I need an anatomy lesson

Body: 

My POP (cyctocele and rectocele) is a million times better when I have a full bladder, both with and without my pessary in. Can anyone explain why this is? I thought it would be the other way around.

sorry I meant to write cystocele

I agree that a full bladder makes prolapse disappear. I think there is quite a simple explanation.

A full bladder becomes the worlds biggest, fattest pessary, filling the space in the lower vagina, and literally lifting the cervix, which I imagine is loosely connected to the bladder by fascia. It also pushes the rectum back out of the vaginal area to where it is meant to be. However, it also straightens out the kink in the urethra, so it is harder to hold on when shifting around, eg getting out of the car, which also produces intraabdominal pressure of its own. Think about a balloon. Hold it up by the stem, as an empty bladder. It flops flat, right? Now blow it up slightly. The weight of the top part will bend it over at right angles at the top of the neck, right? This is the kink. Now blow it up and see how the neck is quite rigid and upright, and the balloon is much taller, and upright as well. The kink is gone, and whatever would have been loosely joined to the flaccid balloon is now pulled up higher, and whatever was in contact with the flaccid balloon will have been pushed well out of the way.

This is one of the reasons why I think it is important to empty your bladder only when it is full, then empty it completely. A continuously empty bladder will not support anything.

It is the same reasoning as why later in pregnancy POP disappears unless, or until, the uterus becomes too big for the stretch of the abdomen and it pushes down on the vulva again.

The front of the pelvis flares out. As long as the belly is relaxed (not pushed out) the bladder and uterus can always find more space just by moving forwards. If you look at chiropractors x-rays (which are often done in a vertical position) you will see the vertical orientation of the pelvis, and see how little opportunity there is for the uterus and bladder to stay back, as long as the posture is Wholewoman style, and keeps the bottom of the pelvis (the bottom rails), and the underside of the sacrum, horizontal. It is when the pelvis tilts backwards, and *makes* a bowl shape, that organs can get trapped at the bottom of the bowl and try to push through the pelvic floor. Tip the bowl over and the contents simply tumble forward until they hit the relaxed lower abdominal wall. Admittedly, women all have differently shaped pelvises, but as long as the bowl is on its side there can be no pushing down of organs. If the organs are being pushed downwards it is simply (or not so simply) a matter of finding out what is pushing them down and why, and addressing that root problem. That is often the greatest challenge.

The answer is not in doing something to the uterus or to the bladder or to the vagina, any more than shaving wood off the bottom of a sagging door, when the frame has whiteants. All you end up with is a bigger gap at the top and the frame will eventually collapse anyway, and the door will crash to the floor.

Louise :-)

ps, now go check your doorframes