Cystocele

Hi and welcome JWells,

You might be interested in reading this thread on injury and cystocele. It’s the most pertinent information we have to date.

Wishing you well,

Christine

Hi Jwells

No, I haven't experienced the onset of POP after a fall or accident, but don't want to let your topic slide by. I have been around for over six years and I have seen posts from women who have had prolapse appear for the first time, or worsen following an event, or trauma.

This makes sense to me. Intraabdominal pressure (IAP) is one of the factors in the pelvic organs being felt in the vagina and vulva. Intraabdominal pressure is the pressure exerted inside the abdomen and pelvis by organs and muscles interacting and moving around, and changing the shape and size of the abdomen. It is not a bad thing. It is just what happens in the body, any body.

We feel increases in intraabdominal pressure when we breathe, and to a greater degree when we sneeze, land after jumping, cough, laugh, or anything else that suddenly brings our abdominal muscles into action, often combined with gravity, eg a fall. Intraabdominal pressure can be lifesaving for clearings the lungs during coughing, or clearing the throat or the nasal passages of irritants or mucous by sneezing or blowing your nose. It is what keeps air cycling in and out of our lungs. It is life giving.

If you go back to high school science, the Boyle's Law states that P x V is a constant. P is pressure, V is volume. As the abdomen can expand greatly, and there is atmospheric pressure on the outside of the abdomen, the abdominal walls expand if the pressure goes up on the inside, to equalise pressure inside vs outside, the same way as increasing the volume of a balloon by blowing it up makes its skin expand, so that pressure inside and outside are equal. The balloon will keep on expanding until the strength of the skin prevents the volume increasing (causing internal pressure to increase above atmospheric pressure), or the skin fails and bursts.

Intraabdominal pressure rises as we inhale, because our respiratory diaphragm contracts down into the abdomen, and pushes the stomach, liver and other organs down and out, expanding the abdominal walls. Air then gets sucked into the lungs because the gas pressure inside the lungs is less than atmospheric pressure. There are also adjustments in the chest and shoulders, with the ribs separating and the upper spine straightening.

There is also a valve at the top of the trachea (air pipe) which has a role in preventing food going down into our lungs when we swallow. We can close off the epiglottis voluntarily if we want to hold our breath (ie keep the volume of the chest expanded) or bear down using intraabdominal pressure (eg purple pushing during labour - yuk), or if we want to do the opposite and keep the lungs empty and suck the diaphragm up during nauli and firebreathing.

If intraabdominal pressure increases, and the abdomen is not able to expand because the abdominal muscles are tense or contracted, the volume cannot increase to equalise the pressure, so unprotected areas of the body will blow outwards. The vagina is one of these unprotected areas if there is a more or less straight line from the diaphragm down to the top of the vagina. This can happen where the body is c-shaped, ie slouched, doing sit-ups or crunches, or bent over from the waist, or if the butt is tucked under. In WW posture the pelvic cavity runs almost at right angles to the abdominal cavity, which protects the vagina by putting it in a position where intraabdominal pressure impacts its front, not its top. In addition the bladder and uterus are bent forward, resting on the pubic symphysis, not on top of the vagina.

If you have a fall you usually tense up to try and recover your balance. If you land in a c-shape (curling up being a reflex self-protection action) it is feasible that the impact could send your pelvic organs down your vagina, especially if you have some damaged fascia or pelvic floor muscles beforehand.

Many women carry pelvic organ prolapse or damaged endopelvic fascia without even knowing it. If they have no symptoms there is no reason for them to know.

Most of us know how stiff and sore we are after a fall. This is often not bruising in the area of the impact, but is muscle soreness caused by lactic acid in the muscles from having to work very hard momentarily to try and regain balance, or to absorb the impact by contracting and bracing, then gradually expanding during the impact itself. This would be a sign that there have been large forces at work in the body during the fall. I think a fall may generate enough increase in intraabdominal pressure to further damage already damaged fascia or precipitate or worsen POP.

I hope this makes some sense. It simply makes me realise what a wondrous machine our bodies are.

Comments are welcome from others.

Louise

I clicked on "thread" and it was such a click to read!!! o my gosh it is such an accurate description of what I also felt.

Hi jwells, although I am an older woman (post meno now) and found my pop worse after meno, I have done plenty of thinking. Now when I was around 20yrold I lifted some very heavy boxes and when I put them down ,I felt like Id all fallen out. I have no other way to explain that. I told an older lady at work, and I had to fill out some form and was sent home to bed.I have no recollection how long it took, but all must have gone back into place not that long after some bed rest, I remember I was frightened at that time.
About a year ot so later I had a vehicle(bike) accident and was hospital bedridden for just over 2 weeks.( I was not allowed off that bed for at least 2 weeks,I was in traction).
I remember thinking in my 20's that I felt too loose but I kept it all to myself. Then I went on to have 3 children and a few days after my 3rd and I had a similar feeling back to when I was 20, the doctor gave me some hormonal cream in a pessary and said I had a partial vaginal prolapse, but it would come right.
Through all these years I did plenty of exercise , heavy lifting and moving of furniture,carrying children etc. From about 40 I knew I could not run without leakage and had to be very careful at aerobics.From 50 it all became a lot worse and I struggled on, not wanting any medical intervention,was about to give in and then found this site.Found heaps of advice and encouragement and thats kept me going,together with posture and other advice.
I was wondering why you asked...? :-)