Several elements within the female body work together to keep pelvic organs from falling down, or prolapsing, against the vaginal walls. Most predominately are the lumbar curve at the lower back, which serves to deflect internal pressures away from the vaginal outlet; the abdominal wall, which directs the flow of intraabdominal pressure and also balances the pelvic organs over the pubic bone; toned buttocks, which leverage the pelvis into its proper position; and long hamstring muscles at the back of the thighs, which maintain normal spinal curvature by allowing the tailbone its maximum lift. These components work together to create a system that keeps the organs pushed toward the front of the body where they are optimally supported. Ligaments and fascia within the pelvis also have supportive value, but it is the surrounding musculoskeletal framework of the spine and pelvis that creates the true foundation upon which pelvic organ support depends.

The uterus is held horizontally within the pelvic cavity with its large base toward the front of the body and its opening, or cervix, pointing slightly downward into the vaginal canal. The female body is designed to hold the uterus in this position by way of a vast muscular network, a tight connective tissue “stocking”, and a supportive spinal curvature, all of which serve to lock the uterus into proper position. When any part of this self-locking mechanism is compromised, the uterus loses its natural support and can descend into the vaginal canal. The major symptom of uterine prolapse is a pointy bulge near or at the vaginal opening. The prolapsed uterus is not itself painful and does not interfere (except psychologically) with normal sexual function. However, because of anatomic misalignment, abnormal pressures are exerted throughout the rest of the body, which can cause discomfort in the lower back, buttocks, pubic bone, and thighs. It is important to realize that it is not the uterus itself that becomes visible, but the top, or apex, of the vagina turned inside out.

Like most chronic disease, uterine prolapse is best prevented. There exist no surgical options for this disorder that are without significant risk. However, postural and other permanent lifestyle changes, coupled with natural shrinkage of the post-menopausal uterus, can allow even severe prolapse to become barely noticeable with time.

The bladder “floats” within the human pelvis in such a way that allows for filling to capacity several times a day and then emptying by simultaneously contracting one set of muscles while relaxing another!

When the integrity of the pelvic structural support system is compromised, the bladder and urethra can fall from their natural positions and press against the front wall of the vagina, sometimes causing a smooth, rounded bulge near or at the vaginal opening in the upright female. This condition is commonly referred to as cystocele. Depending upon which part of the bladder falls forward, cystocele may or may not be accompanied by urinary incontinence. It is important to realize it is the vaginal wall that becomes visible and that the bladder itself cannot fall out of the body.

There is no favorable surgical treatment for cystocele. The very worst surgical approach to this disorder is hysterectomy because the bladder and uterus share common supportive structures and are dependent upon one another for maintaining their proper positions within the pelvic space. As the well-known author and urogynecologist Linda Brubaker points out, "Support of the anterior vaginal wall remains a challenge to the pelvic surgeon." Cystocele responds to postural and lifestyle change.

A protective curtain of strong connective tissue between the back vaginal wall and the rectum guards both structures from the natural forces of birth and defecation. The integrity of this strong sheath is sometimes compromised by obstetric practices and lifestyle habits, allowing the lowest part of the bowel to press against the back vaginal wall and at times protrude slightly from the vaginal opening. Symptoms of rectocele include a bulge at the back of the vagina, inability to completely empty the bowel during defecation, and the need to press on the back vaginal wall to complete a bowel movement. Rectocele is responsive to postural and lifestyle changes, most importantly a healthy diet and avoiding all straining with bowel movements (See TIPS section.)

Just above the upper reaches of the junction between the vagina and rectum, the tissue that encases the small bowel dips slightly downward as the bowel travels across the lower abdomen. In cases of extreme pelvic floor collapse, this section of small bowel can herniate into the pelvis and press against the upper, back vaginal wall. Our natural anatomy protects against this occurrence, making enterocele relatively rare. However, hysterectomy and surgeries that pull the vagina forward (all the incontinence surgeries) virtually guarantee formation of enterocele. For this reason, an additional operation to obliterate this natural curve in the intestinal pathway is usually recommended at the time of hysterectomy.

Losing slight amounts of urine occasionally when laughing, coughing or sneezing is a familiar experience to most women. In normal anatomy strong, yet supple layers of connective tissue under the front vaginal wall allow the urethra to be gently raised and compressed during such increases in pressure.

If this highly synchronized system is compromised, particularly by nerve damage to surrounding pelvic structures, urinary incontinence can become increasingly frequent and severe.

