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♥ My Pelvic Organ Prolapse Journey ♥

 

Warning: This post contains very personal and not-pretty details regarding my anatomy, sex life, and bodily functions. If you don’t like TMI, you may not want to read it. Then again, you may not even be here to begin with in that case! 

“OH! NOW I see the problem!” — not words you want to hear your doctor say when they’re digging around in your lady bits.

But I did. And after 5 years of being told nothing was wrong, it was simultaneously terrifying and incredibly validating.

I gave birth in 2015, to an amazing baby girl. The birth was incredible. It was also incredibly physically traumatic, thanks to a deformity in my tailbone caused by a childhood injury I didn’t even remember. I only pushed for one hour when giving birth to her, but the first half of that was spent pushing against my tailbone until it finally broke to allow her through. All that straining caused some serious issues. I ended up diagnosed with stage 3 pelvic organ prolapse, specifically uterovaginal prolapse.

I knew things were a mess down there. You expect them to be after giving birth, right? But there are some messes that are a bit harder to “clean up” if you know what I mean. I didn’t tear; I just had a couple of small skid marks at the edge of my perineum. My midwife checked me out and said everything was fine. Even my broken tailbone was denied until my chiropractor did an x ray for me and proved what I already knew. I went to my family doctor a few months after birth, asking her to give me a referral to a pelvic floor physical therapist for pelvic organ prolapse because I knew I had it. She did a quick exam and told me everything was fine, and I had no prolapse. I felt dismissed. She gaslighted me. She wasn’t trained in pelvic organ prolapse. She didn’t even know the right ways to check for it, much less diagnose it. I asked her again a few more times over the next year, and was always dismissed. I gave up. I resigned myself to the new troubles I was having as a new way of life.

Over the years, it would improve for a while, especially when I was more sexually active. But during the times when I was not, it would worsen considerably. A student midwife friend of mine told me I just needed to “use it” more. She might have been right, but it’s hard to get in the mood when you’re in pain, or your cervix is hanging out of your body.

In early 2020, I broke my ankle and spent 4 months unable to walk. I only really had sex one time during that timeframe, and it didn’t last long. Without any reminders, my vagina seemed to forget where it was supposed to be. I found myself having to “tuck myself in” more often, and had to wear my period panties all month long because of worsening leakage when I coughed or sneezed. I had more difficulty with urinating and bowel movements, regardless of their consistency, because my rectum was fighting with my bladder for the open space in my vagina. My vagina would bleed after bowel movements, because it would get over-stretched and the walls would tear a little each time, unless I remembered to “splint” it. I had to urinate much more frequently while on my period, when my cervix was at its lowest in my cycle. Whenever I tried to have sex with my husband, I would have to stop very quickly and then curl up in bed, crying in pain after he hit my uterus, so we stopped trying to have sex at all.
Finally, as I recovered from my injury and began walking again, I got determined to demand the care that I needed and deserved. No one deserves to suffer the way I had. I got a new doctor, who referred me without even doing an exam because she knew she was not qualified to diagnose pelvic organ prolapse. At first, the specialist I saw sounded like she was skeptical of my symptoms. I’m young and relatively healthy. I couldn’t possibly be having this much trouble. My body couldn’t be doing the things I said it was doing. Bodies simply don’t work that way.
Halfway through the exam, I finally got the validation I’d been seeking for 5 years. “OH! NOW I see the problem!” That’s what I heard her shout from between my legs, as she poked and prodded and told me to bear down. The tone of shock in her voice sent a chill up my spine, and filled me with dread, while a wave of relief at finally being vindicated washed over me at the same time. She concluded the exam, and had me hold a rubber glove by two of its fingers. She held the other end, and gestured to the palm of the glove. “This is your vagina,” she said. “And these are the ligaments that hold up the top of your vagina,” she continued, as she pointed to the fingers I was holding. “And this is what is happening to your vagina,” she explained, as she had me move the tips of the fingers to meet her hand at the bottom of the glove. My vagina was collapsing because the ligaments that hold it up had become stretched and lax. She showed how I was correct that it was my cervix that was protruding from my vagina and having to be tucked back in. She explained that it was blocking my urethra, making it difficult to urinate or fully empty my bladder. The harder I’d try, the more blocked it would become. My uterus was hanging down and filling the space, putting it in the path of my husband’s penis. She told me that it was technically stage 2 prolapse, but would feel like stage 3 to me because of the protrusion of my cervix.
We wanted to have another child. This news was devastating. I can’t even perform the act of trying to get pregnant, much less carry a baby, with everything trying to fall out of my body! And surgery to repair it would make it dangerous to attempt pregnancy again.
Thankfully, she did give me hope that a pessary and physical therapy could improve things enough to make it possible to have another baby, and pregnancy might even help hold things in place as my uterus got too big to fall into my vagina anymore. So we scheduled my pessary fitting, and she referred me to a pelvic floor physical therapist.

