‘Body come down’ after having children
Dear Dr Mitchell,
After giving birth to four children, I’ve noticed that I have ‘body come down’, and it is embarrassing me. Is surgery the only option for a woman in my position?
‘Body come down’ or prolapse of the uterus and vaginal wall, may be seen as a complication of vaginal delivery. This usually presents with a bulge in the vagina and in severe cases, may be entirely outside of the vagina with the cervix and vaginal wall totally exposed. Some women have associated back pains, described as a ‘dragging’ sensation in the back and lower abdomen. Pelvic floor prolapse or uterine prolapse is seen in cases where there is delivery of a big baby, usually over 4kg or nine pounds, the use of forceps or vacuum extraction to deliver a baby, prolonged pushing in the second stage of labour to try and get the baby out, and also if there is excessive damage to the pelvic floor with lacerations which are extensive.
In the early stage, the first presentation might be difficulty holding the urine, with leaking of urine on laughing, sneezing or during exercise. There may be a problem with incontinence of faeces, involving soiling of the underwear because of the damage to muscles of the anus at the time of delivery.
Women who are overweight, diabetic or on steroids can have weakness in the pelvic floor muscles which can put them at an increased risk for prolapse.
Chronic constipation, smoking and lifting of heavy weights can also make prolapse worse, or might even be the underlying cause. If you have increased pressure on the pelvic floor from fluid in the abdomen and pelvis, this can weaken the pelvic floor and cause prolapse. This may be seen in women with an ovarian tumour.
It is important to have a detailed examination done by your doctor to determine if there is another cause for the prolapse other than the delivery of your four babies. It is extremely important to correct any underlying risk factor for the prolapse before doing an operation to correct it. Women who are overweight should lose weight and maintain this even after the surgery to prevent recurrence of the prolapse. Chronic coughing, constipation and diabetes mellitus should be properly treated and controlled. Smokers should stop smoking.
Pelvic floor exercises (Kegels) should be done to help to strength the pelvic floor.
How to do Kegel exercises:
1. Make sure your bladder is empty, then sit or lie down.
2. Tighten your pelvic floor muscles. Hold tight and count three to five seconds.
3. Relax the muscles and count three to five seconds.
4. Repeat 10 times, three times a day (morning, afternoon and night).
In some women, a ring pessary can be used to reduce the prolapsed vagina and uterus in the short term until surgery can be done. In some women this can be used as a long-term form of treatment, especially if you do not want to do surgery. This ring pessary has to be removed, cleaned and re-inserted by the doctor every three months. Failure to do this can result in infection, bleeding and damage to the bladder and vaginal walls. The ring pessary might also cause pain or discomfort during sexual activity and might not be an appropriate option for sexually active women in the long term.
Surgery can be done whereby the prolapse is corrected by removal of the prolapsed uterus in women who do not want to have any more children. This can usually be done successfully through the vagina, though an abdominal approach is, however, sometimes necessary.
Consult your doctor who will do the detailed examination and determine what is best for you in the short and long term.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