Urogynecologists still do not understand the female urinary system completely:

“[Urinary] incontinence is a multifactorial condition that is very poorly understood. Our understanding of the condition has progressed very little in the last 100 years. Maybe it is time to start talking about what we do not know instead of aggressively propagating what we think we know.” Urogynecology Journal 2003 14:77

Surgery for urinary incontinence is associated with many complications, particularly in the young, sexually active woman. If a woman has all her pelvic organs and has not sustained trauma from surgery or instrumental childbirth, urinary incontinence is responsive to posture, exercise and other lifestyle factors.

Yes. Cystocele is often associated with an inability to empty the bladder completely of urine, due to the fact that the opening into the urethra is higher than the base of the prolapsed bladder. Even a few drops of retained urine are enough to colonize bacteria and lead to UTI. There is a product called D-Mannose (See LINK section) that many women find protective against bladder infection. Pure cranberry juice is also effective treatment. Buy high quality, unsweetened juice, dilute 1:3 with water, and sip throughout the day. There are also 1000 mg. gel caps of pure cranberry extract that can be taken daily.

It is very important to empty the bladder completely of urine. This can be accomplished by a number of methods (See TIPS section.)

A pessary is a rubbery, diaphragm-like appliance that is inserted into the vagina to hold up prolapsed organs. Made of biocompatible silicone and available in numerous shapes and sizes, some women find them very helpful and others cannot utilize them at all. Those who are able to wear a pessary successfully usually (but not always) have primary cystocele. Pessaries seem to be least effective for rectocele. Silicone pessaries must be prescribed and fitted by a physician. Although the medical profession often suggests leaving them in for weeks or months at a time, many women find they feel better removing the pessary each night to let vaginal tissues reinfuse with blood and oxygen. Consult your doctor.

In normal anatomy, the upper vagina closes to a flat, airless space and is therefore protected against the forces of intraabdominal pressure. There is some question whether holding the upper vaginal space open with a pessary could lead to additional prolapse symptoms. Some women have reported new onset rectocele after regular pessary use. Ask your doctor for further information.

This is an undergarment that provides external support to the perineum (See LINK section).

1. Understand how important the arches of your feet are and go barefoot as much as possible. Walk with your feet pointing straight ahead and your ankles not bending in or out.
2. Do not lock your knees, but keep them soft and positioned directly over your ankles.
3. Relax your belly over your pubic bone. This is like lengthening the area between pubic bone and navel. It is not a sticking out of the stomach, but a proud holding.
4. This encourages the natural curve in your lower spine. Understand that this curve creates the internal anatomy that keeps the pelvic organs positioned over the pubic bone.
5. Lift up the bottom of your rib cage slightly as if you were pulling your belly up by the last set of ribs. There should be no great effort to do this, but only an awareness of the chest being gently lifted.
6. Keep your shoulders down and your upper back flat and broad. Do not pull the shoulders back as in military posture, but press them down while broadening the area between shoulder blades.
7. Elongate your neck. Do this by making your head go up and forward by slightly tucking your chin. Imagine your whole body suspended by a string attached to the top of your head (not near your forehead, but back at the crown.) Keep pulling yourself up throughout the day by this imaginary thread.

In teaching the posture, I’ve focused on reinstating the lumbar curve because that is the most obvious change in spinal shape that occurs for most of us. However, a much more accurate description of the goal of the work is to train the body to hold the pelvic diaphragm in its natural slope from the pubic bone uphill to the tailbone. This requires lengthening the hamstring muscles at the back of the thighs and strengthening the gluteal muscles, which results in a definite lifting of the buttocks and a gentle curve to the lower back. Consequently, the vagina and rectum are pulled toward the back of the body while the bladder and uterus are pushed toward the front of the body. The best way to learn the posture is to begin a walking program each morning incorporating the posture into your body/mind so that it becomes natural and automatic.

Create as much space as possible between your shoulders and your ears. Imagine your highest point being the crown of your head and pull up through this crown.

Elongate your neck by slightly tucking your chin. Do not tuck so much that your voice box is compressed.

Keep your shoulders down. The upper back is flat and broad because the shoulders are not pulled back and the shoulder blades are not pinched together.

Do not pull your belly in, but have a sense of pulling it up by the last pair of ribs. There should be a gentle outward curve from the bottom of the breastbone to the pubic bone.

Hold your abdomen out and over your pubic bone. This is not a flopping out of the belly, but more like a proud holding. Your belly should remain relaxed, but slightly firm. Try to gain a sense of the curve in your lower spine that happens naturally when you hold your abdomen in this way.

Keep your knees in the same alignment as your ankles and do not bow them backwards.

