Pelvic organ prolapse is a condition where the pelvic organs – bladder, uterus, and rectum – press against the vaginal walls and in some cases cause the vagina to bulge outside the body. Often resulting in lower back pain and pelvic pressure, prolapse can also cause significant emotional distress. Prolapse is considered by obstetrics and gynecology to be a progressive disorder and has been treated with radical pelvic reconstructive surgery for over a hundred years. Yet, these benign conditions are not cured by surgery but merely traded for more serious problems such as bowel and bladder dysfunction, chronic pain, and sexual disability.
Traditionally considered an “old ladies” disease, prolapse is occurring at an alarming rate in younger women, particularly postpartum populations. To realize why we must first understand the pelvic organ support system.
When a newborn baby girl comes into the world her spine is completely straight, just like an amphibian spine. However, when she begins to stand, walk and run powerful bursts of energy are sent through her torso in a very specific way. With each in-breath her abdominal and pelvic organs are moved down and forward by the strong respiratory diaphragm underneath her lungs.
Over the course of seventeen or eighteen years her bladder and uterus become pinned into position directly behind her lower abdominal wall and are kept there by the prominent curvature in her lumbar spine. With each inspiration the lumbar vertebrae are drawn forward by their connections to the respiratory diaphragm. You can feel this yourself by lying flat on a firm surface and placing your hand underneath your lower back. Take deep breaths and feel your lumbar spine pull forward with each inspiration.
The mark of a young woman is her shapely figure, particularly the prominent curvature at her lower back. There is no reason women should ever lose this natural shape, yet most of us do by age thirty or so because virtually nothing in our culture is supportive of natural female posture – from our clothing, to the furniture and cars we sit in, to the ways in which we give birth. Even the information we receive from our exercise instructors and physical therapists is based on inaccurate anatomy that has been misrepresented by medical science for nearly 500 years.
Most of us understand the human pelvis to be positioned like a bowl inside the standing body, when in fact it is oriented just like those of four-legged animals. The five fused vertebrae forming the sacrum at the base of our spine are completely horizontal and together with the hip bones cause the pelvis to be positioned like a bowl tipped on its edge.
This almost 90-degree correction has profound implications for women because it means there is no “pelvic floor”, but rather a wall of muscle at our backside just like in cats and dogs and horses. Our true pelvic floor consists of wide, flat pubic bones that come together like the straps of a saddle underneath us. Over this bony floor our pelvic organs are suspended from the horizontal sacrum and held into position by the forces of intraabdominal pressure. It is a profound truth that we are horizontal creatures from the hips down and vertical from the waist up, a structural framework made possible by a very pronounced lumbar curvature.
Every time a yoga, Pilates, or ballet teacher tells you to pull your belly in and tuck your tailbone under you are working against an essential shape that nature is trying to maintain with every breath. Every time a physical therapist tells you to perform Kegel exercises while pulling navel to spine you are actually destabilizing your pelvic organ support system rather than improving prolapse or incontinence. Core strength is great, but it is time we understand that women have a completely different core than men – a difference not appreciated by any of our conventional systems of exercise or physical therapy.
During the last weeks of pregnancy the fetal head moves into the pelvic interior, which the sacrum accommodates by rocking up and tucking the tailbone under. The spine stays in this position until the birth process when the opposite occurs: the sacrum moves down and the tailbone lifts up as the baby passes through. Rarely does a woman stand up after giving birth to discover prolapse, rather symptoms usually develop a few weeks after delivery. The most likely explanation for this phenomenon is that the hormonally relaxed postpartum pelvis has not been adequately returned to its innate position of stability due to excessive time spent in soft beds and upholstered furniture. The breath, gravity, and natural shape of the spine cannot work to create pelvic organ support when slouching back into soft furniture, therefore the risk of developing prolapse increases.
Postpartum prolapse is easily prevented and best treated by alternating rest with gentle return to natural sitting and standing postures accompanied by abdominal breathing.