Unfortunately, at my first visit with my physical therapist, I was informed they will no longer take my insurance beyond the end of this month, and there are no insurances I could switch to that they will take. The next closest one is over an hour and a half away. I can’t drive 3+ hours round trip multiple times a week! I have a business to run and children to care for. It simply is not feasible for me.
Lucky for me, and for anyone reading this and going through similar, but unable to get treatment, I won’t give up that easily. Stay tuned for updates on my journey as I learn more about pelvic organ prolapse and ways to treat it without a professional physical therapist.

♥ SPD – Symphysis Pubis Dysfunction ♥

This is something important for all women to know about. It is a lot more common than you might think, despite the fact that most doctors in the US don’t know about it, or don’t believe it exists. Don’t ever let your doctor tell you that excruciating pain is “normal” or tell you to “just deal with it”. If you are experiencing a large amount of pain, you have every right to adequate treatment of the cause, not just of the pain! If you suspect you may have SPD, and your doctor refuses to refer you to a specialist, find another doctor. SPD can cause permanent, sometimes debilitatingly severe damage if not handled properly. Please see the warning about labor and delivery near the end of this post for more information on this.

 

 

What is SPD?

 

SPD stands for Symphysis Pubis Dysfunction. It is also sometimes referred to as pelvic girdle pain, or PGP. It affects pregnant women, but can persist beyond pregnancy in a rare few very unlucky ladies. In simple terms, SPD is a misalignment of your pelvic bones, caused by your body producing too much of a hormone called relaxin during pregnancy. Relaxin is what helps your spine realign to make room for Baby, your hips to expand, and your pelvic bones to separate to allow Baby to be born. It’s a good thing — in proper amounts. When your body produces too much of it, the joints in your body become extra flexible, and much more prone to misalignment. In some women, this doesn’t become a problem unless they have some kind of trauma occur, such as a car accident or a fall. We don’t exactly have the best of balance when we’re carrying an extra 20+ pounds in front of us and our joints are soft, do we? When we fall, especially if we land on our hands and knees (which of course is much better than our bellies) the pelvis can easily become misaligned. In my case, my right hip became tilted backward. The body does not naturally realign itself without proper guidance, so the misalignment, if not corrected, can cause excruciating pain that lasts for a very long time, and only gets worse. In some women, however, SPD can occur without any kind of trauma. The hypermobility in the joints caused by the excess hormone can make it easy for the symphysis pubis to work itself into misalignment over time.

How is SPD Diagnosed?

It cannot be 100% diagnosed “officially” until pregnancy is over, by doing an x-ray to see if the symphysis pubis is misaligned. It’s not that difficult for a good chiropractor to recognize it, though. For one thing, most people that have SPD have one leg slightly longer than the other, due to the misalignment of the pelvis. 

How Can You Tell if You Have SPD?