Always walk with the feet pointing straight ahead. Distribute your weight evenly between three points on the soles of your feet: below the big toe, below the little toe, and in the middle of the heel. This will help you not roll your ankles in or out.

Too much lumbar curve can cause arthritis of the lumbar vertebrae and is prevented by the way in which we hold the upper back and head. It is not possible to hyper extend the lumbar spine while keeping all other aspects of the posture. Strong abdominal muscles work to oppose the back muscles that hold the lumbar curve, thus preventing too much curve. The best way to strengthen these muscles is not through sit-ups, which can aggravate prolapse, but through vertical leg raises. The posture itself exercises the abdominal muscles because the belly is being held in a relaxed, yet “braced” way.

The belly should not flop out in front. Rather, it is held in a braced, yet effortless way over the pubic bone. This is a beautiful, feminine look that can be found in the pages of fashion magazines and also on the most beautiful dancers in the world. We want to avoid trying to achieve a flat, board-like abdomen, but one that is toned and ever so slightly curved from breastbone to pubic bone.

These are: sitting on the floor with a straight back (while maintaining all aspects of the upper body posture) and the legs stretched out in front; sitting cross-legged with a straight spine; coming down from a kneeling position onto the soles of your feet with a small cushion underneath your bottom; straddling a wide stool.

Hatha yoga is a physical and spiritual discipline that was historically practiced by male ascetics in India. Traditional Indian women did not practice “yoga” as we know it in America. Rather, in ancient times women were temple dancers who perfected a beautiful form of movement that reinforces all elements of natural female posture.
Like the ancient tradition of yoga, Pilates is a form of exercise created by and for the male body. The original core mat program of Pilates places the body in a wide V-shape, with head and feet held off the floor. This sends tremendous stress to the pelvic diaphragm, an area that is compromised for many women.
Women certainly need core training. However, we have a differently shaped core than men. Men have a relatively straight torso and women have an L-shaped torso due to the pelvis being at right angles to the abdominal wall. Women benefit most from exercises that work both the abdominal muscles and the gluteal muscles at the same time.

Yoga and Pilates can be appreciated by men and women alike, but it is best to be aware of posiitons that send undue pressure to the female pelvic diaphragm.

Here is a list of poses that present a problem for women due to extreme increases in pressures exerted against the pelvic diaphragm: all variations of the sitting boat pose and the classic Pilates mat program; the camel; the fish; the locust; lumbar lifts and lumbar presses; the warrior; lateral angle lunges with or without twists; the bridge; the wheel and all passive supine backbending. Even tadasana challenges us to conform to the male spine.

Inversion boards and poses are great for such things as improving circulation, but these have no lasting effect on prolapse. The work gets done when we’re on our feet.

The singular focus gynecologists have made of the pelvic floor has been in large part a wild goose chase. Doctors of yore observed that the organs were falling through the genital hiatus, or split in the pelvic floor musculature, and therefore assumed muscle weakness was responsible.

The human female pelvis can be thought of as a box-shaped space. In normal anatomy, this box is balanced on its edge. One flat plane of the box extends up and back from the bottom of the pubic bone…this is the pelvic floor. Another flat plane of the box extends from the top of the pubic bone forward and up…this is the lower abdominal wall. The other planes of the box extend across the pelvic cavity and down the sacrum (this makes it not exactly a square box, of course.)

What happens in the development of pelvic organ prolapse is that the box has fallen from its edge onto one of its flat planes (the pelvic floor.) Concurrently, the organs have pulled away from the front of the body, due to the gravity of their weight.

When we reinstate natural female posture, we are tipping this box back up onto its edge so that instead of the organs falling into the vagina, they are now falling over the pubic bone, where they have adapted to be optimally supported. There is a co-contraction of the pelvic floor muscles every time we hold our body in this way, because a “braced abdomen” works synergistically with the pelvic floor. You can sense this yourself.

The pelvic floor is connected to the pubic bone in front, the ischial spines at the sides of the pelvis, and the coccyx in back. In the non-prolapsed state, the cervical os, or opening, is at the level of the ischial spines. If the uterus and bladder are only slightly prolapsed, kegel exercises can help to move them up to the level of the pelvic floor. With severe prolapse, however, it is anatomically impossible for pelvic floor contractions to pick these organs up from way down below and lift them back up into the pelvis.

The error of the pelvic floor hype is that it is just one side of the box! Unless you change your posture you can kegel until you are blue in the face and still it’s very likely your condition will remain progressive.

Doctors advise against any sort of “jarring” exercise such as running. However, several of our members run regularly with no exacerbation of their symptoms. Maintaining the posture while running is the key to proper support. Consult your physician before beginning a running program.

