out the lumbar curve and causes her to pull her stomach in rather than letting it fall toward the ground, reversing pelvic organ support.

I made it sound easy to let her belly fall and start to make the correction, but in fact, she probably will not be able to un-hunch her spine and allow her lower (lumbar) spine to curve because it is frozen into that shape. She can either continue moving into this increasing deformity, or begin to work slowly and carefully to reverse it. How much reversal she will see I cannot know, but from my perspective it is always better to try to work with what we have.

Christine

Just passing on something to you from my own experience ( am NOT an expert)...I could not have gotten into the prayer position a month ago. I found out through the women here that I needed to seriously get my bowels moving - and that that was what had been preventing my u from going all the way back into place. I felt awful in the position for the exercises, sitting on my feet, etc. Awful. But soon as I started making sure my bowels were voided ( I had no clue I was constipated, as I'd been going what I thought was quite often. Someone, well a few people here, pointed out if both your bladder AND rectum are full (but I had no idea), then your organ might not be ABLE to go back in place. So I started drinking LESS (I had been drinking a lot) and voiding - and poof after swimming and avoiding clothes AT ALL tight - my u went back into place and I feel GREAT). Maybe something in that rings a bell for you or your mom.

Hi Chckaboom

After watching some YouTube vids I can see that there are so many moves prescribed precisely for during prayer. Like many things in this branch of religion much of the tradition of rituals is kept by the men. If a particular ritual does not work smoothly for a woman's body, or if it could worsen a woman's medical condition I doubt that men would really understand that. However, in all the video footage I watched there was always a statement that if you have a medical condition that makes it impossible to do the movement as instructed, that the person should just do their best, as close as they can. I will leave it at that.

I do agree that most of the movements look to be supportive of a woman's body structures, except for keeping the legs and feet close together during prostration, which would compress the belly. It would be more helpful to allow the belly to fall between the thighs. This would also prevent the woman from using her belly as a fulcrum when rising, which would otherwise compress it further. It is important to use the muscles in the hips and pelvis to rise. It might also be possible to use the assistance of the arms.

It is interesting the way an older woman's upper back tends to stoop and her shoulders become more round. An attitude of humility, or stress or sadness also makes these things happen. We close our bodies up, rather than leaving them open and proud. The actress Bette Midler once said, "Old age is for sissies." I think there is a lot of truth in it. The whole world seems to be stacked against older people. No wonder they stoop! No, seriously, muscle bulk does decrease the less we use it. An active woman will stoop less than an invalid. Muscle holds our skeleton up. If there is less muscle, we have to droop like a flower in a vase with little water. Since my mother has become less active, and now only walks short distances, and has carers to look after her she is much more physically comfortable, but I have noticed that she has become more stooped in the last five years. She is now 99 years old.

The moral of the story is to stay as active as possible for as long as possible. Exercise our muscles, and keep our joints happy so we can use our muscles to maintain our insides.

Louise

and then I went and tried it. I think it's probably a great position. I can't comment long- I must get some cleaning done while my dh is willing to help out- but when I did this position I followed the instructions. I put my hands on my knees- fingers spread out wide and grasped my knees. I kept my arms straight. I kept my spine in line from the top of my head down to my tailbone.
I did indeed have a strong lumbar curve! My belly (postpartum belly) hung loosely and I could sense my uterus there in that space.
Here's something she might try: right before getting in this position either A. do the Louise 'jiggle' or B. do downward dog. This will encourage her uterus to pull forward and bring the cervix higher- then immediately get into prayer position.
Ok- gotta go- good luck!

Just a reassuring thought Chikaboom,

Form what I have learned, prolapse almost never causes incontinence. This was what I was scared of when I first thought I had it, because everything I found on the net or from my PT was so vague and linked everything 'down there' together. I think I have had mild prolapse for ten years and I have never had a hint of incontinence. Nor has my mother, who had six large babies the natural way and is now in her eighties. She doesn't think she had prolapse either, but what I think is that for many women the symptoms are so mild that they never bother you and you never get a diagnosis. Your mother sounds pretty cool even talking about it as many older women seem to feel that ignorance is bliss about gynae conditions

It's odd the way many women here seem to have pestered their doctors for a diagnosis, after being told that they were fairly normal for women who have had children. I suspect that most women who have had children have a degree of prolpase and that they're not aware of it. From all I've learned since I found this site and Christine's research, it only really gets to be a problem after serious childbirth trauma, years of bad lifestyle or surgical intervention. The medical websites and many doctors all say that it's usually progressive, but I'm convinced that that's because they haven't seen many women who've been doing this work for long. After ten short months my prolapse has progressed: it's improved. Many women who have been here longer or are pretty young have had major reversal. I'm convinced that we can all stabilize it, if we give our bodies a chance to behave as they are designed to.

