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Postnatal pelvic floor problems

It can be really distressing to have discomfort as well as feeling a vaginal bulge or lump following childbirth especially if it affects bladder and bowel function, your perception and appearance of sexual parts and the possible effect on their function. It is usually result of pregnancy and birth; this could be recently or from many years ago. Many women feel that having these problems is something that they just have to put up with, but there are things that can be done.

A vaginal delivery can stretch the front wall of the vagina causing the bladder to bulge into the anterior vagina ( cystocoele) or the back wall causing the rectum behind to bulge ( rectocoele)

This may cause a feeling of pressure as well as a bulge which may be temporary and improve with pelvic floor exercise and also when vaginal oestrogen normalises after stopping breastfeeding and periods return. Symptoms may ease for a few years but can return at the onset of perimenopause or menopause.

However the bulge may be uncomfortable and unsightly and affect sexual function, and may also cause an increased feeling of needing to pass urine if it is a front wall prolapse or constipation if a back wall prolapse. Occasionally women can leak small amounts of urine

Your doctor or specialist may suggest repair ( colporrhaphy) but this is often best left until your family is complete for several reasons.

In some cases, if you are planning more children birth would almost certainly need to be by Caesarean section to prevent recurrence and occasional significant tearing in the scar tissue but even a Caesarean doesn’t guarantee that the bulge won’t recur as sometimes it is just the weight of a future pregnancy can cause it to happen again.

Significant problems with bladder or bowel function may mean that you might be unable to wait and will need repair surgery before completing your family, but it is important to talk to an experienced professional who will help you to weigh up all the pros and cons before having a repair as time, exercise and weight loss may make you comfortable, and hospital admission, surgery and being unable to lift for weeks with a young family is also difficult to manage.

Repair if and when necessary will generally return the vagina to a less stretched state and may improve sexual function without long-term discomfort

Richard Sheridan

Private Consultant Obstetrician and Gynaecologist

The Birth Team ,Spire Hospital Bushey and Honorary Consultant Queen Charlotte’s and Chelsea Hospital