Pondering Pelvic Prolapse

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Ever wonder about pelvic organ prolapse and what it means? Well, here is everything you need to know!


Q: Where are my Pelvic Floor muscles?
A: The muscles create a hammock that go from your pubic bone (in front)  to your coccyx (in back) as well as side to side. The pelvic floor muscles consist of three layers; the superficial layer can be found externally and internally while the two deeper layers can only be found internally.

Q: What is the job of the pelvic floor muscles?
A: These muscles support your organs, provide sphincteric control to help maintain bladder and bowel contents, and contribute to sexual function.


Q: Ok but what exactly do these muscles do?
A: In order to urinate, pass a bowel movement, or achieve orgasm the Pelvic Floor muscles need to relax and expand. In order to prevent urinary or fecal leakage the pelvic floor muscles need to be strong and remain active. For a variety of reasons the pelvic floor muscles can become weak, spastic, or restricted leading to difficulty with bowel movements, urination, or sexual function.

Q: What is Pelvic Floor Physical Therapy (PF PT)?
A: Physical therapists are musculoskeletal experts, this applies to the pelvic floor muscles as well. A physical therapist works with the client on re-training the Pelvic Floor muscles to work properly. An underactive Pelvic Floor (example: prolapse, weakness, urinary incontinence, postpartum issues) requires a strengthening/up-training program, whereas an overactive pelvic floor (example: constipation, chronic pelvic pain, sexual dysfunction) requires relaxation/down-training program.

Q: How do my Pelvic Floor muscles relate to my prolapse?
A: The job of the pelvic floor muscles is to support your organs. If the pelvic floor muscles are weak they will be unable to support your organs. This lack of muscular support will cause the organs (often times the bladder or rectum) to descend which is known as a prolapse.

Q: How can Pelvic Floor Physical Therapy help my prolapse?
A: PF PT works on re-training and strengthening the muscles through an up-training program to better support your organs. Once the muscles that support your organs are strengthened the organs will have a better support system and not descend.

Q: Should I just do kegels all day every day and hope the prolapse resolves? If I don’t have a prolapse should I be doing kegels to prevent a prolapse?
A: Kegels are great WHEN they are done correctly. Unfortunately most people do not know how to properly engage their pelvic floor muscles and perform the kegels. People tend to substitute with their inner thigh muscles or gluteal muscles instead. This is why in certain countries, such as France, women are sent to PF PT after giving birth to learn how to properly perform kegels and strengthen their pelvic floor muscles. In order to prevent substitutions it is beneficial to see a PF PT to ensure proper pelvic floor muscle activation.

 

Q: If I haven’t yet seen a PF PT but was diagnosed with a prolapse is there anything I can do in the meantime?

A: Yes! There are certain positions that will alleviate the pressure placed on your organs providing you with some much needed relief. Gravity is working against you and your prolapse putting pressure on the organs, when you take the pressure off the organs you allow gravity to work in your favor. One of the positions is to lay on your back on the floor with your feet up on the couch alternatively you can lay on your back with your hips elevated upon pillows or a wedge. Finally downward dog is a yoga position that helps temporarily pull the organs back into alignment.

Planting a Seed

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While it may not be self-evident, NOT all bacteria are created equal. Like good cop-bad cop, there are good bacteria and bad bacteria. In fact, this discussion has recently become relevant to a different conversation, namely, the pros and cons of vaginal delivery vs. cesarean section (c-section) delivery. Vaginal delivery introduces the newborn to vaginal fluids which help develop a healthy newborn microbiome (the collection of microscopic organisms which live on and in us).

These microorganisms exist on the skin, in the mouth and saliva, in the eyes, and in the gastrointestinal (GI) tract. It is believed that many of these organisms, especially ones in the GI tract, contribute to healthy gut flora and function. In other words, exposure to the mother’s vaginal fluid, bacteria and all, helps develop a healthy newborn microbiome. Furthermore, it helps develop the neonatal immune system, prevents growth of negative bacteria, and produces certain vitamins.

Babies delivered via c-section are deprived of the maternal vaginal fluid along with its corresponding health benefits. Furthermore, c-section delivery is often accompanied by antibiotic usage which may also interfere with healthy infant microbiome development.  In fact, it has been hypothesized that the recent rise in childhood asthma, immune diseases, and obesity may be associated with the increased rate of c-section, which nowadays is approximately one in three births nationally.

This has led researchers to explore the field of vaginal seeding, the artificial introduction of maternal vaginal fluid to the infant’s mouth, nose, or skin. This exposes the baby to the same bacteria he or she would have encountered through a vaginal delivery. This progressive and creative solution is still in its initial stages, and the American College of Obstetricians and Gynecologists (ACOG) is recommending, “Ladies, don’t try this at home.” In fact, they only recommend undergoing the process as part of an IRB approved clinical trial. The reason for this is because they still lack adequate research to support this procedure routinely. It is still unclear if the benefits outweigh the risk of exposing the infant to pathogens or other dangerous maternal bacteria.

However, it won’t be long before we have more data, and clinical trials are well underway. In fact, microbiologist Dr. Maria Gloria Dominguez-Bello’s pilot study compared the microbiomes of infants born vaginally with those of infants who were delivered via c-section followed by vaginal seeding. Dominguez-Bello found that the microbiomes of both groups appeared very similar after one week. This is promising, and longer-term studies with larger sample sizes will determine if vaginal seeding will become par for the course within the c-section community.

To learn more about this fascinating research, I encourage you to listen to Dr. Aviva Romm’s interview of Dr. Dominguez-Bello. Dr. Romm is a physician, a midwife, and an herbalist with over thirty five years of experience. She has an amazing website replete with valuable information, including her blog and podcasts. This is the link to her website, and this is the link to her interview. I hope you find this information as exciting as I do!

 

Dominguez-Bello MG, De Jesus-Laboy KM, Shen N, Cox LM, Amir A, Gonzalez A, et al. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nat Med 2016;22:250–3.