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Hi All,

I have been contacted for advice by a lady who, 14 months after giving birth is struggling with a prolaspe. She attended my pregnancy yoga classes and I did a few postnatal one to one sessions with her shortly after the birth, focusing on the reverse breathing and birthlight postnatal recovery techniques. Despite this and doing pelvic floor exercises pre & postnatally, she is still suffering with vaginal prolaspe. Her GP has advised no matter how much pelvic floor exercise she does, it won't change as the damage is internal due to natural childbirth. She was referred to consultants who recommended surgery (Laproscopic Hyteropexy).

It seems she is keen to avoid surgery if possible has done her own research and mentions a book called 'Holding the Ball- how I survived pelvic organ prolapse without surgery and Michelle Kenway (Australian Physiotherapist's) exercise book.

I have pointed her in the direction of a local pyhsio that specialises in women's pelvic health but wondered if anyone is aware of any other resources, information or yoga techniques in addition to pelvic floor exercises, that maybe helpful.

Many Thanks in advance for any comments or help

Sarah Bickley

Prolapse, hyteropexy and birthlight yoga

Hi Sarah, as usual with posts about complicated postnatal issues, your post about repair of prolapse (you say vaginal but it seems more like a uterine prolapse felt in the vagina?) raises more questions before anything sensible can be said. The first question is about the birth, how was it? Do you know whether this lady had a retroverted uterus? was the baby posterior? was the baby large? lenght of labour and any interventions? Sometimes the birth process causes extreme tension of some of the ligaments that attach the uterus to the pelvis, particularly to the sacrum. Did this lady experience sharp pains at any time during her pregnancy, particularly in mid pregnancy? How does her prolapse feel: as heaviness in the top part of her vagina? or as a collapse of one or both walls? when she walks? more when she gets up after sleeping? How are her bowel movements in general and at present? has she been experiencing any bladder problems before or since giving birth? All these questions aim at understanding better where the weakness is. A hyteropexy consists of applying a mesh of artificial tissue to support the cervix, or a replacement ligament sling to hold the uterus in place without affecting the cervix (preferable if this lady wants to have more children). This sounds like a great replacement of natural body functions without damage to the organs. Yet after meeting several women who had this procedure I have been alerted to possible complications, both short term (bladder issues, painful sex) or long term (need for further surgery after a few years and particularly around the menopause when hormones affect tissues).  In the Oxford medical dictionary, the risk of complications is given as 1 in 3 or 4. It may be a coincidence that I met women who experienced complications but nevertheless the risk seems high enough to be taken into consideration. Also, 3 to 4 weeks of bed rest are recommended after the procedure as per the Oxford entry.  Which new mother can comply with this unless she is lucky enough to have full time child care? what are your lady's circumstances? She might not even be told that she needs this rest, as the women I met who had hyteropexy. So lots to be taken into account! Re yoga: our birthlight postnatal breathing and pelvic re-alignment practices are taught in a basic way that is appropriate for a majority of new mothers but in the case of any prolapse much more is required. This becomes yoga therapy rather than yoga and demands more knowledge and skills. In the module of the Postnatal Manual on addressing postnatal ailments with yoga, there is a short description and an image of Maha Mudra practiced with a belt or rebozo. I have used this classic yoga pose with bandhas successfully for reversing uterine prolapses, even after a long time, before laparoscopic surgery could be offered to women (it was hysterectomy or put up with it !). I would also recommend the '3 sphincters' toning in a supported setu bandha pose 3 times a day (just a few minutes followed by rest in the supported inversion). Make greater use of the isotonic practices (pressing palms of hands on exhalation) in supported setu bandha to improve general muscle tone in the pelvis. The breathing needs to be really full, with awareness and dedication. More than this I cannot comment without appraising this lady. I am sure you have taught her well, Sarah, prolapses are complex and require more than our standard yoga practices. My views on the ball exercises you mention are that they can be beneficial or harmful depending on cases, while yoga is more gentle and restores elasticity long term irrespective of the kind of prolapse. But then you can say I am biased! I am interested in improving our practices therapeutically to help ladies in situations like the one you describe and your post is an incentive to go deeper and offer more effective practices. Please let me know what this lady decides to do and if you send me a personal email I am happy to guide you in supporting her with yoga either as an alternative to surgery she can try or as a post-surgery recovery (that will be needed). All best wishes, Francoise.