Try not to be afraid - it's not catching and it's controllable.

Doubtful

I need to have a think on this one.

Bladder prolapse (aka cystocele) is simply that your bladder has moved backwards and probably rolled backwards as well, onto the top of the vagina. There are several other things happening.

If the woman uses zip and tuck posture her pelvic floor will be horizontal, and there will be a backwards slope to her pubic bones which makes it easy for the bladder to slide/roll backwards.

She may have damage to the pelvic floor muscles which means that they are no longer able to stabililse the contents of the pelvic cavity against the lower abdominal wall.

The fascia between the bladder and the anterior vaginal wall has broken down sufficiently that the bladder is no longer stabilised by the anterior vaginal wall, and will make it bulge backwards, which is the soft lump we feel impinging into the front of the vagina.

The pelvic floor muscles can become weaker for several reasons. Sedentary lifestyle means that they don't get a good workout with everyday activity, and particularly walking. The constant downward weight of pelvic organs in the wrong posture keeps them stretched, so they never get the chance to contract, and maintain their tone.

Insufficient recreational use of pelvic floor muscles could be a factor too. Some women don't want to know what goes on below the waist. Perhaps they think it is none of their business, that only a doctor or their husband should be interested in that part of them. Wha?

I believe that selective strengthening of the abdominal muscles can exacerbate this because it pulls the pubis symphysis upwards towards the chest and flattens the abdomen. If the front of the abdomen is really taut, then intraabdominal pressure is going to be reflected downwards and blow out the pelvic floor. You artificially strengthen your abdominal muscles, without artificially working on your pelvic floor, at your own peril!

Undoubtedly childbirth plays a major role in loosening a woman's insides. When you see what happens during stage 2 of labour a bladder that is well tethered to the anterior vaginal wall may become stretched along with the vagina. This will include the fascial supports of the urethra. It is legend that a woman who has given birth, or probably even had a full pregnancy, will have a larger diameter urethra afterwards. My commonsense tells me that a larger diameter urethra will not close as effectively as a small one. Postpartum reversion will take care of a lot of this stretching, but it can take some time to revert, and it may not revert completely.

There is stress incontinence, when the urethra is unable to stay closed during intraabdominal pressure changes. This may be because it is bigger overall, or that the top of it, where it enters the bladder, has become a cone, rather than a hole, so urine is forced down the urethra. When the bladder rolls backwards as a part of POP, the top of the urethra ends up at the front of the bladder, kinked down hard against its side. In addition to this, her bladder will be lying on top of it, flattening it. These two mechanisms are what we think gives a woman with cystocele the mechanism to remain bladder continent.

Urge incontinence is a different beast, which may be caused by nerve damage, or mixed up brain signals, or pressure/extra fullness on the bladder, or inflammation, different foods and drugs, or maybe other medical things. Bladder training and increasing awareness of sensations can often help this type of incontinence, where there are brain signal, sensation detection and logistical causes.

Many women can relate to getting inside the door of the toilet and having to concentrate really hard to get their knickers down in time. Why? Does our brain have another agenda, when it knows we have an armful of shopping, and our phone is ringing, and the key is stuck in the door?

I find that now my prolapsed organs are back in place my urine stream is much thinner, but if I have been sitting for a long period of time it is wise for me to go to the toilet first thing I do when I stand up, if I intuitively know that my bladder should be full. At least, that way, I have two hands free to manage the knickers!

So, I think the answer is yes, and no, depending on what factors are at work at the time.

