The six-week-old baby nestled peacefully in his mother’s arms was like a dream come true. His birth had gone almost according to plan and everyone who came to visit noticed how closely he resembled his handsome father. Only those who knew Emily well could sense something amiss in this joyful scene, but when asked she would smile anxiously and insist everything was fine.
In truth this new mother was struggling with a condition she had never heard of and had no idea was even possible. Extreme perineal heaviness accompanied by an alarming bulge at the entrance to her vagina had sent her terrified to her gynecologist a couple of weeks earlier. Diagnosed with pelvic organ prolapse, where the bladder, uterus and/or rectum fall into the vaginal space, Emily was told to not lift anything heavier than five pounds and referred to physical therapy for pelvic floor exercise. She was also advised that her condition would only worsen and that when she had completed her family she would require reconstructive pelvic surgery.
For over a century the most silent epidemic in history has resulted in radical and experimental surgeries performed on hundreds of millions of women around the world. Today by age 65 half of all women in the United States no longer have their uterus, 25% of these operations performed for symptoms of prolapse. Hysterectomy leads to vast and permanent skeletal and biochemical changes, often resulting in bowel and bladder dysfunction, chronic pain, and sexual disability. Uterine suspensions and operations that narrow the vagina in an effort to correct prolapse are also associated with high failure rates and poor outcomes.
The human body is greatly protected against prolapse and for the first time in history the true story of female pelvic anatomy is told in the book Saving the Whole Woman – Natural Alternatives to Surgery for Pelvic Organ Prolapse and Urinary Incontinence, Second Ed. www.savingthewholewoman.com. Medical science has only recently begun to correct a 500-year misrepresentation of the position of the human pelvis in the standing body. In reality the pelvis is not a “bowl” with a “floor” but rather a vertical structure with a muscular wall behind it (Figure 1). Our true pelvic floor consists of wide, flat pubic bones that come together like straps of a saddle underneath us (Figure 2).
This concept has huge implications for women because it means our pelvic organs are not held up by a floor, but rather forward away from a vertical pelvic outlet. The way we keep them forward is not through Kegel exercises but by maintaining the natural shape of our spine, from which the pelvic organs are suspended. The pregnant body is a revealing example of how the pelvic organs are actually located over their true floor, the pubic bones (Figure 3). In the non-pregnant state, the bladder, uterus and sigmoid colon remain positioned directly behind the lower abdominal wall where they are pinned into position by the forces of intra-abdominal pressure(Figure 4). Natural breathing, coupled with a relaxed lower belly, creates and maintains pelvic organ support.
During the last weeks of pregnancy the fetal head drops into the birth canal, a process often referred to as “lightening.” In order to accomplish this the spine must assume a position of lesser pelvic stability. Breathing becomes easier but women also become less steady on their feet. During the birth process the spine must once again reconfigure so the baby can pass under the mother’s tailbone to be born. Birth positions that allow full movement of the spine, such as hands and knees or half-squat, open the pelvic outlet completely and help prevent abnormal stretching of the vaginal walls.
Rarely does a woman stand up after giving birth to discover prolapse. Rather, symptoms usually arise in the early weeks postpartum. This can be explained by the fact that most modern women do not engage in postures that return the pelvis, and therefore the pelvic organs, to natural positions of stability. Rather, they spend long hours in bed or upholstered furniture cuddling their newborn. Anatomically, the slouched, C-shaped spine destabilizes pelvic organs so they become subject to moving back from the lower abdominal wall and toward the pelvic outlet.
Several weeks of quality rest is highly desirable for postpartum mothers. However, to help prevent prolapse rest should be alternated with seated and standing postures that sustain the natural shape of the spine and consequently the pelvic organ support system. Additional lifestyle practices, such as discontinuing all straining against the toilet seat, are encouraged to prevent or stabilize prolapse.
Emily may never be completely free of vaginal bulges due to the resistance of pelvic connective tissue to regaining its original shape. However, by recreating the natural contours of her spine Emily’s symptoms may greatly improve. Coming back to inherent female posture means returning to natural pelvic organ support, the most reasonable and successful strategy for prevention and treatment of pelvic organ prolapse.