Yes, the organs are pushed into their natural positions with sexual intercourse and sex can be therapeutic exercise. However, some women report discomfort during sexual activity, particularly those experiencing primary cystocele or rectocele (See TIPS section). If you are unsure about sex, proceed with caution and make certain your partner is considerate of your special needs.

Heavy lifting has been traditionally identified as a primary causes of prolapse. The female body is not designed for heavy lifting, yet certainly has the capability of safely carrying moderate loads, such as the weight of a small child. We are discovering at Whole Woman™ that how much you lift is not as important as the way you lift. Bend the knees, strongly contract the pelvic floor, and keep a straight back while lifting. Consult your doctor about any specific lifting restrictions you might have.

Acupuncture is useful for many conditions, but has never been shown to have any effect on prolapse. Prolapse is a structural problem; therefore changing the structure is the primary focus of treatment.

Manually moving the pelvic fascia is expected to have some benefit for prolapse, but it is probably minimal. Prolapse is a whole body problem, therefore the entire musculoskeletal system must be mobilized to restructure the spine and pelvis to better support the pelvic organs.

All forms of prolapse virtually guarantee a retrodisplaced uterus. Retroversion describes the “tipped uterus” we hear of over and over again, which is actually the earliest stage of uterine prolapse. The normally tight vaginal angle that keeps the cervix pointing down and slightly back toward the spine, and the uterine body, or fundus, flipped over and positioned toward the front of the body has straightened. The uterine fundus begins to tip upward, while the cervix starts to point directly downward. Intraabdominal pressures striking the end of the fundus now work to push the uterus further into the vagina.

Sometimes a coexistent rectocele, cystocele, or both, will stop the uterus from descending all the way. However, intraabdominal pressures continue to push on the displaced uterus so that eventually, instead of striking the top of the uterus, they are now striking the underside and pushing it against the rectum. This is a condition known as retroflexion.
This is all part of the same process for which 100 years ago almost all women in this country, young and old alike, were operated on (thus the development of hundreds of variations of uterine suspension.) This quote from 1914 by a Doctor Baldy is quite telling:
“In my opinion nine-tenths of the operations performed on women for retrodisplacement are uncalled for…I am sorry to say it but it looks to me as though the possible number of retrodisplacement operations performed in this country is limited only by the number of females in existence.”

Yes, the postural work is expected to improve the position of a retroverted uterus.

Many of us have been told our conditions have their origin in disorders of our connective tissue, a diagnosis that speaks to the heart of very deep and complex issues surrounding the treatment of pelvic organ prolapse.

Connective tissue disorders are serious, systemic diseases involving connective tissue throughout the body including that of the heart valves, eyes, and aorta. There are no connective tissue diseases involving only the pelvic structures. Although severity can vary widely, many people with true connective tissue disease (CTD) do not tolerate pregnancy well and have a shortened life span.

Although conventional medicine sees CTD as having a purely genetic etiology, there is also much data to substantiate the widely held belief that these conditions are the result of multi-generational dietary deficiencies.

Not unlike the demeaning diagnosis “vaginal atrophy”, when we are told we have a connective tissue disorder the blame falls squarely in our court. When something so complex, so incomprehensible, so out-of-view as our own microscopic tissues are deemed to be responsible for prolapse, we are rendered helpless and can easily become trapped in an elusive, pseudo-scientific arena where drugs and surgery become reasonable options. Remember that medicine is a poor stepchild of science, and ob/gyn in particular has an extremely poor track record for truth-seeking in the area of pelvic floor health. The highly respected alternative health practitioner, Andrew Weil, M.D., compares this sort of treatment to delivering a “hex” and makes a sound argument that modern medical tactics are sometimes very similar to voodoo in that we believe the things our doctors tell us and therefore they become self-fulfilling prophesies.

That being said, there is also overwhelming evidence that serious, chronic malnutrition is affecting the health of much of the human race. Just as many of us have dental cavities, degenerative joint disease, allergies, and acne, we also probably do not have the healthy connective tissue of our ancestors who consumed exclusively whole, unprocessed, largely uncooked, wild food and mineral-rich, uncontaminated water. Connective tissue is the “glue” that holds bodily structures together and this tissue is built and maintained by nutritional components.

If we do have degenerative connective tissue disease with ligaments and fascia like “lacework”, is amputating, pulling, stitching, and stapling something that is bound to help our condition? It might be a wiser choice to see how we could improve not only the health of our own tissue, but that of our offspring.

This is true. The human pelvis is designed to urinate and defecate in the squatting position. A half-squat is also a natural female position for carrying out these functions.