Louise

Hi Chickaboom

Sorry my anatomy posts go right over your head. Hopefully, one day you will be able to understand them. I am on a continuous learning curve, being formally untrained in anatomy, but I have figured out a lot of stuff from reading, and from my friendly plastic, half-size skeleton, who stands on my desk. Anatomical language is quite challenging to get into your head, and I don’t use all of it, by any means. It does give an unambiguous framework for describing anatomical features. There is a summary of anatomical language in Saving the Whole Woman, to help us all understand the orientation of different body parts. I would encourage you to start your own anatomical learning journey. It is only by understanding that we can interpret our own body and be responsible for its wellbeing.

We need to have these deep and meaningful anatomical discussions on the Forums because we are trying to interpret the female body in ways that nobody else seems to do. We are talking about questions that we are unable to find ready-made answers for. We are all learning together. Please don't feel intimidated by these posts of mine. I would love it if more women would respond that they don't understand a particular thing, even if it is the most basic information. By getting answers you are starting to learn it. I am certainly not going to judge your lack of understanding of the basics. I was there once. I want you to understand it, and if my raving descriptions don't make sense I would very much like to know, and to try and help you understand.

I would also like to know if you think I have something wrong. I am trying to figure it all out too!

Re jiggling, you can use the Search box to search ‘jiggling’. It is a technique I described for kind of shaking the pelvic organs up out of the pelvis with the torso inverted. I think one of the aggravating factors with POP is that too much intestine gets pushed down into the pelvic cavity by intraabdominal forces sent in the wrong direction by faulty posture and constipation. It is sometimes necessary to tip it all out, then allow it to settle back with correct posture. Done enough times, and reinforced with WW posture, the body seems to get the message and get our organs configured properly again. This has certainly happened with me by using all the techniques I can for several years.

Re hysterectomy, I think many women do happily accept hysterectomy because it does erase an organ that can be troublesome in different ways. I have a friend in her late 50’s, who had an hysterectomy after the birth of her fourth baby because of an enormous fibroid. She tells me, quite honestly I believe, that she has never had any problems. Here’s hoping it remains that way. Sadly, there are probably some women for whom hysterectomy means relief that she will not have to bear any more babies. And for some hysterectomy means the end of a lot of unresolved physical suffering. Who am I to judge any woman’s decision?

Re the position of the cervix, I think the Natural Family Planning people have the description of the non POPped cervix about right. I can remember palpating my own cervix for fertility awareness, before and between pregnancies. Sometimes I had to reach pretty high! My own uterus only descended when my bladder came down, and my rectocele appeared, which was well after my third baby, who was a Billings surprise! Even though the organs seemed to be in the right place I couldn’t use tampons after having babies, so the prolapse must have been there. We used condoms after that because we really were not planning any more babies, so I was no longer observing my cervix. Good old condoms, eh? Yes, I did fall pregnant again about four years later. I was forty at the time and miscarried, for better or worse. Perhaps we should have kept up the natural family planning, eh?

I think finding tampon use impossible is probably one of the ways in which modern women suspect they are sagging inside. In our sexualised world a vagina that is anything other than virginally tight and perfect is kinda frowned upon, particularly in macho world. A woman with a loose vagina is regarded in those horrible men’s only conversations as no good for anything. There must be a lot of very sad, frustrated men around! We modern women think a lot about our vagina, maybe because we think they are yet another bit of our bodies that we ‘know’ is not perfect, and ‘will’ make us unlovable. Sad.

My mother’s generation did not have tampons, or natural family planning, so they were blissfully ignorant of anything that was going on down there. No wonder they didn’t think much about POP until one day, out of the blue, it all dropped. Now that would be scarey!

Louise :-)

Hi Louise

Having read your post, I take the point that I'm probably making a sweeping statement saying that POP almost never causes incontinence. I am often guilty of talking down the problems different women experience with POP because I've been lucky and never had significant symptoms and also because I want to dispel the vague fear that is encouraged by the medical system - POP = everything falling to bits+ incontinent little old lady or even worse, incontinent young lady.This was the way I felt when I first suspected I had pop and it's alarmist and not helpful. There is so much we can do to stabilize it and it still seems to me that few women here report incontinence. It can also happen to old people for other reasons: my family is very long lived but the only old member who had incontinence issues also had dementia and was male.

Maybe my urethrocele ( or little cystocele, or whatever it is) has protected my post babies body from incontinence but please will people tell me off when I'm replying too much along the lines of 'POPs a breeze' when this isn't true for all women.