 

A tearing feeling in the middle of your pubic bone and/or perineum is a pretty strong clue. I’m not talking about the odd twinge here and there caused by stretching during pregnancy. This tearing feeling is different. It feels like you are being ripped in half. While the pain may subside quickly in the beginning, over time (if left untreated), it becomes more constant, and spikes with every movement, rather than just walking. It may hurt when rolling over in bed, or when sitting in a bad position. The pain usually subsides for the most part when sitting or lying down, at least until the condition progresses very far. Taking long strides when walking, going up and down stairs, and standing or walking for very long also cause great pain. This pain can also be felt in the hips, usually one side more than the other, or only on one side. The pain can be in different areas for different women, and may feel a bit different because everyone perceives pain differently, and the misalignment can go in various directions and affect different places. 
Clicking, cracking, and popping noises and feelings in the pelvic region and hips are also very common when you have SPD. Sometimes they can be so loud that others hear them, and sometimes they just feel like they are. Sometimes these pops can bring relief, other times they can make the pain worse. It just depends on whether or not your body is adjusting itself in the right direction.

How is SPD Treated?

There is no one-size-fits-all treatment. A combination of stabilization exercises, ice, positioning, and manual therapy is the most effective. Stabilization exercises reduce stress on the joint and improve stability. Stabilization exercises include strengthening the abdominals, pelvic floor, gluteals, latissimus dorsi and hip adductors. Chiropractic care is the most highly recommended component of treatment by those that have tried it. It is certainly what I recommend over anything else. Physical therapy is common in the UK, and sometimes attempted in the US, as well. Swimming is a good option, especially in conjunction with aquatic therapy if you can find a therapist trained in treating SPD. 
Many doctors will simply tell women to take acetaminophen (also known as Tylenol or paracetamol), and if the pain gets bad enough, give them crutches, or in rare cases, a wheelchair. This isn’t really treating the problem, however, only the symptoms. There are also a couple of different types of surgery that can be performed to try to repair it if it persists after delivery, but they have very low success rates, and sometimes can actually make the pain worse. One type involves fusing the pubis together with a metal plate. Another involves binding it with something else, like thread or ligaments from a donor (like a pig) or another part of your body. These surgeries also make future pregnancies highly inadvisable, since they immobilize the pubis, and make future vaginal delivery impossible. They can also come undone if you do become pregnant again because it will try to separate anyway to make room for Baby. I do not personally recommend these procedures at all, based on their outcomes, unless everything else has failed and you are desperate enough to risk it.

What Can You do to Minimize the Pain of SPD?

If you have SPD, or think you might have SPD, always be mindful of the following:
♥ When getting in and out of a car or getting up from a chair or bed, keep your knees together.
♥ Do NOT do extreme stretches, especially one-sided ones. DON’T do lunges or squats. These kinds of stretches have the ability to cause irreparable damage to the symphysis pubis that simple chiropractic care or physical therapy cannot fix, and then your only hope left would be the dismal chance of successful surgery. It is important that any stretching you do be symmetrical, to avoid exacerbating the misalignment, and that it be done while sitting or lying down, to avoid pressure on the pubis. 
♥ Sleeping with a pillow between your knees helps to stabilize the pubis at night.
♥ Sleep with your knees in a symmetrical position. Do not sleep with one knee drawn upward and the other leg straight, as this can worsen the misalignment and cause you much more pain, despite potentially being comfier for sleeping. It might take some getting used to and a lot of training yourself to be able to sleep in a different position, but it is well worth it. 
♥ Sit down to put on socks, shoes, underwear, and pants. 
♥ Take stairs one step at a time if you cannot avoid them altogether. A good phrase to remember is “up with the good foot, down with the bad foot,” meaning that you lead with your least painful side when going up steps, and your most painful when going down. 
♥ Take small strides when walking, trying to keep your knees as close together as possible, and don’t walk for too long at a time. 
♥ Rest frequently. 
♥ Do not cross your legs while sitting.
♥ Limping actually makes the misalignment, and thus the pain, worse, so try to avoid it if at all possible. 
♥ Keep your knees together when rolling over in bed, or with the pillow still between them. 
♥ Try sitting in a tall chair if you do the dishes or cook. 
♥ Anything you can do to take pressure off of your pelvis will help. 
♥ Change positions and shift your weight frequently when standing. Try not to favor one side when doing this, as this helps further the misalignment.

What Should You Do if You Think you Might Have SPD?

