advanced prolapse

Body: 

My OBGYN whom I am now leaving for a new doctor at our med school, advised me to do nothing and live with stage 3 ( really bad) prolapse. I have done kegals but don't understand how if something heavy drops and is pulled downward, how does the opening to the vagina resist this kind of pressure.
I hope to be fitted with a pessary.... does that mean no sex!

Hi Margi,

In all cases of prolapse and all cases of stress incontinence, the organs (bladder, uterus, and/or sigmoid colon) have pulled away from their natural positions close to the lower abdominal wall. This can initially cause “wheeling” or hypermobility of the urethra and urinary incontinence when you cough or sneeze, until the bladder base moves back far enough to abnormally kink the urethra. This corrects the incontinence, but also leads to inability to empty completely of urine due to the bladder base being lower than the urinary outlet AND, of course, the bulge of cystocele. For some women, it is a hypermobile uterus that has stretched its broad, ligamentous connections to the pelvic sidewalls presenting first at the vaginal opening.

You ask a very logical question and I’m betting you will be able to visualize the answer to your question in short order.

Imagine: every time you take a breath, pressure within your body cavity is actually blowing your pelvic organs down and back. This anatomical reality is very easy to SEE by just looking at the way the urethra/bladder, vagina/uterus, and rectum/colon are positioned within the body. It is no accident that they all look like they are being blown backwards by a powerful wind, like this: 777. The urethra, vagina, and rectum are being forced backward, but something causes the bladder, uterus and sigmoid colon (the top part of the ‘sevens’) to hold their positions near the front of the body. That something is the lumbar curve in our spine, which forms a bony arch above these organs and causes the pathway of intraabdominal pressure to press DOWN on them instead of back, essentially pinning them into place. Sharp right angles are consequently created in all of these organs, adding a significant aspect of pelvic organ support. Loss of this spinal curvature causes the organs and their respective channels (urethra, vagina, and anus/rectum) to become vertically oriented within the pelvis and completely unprotected from internal pressures.

You are right, the vagina has no resistance to descending organs. The fact is, it doesn’t need to in normal anatomy when it is being pulled to the back while potentially-prolapsing organs are simultaneously being pushed to the front. Someday all women will understand their own anatomy and will be able to see the futility of presenting studies on the benefits of traditional kegels as it becomes obvious that skeletal shape and positioning of the organs are all that really matters.

IN ALL CASES OF PROLAPSE the organs have pulled away from their natural positions at the front of the body. Causes of such displacement can be as varied as loss of normal spinal shape or chronic, extreme rises in pressure from straining on the toilet.

Your doctor gave you good advice in one regard. Surgery is a terrible response to prolapse. Generally speaking, the worst wholewoman day cannot even be compared with the best post-reconstructive day. Once you stabilize your prolapse through posture and lifestyle YOU WILL SEE how much control you have over your condition and that it never need progress for the remainder of your active years and will probably improve considerably. We are once again creating the anatomic elements of postural pelvic support so that the organs begin to retract naturally. This is not a total cure, but a way to live very well with these conditions.

Do Nothing is horrible, heartless, cowardly advice. Learn the posture, walk, run, leap, have lots of sex, get fitted for a pessary and enjoy the rest of your life knowing that you have a body perfectly capable of responding to prolapse.

Wishing you well,

Christine