Sorry

Doubtful

No need to apologise, Doubtful. Your comment just got me thinking.

You are right. Everyone is different. And just because incontinence happens in conjunction with POP, it doesn't necessarily mean that one causes the other. Does constipation cause POP or does POP cause constipation???

By coincidence, today I was at an upholsterer's shop, organising the reupholstery of our lounge suite, which has suffered considerable wear and tear over the last 35 years and three adult kids. A program came on the radio while I was choosing fabric, where the woman being interviewed had just written, and was launching a book of hints for women who were going to have hysterectomy. Lots of stuff about looking after yourself post-op and following doctors' orders. *Nothing* about why the hysterectomy is done in the first place, as if it is assumed that all women will need one. I was fuming! I was also interested to hear her say that hysterectomy in Australia has overtaken heart surgery as the most common major surgical procedure. Now, that did scare me!

There are so many assumptions made when things are *not* said. Things are not said when it might be TMI on daytime, public broadcasting radio. Therefore women draw their own conclusions from a woman who is clearly defending her own decision to have an hysterectomy. At least she made no secret of how major a procedure it is!

I hope I didn't get so flustered that I chose the wrong fabric. It could be a very expensive mistake!

Louise

ps, I am interested in the opinions of others about the link between POP and incontinence. Christine has commented, I believe along similar lines as my comments, on the kinking mechanism where there is POP, that protects against stress incontinence.

Here is something Gmom had written years ago, I saved it for myself, useful info. 1-2 posts about the nulliparous vaginal walls.

Liv

I am one of those who have POP and incontinence. They came together --- actually started while taking some golf lessons. That put an end to that! I felt a little "squirt" when I would swing the club and since then it's just gotten worse. I could handle the pop but the incontinence is very very difficult. I have been working the posture -- I'm far from perfect yet, and doing exercises --WW as well as physio exercises, but have not seen any improvement yet. Seems to be worsening. The POP doesn't seem to be that noticeable most of the time but the "wet feeling" is always there. I tried a sea sponge for a couple days and that worked pretty well. However, today I am not using the sponge and it seems worse than before. Has anyone used a sponge for incontinence and if so how did it go?
I would love to take a magic pill for this --- and I hate medications--but this one I would take.
Anyone know of the magic pill????

Yes Chelan, golf does some pretty weird things to the human body. There must be enormous intraabdominal forces generated with the twisting backwards and forwards of a swing. Just the duck's nuts for a man's upper body strength, but perhaps not for a woman. Perhaps this is why many older women eschew golf for lawn bowls?

(Now, if you could play lawn bowls on a golf course, as a progressive game, rather than as a 'down to one end and back again' game, with the jack on each green, players could get the exercise benefit of walking in a changing landscape, and communing with the ants, minus then un-POP-friendly swing. Don't know what the golfers would think of this? I think I had better keep out of it. I don't play either game!)

;-)

Wouldn't you say your full bladder is probably holding your uterus up like a buoy?

Our old-time member, Sybille, coined the term Nature's Pessary - primarily referring to cystocele/rectocele keeping the cervix up above. It has since been more widely applied to mean all three organs vying for the exit. Since all three can't fall through (we've never heard of it here), they actually prevent any one from bulging to the extreme. Your full bladder falls into that category.

You have many women - young and mature - assuring you that your cervix is much more likely to move forward than back with this work. Try not to sabbotage your progress with worry about something that's likely not to happen.

Christine

SH, if you view the pix and videos of these moves, you will see that the spine does flatten out during the exhale; in firebreathing, it is pretty impossible to get the full benefit and really pull those organs forward during the exhale if you are trying to hold a strong lumbar curve throughout. Let the video footage be your guide. - Surviving

My philosophy is, the less looking the better. And that goes for touching too. My symptoms alone tell me all I need to know. After childbirth, you could not have paid me to take a look down there! Ignorance definitely is bliss for me. But I think I'm the exception; most members on here seem to have a much more intimate relationship with their prolapsed organs.

I honestly don't know the answer to your question, so I won't try to sound like I do. I often can't distinguish between my front and back bulge because, on those RARE occasions when I've actually looked, it seems to be on the side. Go figure. I know it's not my cervix because, though I can feel my cervix, it's not that close to the opening.

Hoping for some other answers to this one. - Surviving