If your insurance will cover it, or you can afford it, don’t wait for the pain to become unbearable. Get an adjustment from a knowledgeable chiropractor at the first sign of trouble and see a physical therapist to instruct you in stabilization if at all possible. This makes it much easier to treat, and increases your chances of a full recovery.The longer you wait, the worse the damage becomes.Many chiropractors have a self-pay option for $25-50 per visit, and some give discounts for those on Medicaid or who are uninsured or have low or no income. Reach out in your local community and ask for help. If you are in the US, call 211 to ask for referrals to resources that may be able to help. Start a GoFundMe. Do whatever you can to take care of yourself. Don’t let yourself suffer.

 

What is Good to Keep in Mind During Delivery if you have SPD?

 
The best position for delivery if you have SPD (and one of the best for everyone during labor in general) is on all fours. It is the most natural, and allows more room for the pelvis to expand, while actually taking pressure off of the pubis. In this position, the tailbone has room to move to make more space in the birth canal. It is much more comfortable during contractions for most women, as well.
Squatting has been recommended by some providers. I have not heard any accounts from people that have SPD that have delivered in this position, though, and since it still puts so much pressure on the pelvis, and stretches it so much, I would personally be a bit hesitant to try it, but I would definitely try it before the lithotomy position if I needed an alternative to being on all fours. A supported squat using a birthing stool or sitting on the toilet may help decrease the chances of injury with squatting.
Waterbirth is also a really good choice. This is when you actually deliver Baby in a pool or tub of water. It helps to decrease tearing of the perineum, and decreases the pain of contractions, as well. This is not always possible, but is becoming an increasingly more available option across the world. It is most common in birthing centers, but some hospitals do offer it. Homebirth with a midwife or freebirth (without any medical professional in attendance) also make this possible. 

What is the Most Important Thing to Know About Having SPD?

 

You have to be careful during delivery when you have SPD. If Baby is in a funny position, such as with their arm up by their head, during delivery, most doctors/nurses will forcefully grab your legs and push them up to your shoulders. This is one of the absolute worst things that can be done to someone with SPD, and almost always results in irreparable damage to the symphysis pubis, which can cause extreme pain for the rest of their life. Like with the stretching I warned against, this can actually cause severe tearing of the ligaments and in some cases, the muscles around the pubis. 

The lithotomy position (lying on your back on a bed or table during delivery) is the worst possible position for anyone to give birth in. Not just anyone with SPD, but anyone at all. The World Health Organization cautions against this position. Despite the fact that the US uses this position almost exclusively, it has been banned in many countries. It compresses the birth canal and slows labor. It also increases the chances and degree of tearing that may occur during birth. It may even increase the chances of needing an emergency C-section and the use of other interventions, such as forceps or venthouse. The common use of stirrups in this position is one of the dangers to people that have SPD, as it can also cause tearing of the ligaments in the pubis.
Having an epidural or spinal block also increases your chances of permanent damage due to SPD. Because it numbs you, your body can’t tell you when you are in a position that is putting too much stress on the pubis. You won’t be able to feel if your ligaments or muscles do begin to tear. If you can’t feel it, you can’t stop it.
It is very important that you make sure the doctor/nurses/midwife present at your delivery know that you have SPD, and know not to force your legs apart or to put you in stirrups. Some doctors will try to tell you that you cannot have a vaginal delivery if you have SPD. This is simply untrue. While there may be more risks to the pubis with a vaginal delivery than with a C-section, there are still more risks in general with a C-section, so it is still no more advisable over a vaginal delivery for someone with SPD than someone without it, unless there are other issues present that make a C-section a safer option.
Again, don’t ever let a doctor blow you off if you are having extreme pain. Trust your body. If something doesn’t feel right, then it probably isn’t. You know your body better than anyone else. Doctors may have lots of knowledge about lots of things, but they are not omniscient. They do not know everything. The best doctor can admit that sometimes the patient does know better than they do. If your doctor is unwilling to listen to your complaints, or is refusing to investigate your symptoms, please don’t hesitate to find another doctor that will listen to you and CARE. Many doctors think of patients as just numbers — money in their pocketbook. A truly good doctor will actually care about you as a person.

Where Can You Find More Information on Treating SPD?

You can find further information on:

 
 But the best information by far that I have come across in my research came from