What is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when the pelvic organs (bladder, uterus and bowel) are forced away from their normal positions behind the lower abdominal wall and bulge into, and sometimes out of, the vaginal space.
Why does prolapse occur?
Prolapse usually occurs slowly over time due to changes in the natural pelvic organ support system. The human female spine, pelvis and pelvic organs develop in a very specific way as a result of intraabdominal pressure, or the expansion of our lungs under the forces of gravity. That anatomy is supported by the ways in which women sit, stand and move throughout the day. Modern culture no longer encourages natural posture, therefore the innate female pelvic organ support system becomes compromised in many women.
What age groups are at risk?
Women of all ages experience prolapse. Although more commonly occurring in women who have given birth, teenagers can also develop symptoms. Support of pelvic organs depends upon an anatomic system that develops over time as we mature from infancy to womanhood. Prolapse results when that structural system is weakened by gravitational and mechanical forces.
Does giving birth vaginally cause prolapse?
Prolapse is epidemic in the postpartum population. This does not mean, however, that vaginal birth is the major causative factor. It is now recognized that birth position, anesthesia, episiotomy and instrumental delivery pose the highest risks for maternal injury.
I had a gentle home birth and still developed prolapse. Why?
There are several possible reasons for this. Birth practices vary greatly within the midwifery community, ranging from gentle reassurance that human birth takes a very long time and to go with the flow, to heavy coaching to push even in the absence of any urge. The quality of maternal connective tissue also plays a role in who will develop postpartum prolapse. Most striking is the observation that prolapse symptoms rarely present immediately after birth, but occur a few weeks postpartum. This suggests it is not the birth event itself that causes organ misplacement, but compromises in the surrounding skeletal support structure due to postural and lifestyle factors.
I have been told by connective tissue is genetically weak and that all women with prolapse have weak connective tissue.
This assumption results from an incomplete understanding of the dynamics of pelvic organ support. There is no question that the quality of the cellular matrix comprising the fibrous tissue surrounding pelvic organs is an important factor in their support. This is a nutritionally determined condition rather than a genetically determined one in the vast majority of women. Therefore, it is subject to change and women can improve prolapse symptoms by adopting an anti-inflammatory diet. Proper nutrition is a critical player in pelvic health, but equally important are the basic elements of pelvic organ support, which include gravity, the force of our breath, the natural shape of our spine, and the weight of the organs themselves.
Will a Cesarean section protect me from prolapse?
There is no data to support this. What is protective of prolapse is avoiding common obstetric practices known to compromise pelvic organ support. The primary sites of vulnerability are the perineum and perineal body, which act as vaginal sphincter, distal legs of the clitoris, structural support of the urethra/bladder, and central tendon of the pelvis. The lower belly is an integral part of the pelvic organ support system, proper function of which can be undermined by scar tissue and adhesions. Many women alive today remember grandmothers who birthed eight and ten children at home, yet remained active and productive throughout their lifespan. The elective cesarean movement arose from obstetrics and gynecology, not the natural history of human birth.
My doctor told my that prolapse cannot be reversed and that I will need an hysterectomy after I am through having children.
This is not true. What is true is that many hysterectomized women struggle the rest of their lives with significant health issues. Prolapse is easily stabilized by returning to the natural pelvic organ support system. Through these techniques, a reduction of prolapse symptoms is experienced by many young women and by older women as well.

It is also true that not all women will see significant improvement. Therefore, it comes down to choice. Hysterectomy removes the hub of pelvic organ support. Not only do vast systemic endocrine changes result from hysterectomy, but equally tremendous skeletal alterations occur when connective tissue surrounding the uterus no longer holds the bony pelvis and spine in proper anatomical alignment. These changes are easily seen in one-third of U.S. women who have been without their uterus for several years.

