Got a second? Try this: bend down to tie your shoe. When you’re down there, exhale. Were you holding your breath? Yes? Don’t do that.

If you’ve ever taken scuba diving lessons, you know the #1 rule: don’t hold your breath. Turns out, that’s a pretty good rule for life out of the water as well.

Pelvic organ prolapse – when the uterus, rectum, vagina, or bladder droops from its normal position – is an astonishingly common condition, occurring in maybe as many as half of all women worldwide. And holding your breath is one of the risk factors.

Because menopause is another of the major risk factors for this condition, our DPTs Meagan and Brianna filled us in on what we need to know.

What is pelvic organ prolapse and why does it happen?

Your pelvic floor is a sort of hammock of muscle and tissue helping to keep internal organs – the vagina, rectum, uterus, and bowels – in place. If that muscle becomes too weak or the connective tissue is too stretched, the organs can droop, collapsing the vaginal wall. Pelvic organs can even drop into the vaginal canal and protrude outside the body.

What are the risk factors for pelvic organ prolapse?

The two biggest risk factors, according to Bri and Meagan, are menopause and childbirth. Bearing all that extra weight during pregnancy, then delivering vaginally, can weaken the pelvic floor, especially after multiple births.

Menopause or estrogen loss for any reason can also be problematic. The drop in estrogen can affect strength, elasticity, and density of muscles, all of which can result in a weakened pelvic floor.

Having a hysterectomy is another risk factor. The uterus is kind of like the keystone of an arch, Meagan says; all the organs are wedged in there, supporting each other. Once the uterus has been removed, even if the surgeon ties everything back into place, the architecture just isn’t as sound and the structure can start to crumble.

Another risk factor is chronic constipation. If you’re doing a lot of pushing to pass stools, Meagan says, you’re nudging all your pelvic organs that direction as well.

Chronic coughing (seriously, are you ready to give up smoking yet?) puts pressure on your pelvic floor, Brianna told us, so smoking, emphysema, even chronic allergies can be concerns.

Genetics plays a role, as it does in most things. Those with connective tissue disorders such as hypermobility should seek help early.

High-impact exercise. If you’re doing a lot of bouncing, like runners do, it’s good to get some advice from a pelvic floor specialist before symptoms arise. Abdominal gripping, like doing too many crunches or other “gotta-have-a-six-pack” exercises, can cause an overstimulated pelvic floor that doesn’t relax naturally. While this is different from having too-weak pelvic muscles, the end result of incontinence and prolapse can be the same.

Heavy lifting, whether for exercise or work, needs to be done correctly, says Brianna, which brings us to one of the most common factors …

Breath holding. Remember that test of tying your shoe? We hold our breath too much, says Brianna, and often we’re not even aware we’re doing it. But it’s not good: “When you hold your breath, your organs have nowhere to go. There’s all this pressure from above, so they start to move south.”

(Know what else isn’t great for your pelvic floor? Your shoes….)

What are the warning signs of pelvic organ prolapse?

One of the earliest symptoms, say our PTs, could be trouble with tampons. If they’re just not staying in place or if you can’t keep them in at all, that’s a really important warning sign that something else is occupying that space.

Another sign may come from this simple test: lie flat on your back and bend your knees. Put a pillow under your hips. If you feel some relief from pressure down there, that could be an indication that things are happening that shouldn’t. (Bonus: this is also just a good preventative measure to do every day.)

Other symptoms include feelings of pressure or fullness in the vagina or rectum or both; urinary or fecal incontinence; low back pain; urinary retention, which is the feeling that you can quite empty your bladder entirely or you have to go twice; feeling a bulge or something actually protruding; painful sex.

(Is your urination “normal”? Answers from our PTs on pees.)

What do I do if I’m worried about prolapse?

Definitely make an appointment with your ob/gyn and ask that they do a standing test. When you’re on your back and the doctor’s speculum is actually holding things in place, it may be harder to gauge the presence or severity of prolapse. Since, as Meagan says, “most of us live in a vertical world,” a standing test with gravity doing its thing may make diagnosis easier.

If you have any concern that you have or may be at risk for prolapse, ask for a reference to a pelvic PT. If you have mild prolapse, your PT can help you keep the condition from worsening; if your condition is more developed, you can get educated about all your options, like surgery or non-surgical options such as a pessary. If you have no symptoms of prolapse, great! Celebrate and then find out how to stay that way.

If you’ve had prolapse surgery, you definitely want to work with a pelvic PT – one in three women who’ve had surgery need it again because they haven’t fixed the behaviors that caused or contributed to the problem.

What can I do to minimize risk? Kegels?

For some women, Kegels are great. Their pelvic muscles are weak, and Kegels can help strengthen them. But these aren’t for everyone, and alone, they may not be enough. Here are other things you can do to manage your risk of pelvic organ prolapse:

  1. Relieve constipation: hydrate, add fiber to your diet.
  2. Manage body weight. Excess weight increases pressure on the abdomen and pelvic floor.
  3. Breathe when lifting (including your breathtakingly gorgeous kids).
  4. Learn some breathing strategies.
  5. Invest in support garments that supply pressure to the perineum.
  6. As mentioned above, lie on your back, knees up, pillow under the hips. Let gravity work for you, relaxing the pelvic muscles and shifting things back into their normal position. This is especially good for women who are on their feet all day.

A pelvic PT like Brianna or Meagan can help you learn toileting posture, breathing strategies, lifting strategies, etc. You don’t have to give up your job or your exercise routine, but you should learn how to do things properly to minimize risk. Not willing to do any of this? Well, Meagan says, you can always become a mermaid or move to the moon …

Having children – or any of the other risk factors – doesn’t guarantee prolapse is in your future. Equally important to know: never having children – nor any of the other risk factors – doesn’t mean you’re guaranteed to stay free from prolapse.

Best thing you can do to minimize your risk? Go see a pelvic PT. Get an assessment. Learn strategies that allow you to do the things you want to do without negatively impacting your health. Share the knowledge with friends, colleagues, other women in your Mommy and Me group, your menopause Facebook group, etc. There’s a lot you can do beyond (or instead of) Kegels, so get educated, and get going!

Have you dealt with incontinence or prolapse? We’d love to hear how you’re managing it. You can leave a comment below, shoot us an email at info@genneve.com, or talk to us on Facebook or in our closed Facebook group.

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Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.

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