Cystocele and pelvic floor tone

I am seven weeks postpartum and have a one to two degree cystocele and a small rectocele. I was told to wait six months before considering surgery. I was also told that Kegels will probably not remove the bulge. A midwife delivered my nine pound baby without performing an episiotomy. I believe that this would have prevented the cystocele. What do you think?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

There are many influences on the pelvic floor, such as maternal age, weight, medical condition, parity, length of the pushing phase of birth, use of forceps, birth weight and genetic predisposition.

The studies vary according to which of these is the more problematic, but non-performance of an episiotomy is generally not sited as causative. In fact, the cutting of the tissue may predispose women to pelvic floor relaxation.

If the anterior vaginal wall is relaxed and causing the typical bulging, then it is prudent to wait to see what improvement time will bring. Kegels, especially with some feedback about how strong the muscle contraction is, can really help. Some women use vaginal cones, or meters or dials that are available through medical offices or physical therapy centers.

Some relaxation is preventable. That is why, when giving birth, it is prudent to push slowly as your body tells you, avoid the unnecessary use of forceps, watch your weight gain and exercise, including some form of pelvic muscle exercise several times each day for your whole life.

You may be surprised how quickly this improves with proper toning. If possible, I would consult a physical therapist who is experienced in childbirth education.

I wish you the best and I hope this resolves.

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