Due to critical changes at the level of the sacral spine, curvature is lost in the lower back and women become wider across the buttocks. The thoracic spine compensates for loss of lumbar curvature by developing a hump at the base of the neck. This hump causes the head to be held out in front of the body instead of directly above the spine. Given enough time, severe prolapse in the post-hysterectomy woman is a certainty. As difficult as prolapse symptoms can be for the wombed woman, prolapse in the post-hysterectomy woman is usually far more difficult. Your doctor is misinformed. Many women, regardless of age, are finding they can stabilize and reduce the symptoms of prolapse through postural and lifestyle changes.

I was also told that if I refuse hysterectomy, an equally successful operation would be to shorten my uterosacral ligaments and repair my front and back vaginal walls with mesh.
There is no successful operation for prolapse and this is why many surgeons are replacing tradition “A&P repairs” with more extreme surgeries in the form of mesh implants. The concept of “weak vaginal walls” is erroneous, and attempts to “strengthen” them with either scar tissue or mesh have been disastrous. There is no “hole” at the bottom of a soft-tissue pelvic “floor.” Rather, there is a thin, sinewy wall of muscle at the back of the body and in natural female posture the organs are held toward the front of the body and away from the pelvic outlet. When we return to natural posture, our symptoms often improve.
I have already had an hysterectomy. Will these techniques work for me?
We do not yet have a definitive answer to this question. It is logical to assume that the remaining pelvic organs - the bladder and sigmoid colon - must be held in natural posture to prevent further prolapse. If the organs are being held toward the front, they cannot fall out the back. However, the vagina has lost its major support, the uterus, which is connected all the way around the body through its ligamentous attachments. Therefore, there is little preventing the vagina from turning inside-out and bulging out of the body like an inflated balloon. At this time, we do not know if the Whole Woman™ work is capable of stabilizing prolapse in the post-hysterectomy woman. There is also some reason to believe that trying to re-create natural posture in the post-hysterectomy spine aggravates the sacroiliac joints on either side of the lower back. In time we will have more data.
My prolapse symptoms are really severe and I don't think I can live this way.
Severe prolapse is not an easy condition to live with. However, we believe that through the Whole Woman™ work most cases of prolapse can be significantly improved. Even if you have a long-standing prolapse condition you should experience some level of improvement. Yet, how much is impossible to say. If you still have your uterus it is expected that you can learn to live well with prolapse. We cannot tell any individual woman whether or not she would be better off with or without surgery, because in reality we have no way of knowing this for certain. There is much in the medical literature to support the fact that prolapse is best prevented and does not respond well to surgical intervention.
My PT has me doing repetitions of Kegels on my back. Will this help my prolapse?
Every prolapsed woman knows that kegels do little to improve prolapse. The pelvic floor functions as a trampoline to rebound intraabdominal pressure. In order for it to function in this way, it must be stretched taut into its functional dimensions. Contracting the pelvic floor with the goal of strengthening these muscles to hold up prolapsed organs is a misconception.
Where can I get more information?
At the Whole Woman Store you'll find my book, Saving the Whole Woman and my DVD, First Aid for Prolapse which will give you a thorough understanding of your anatomy, the risks of surgeries and how to manage your prolapse successfully for a lifetime without surgery.
What is the Whole Woman posture?
Stand with your feet about six inches apart and pointing straight ahead.

Distribute your weight evenly between three points on the soles of your feet: below your big toe, below your little toe, and in the center of your heel.

Make sure your ankles are not bending in or out, but are directly over your feet.

Sense that your knees are directly over your ankles and are straight, but not bowed backward.

Relax your lower belly.

The abdominal wall will be pulled up instead of in.

This is a much more graceful and beautiful look than when the stomach is pulled in and the tailbone tucked under.

Lift your chest, while at the same time keeping your shoulders down.

The palms of your hands should face the sides of your thighs.

If they are facing the front of your thighs, rotate one shoulder back and then the other shoulder back so your arms are hanging at your sides.

The shoulders should be kept down and the upper back flat and broad.

In other words, your shoulder blades should not be pinched together.

This will allow your lumbar spine to expand on its own.

Pull up through the back of your neck and crown of your head.

Holding your body in this way may feel uncomfortable at first, but over time it becomes extremely natural and effortless.