When we strain against the unyielding rim of the toilet seat, downward moving energies are stopped at our hips and forced back up through the pelvis in harmful ways.

You can avoid straining by lifting off the seat whenever you need to push and allowing your legs to momentarily support you in a half squat. Some women use other methods of squatting (See TIPS section.)

Yes, pelvic organ prolapse uncomplicated by other medical conditions should have no impact on your ability to bring a viable pregnancy to term.

The practice of obstetrics has historically given women very little information on this surprisingly common condition. However, a wealth of anecdotal evidence suggests that in most cases by the beginning of the second trimester the cervix has risen out of the vagina and symptoms disappear.

Further evidence suggests that pregnancy-induced uterine prolapse often resolves on its own by several months postpartum.

There is no reliable data suggesting cesarean delivery either prevents prolapse from occurring or precludes worsening of an existing condition. Integrity of the lower abdominal wall is part of the pelvic organ support system and should be considered in any decision regarding prolapse and mode of delivery.

No one can predict the outcome of vaginal delivery after prolapse. The practice of obstetrics generally believes that because surgical repairs are going to be required anyway, a prolapsed woman might as well deliver vaginally and then have all the damage “repaired” at once.

At Whole Woman™, we see birth as a normal biological process that is protective of pelvic structures. In standing, kneeling, and squatting birth positions, the bladder is held horizontally over the pubic bone while the vertical baby slides past. The cervix does not push down into the vagina but pulls up over the baby’s head and torso. When a woman labors on her back with her legs in stirrups, shear forces are more likely to pull the connective structures surrounding the bladder and urethra down toward the vaginal canal.
A period of at least several days of quality rest is suggested postpartum, after which the maternal spine should be trained to once again hold its natural curvature.

Current medical and scientific literature states that loss of pelvic organ support often begins with episiotomy. The perineal body, or thick, pyramid-shaped tendon between vagina and anus, is a major support structure of the female pelvic system. More and more professional voices are calling for preserving the integrity of this vital structure by avoiding the surgical procedure.

No. This hormone is produced only in the final months of pregnancy and works to open the joints of the pelvis to their maximum capacity in preparation for delivery. Blood levels of relaxin drop immediately postpartum.

There is no data to support this. On the contrary, the hormone oxytocin works to contract and tone the uterus, while bathing both infant and the nursing mother’s brain in a hormonal infusion described as the “biochemistry of love.” The temporary decrease in estrogen blood levels while breastfeeding should have no affect on young, healthy pelvic tissues.

Yes, this is very common and probably has to do with the weight of the endometrium being sloughed off with your period. Women throughout the ages have responded to these days by turning their attention inward, minimizing activity, and nurturing their body through such things as healthy food, herbal teas, massage and rest.

All unusual bleeding should be checked out by a women’s healthcare practitioner. One of the great tragedies of gynecology is responding to women’s concerns about menstrual flooding with the diagnosis of “dysfunctional uterine bleeding” and taking the uterus out as a first course of treatment instead of working with diet and natural therapies to try to alleviate symptoms. Prolapse complicated by heavy bleeding can be exhausting and certainly indication for additional rest and care.

Diet is crucial. Animal foods pack an abundance of energy, but their complexity in the form of hormones, prostaglandins, and loaded lipids (environmental toxins concentrated in fat) may make them more stressful on the body than nutritional. Try getting iron supplementation from vegetarian sources (See TIPS section.) Fibroids grow in response to natural estrogen and often shrink or completely disappear after menopause. Consult your doctor.

Women who report improvement with these techniques range in age from late teens to late seventies. It is never too late to support the female body back toward its natural, functional design.

You would probably be interested in reading my book, Saving the Whole Woman, for another perspective.

The data is not encouraging. The uterus/cervix form the hub of a wheel of connective tissue that holds up the interior of the pelvis. Women experiencing post-surgical prolapse should consult their doctor.

Not at all. Surgery can be life saving and life-transforming. However, the medical literature is clear that pelvic organ prolapse can be highly resistant to surgical repair. Surgeons themselves understand that nothing less than “total repair” is likely to fix a prolapse. These long, extensive operations strive to lift up the entire pelvic area by excising tissue and anchoring organs in anatomically unnatural ways. The result is almost always recurrent prolapse, usually of the front vaginal wall, but can be as severe as urinary dysfunction, bowel paralysis, fecal incontinence, sexual loss, chronic depression, and autoimmune disorders.

No one can argue with another person’s reality. However, we now have almost 30 years of scientific data pointing to the fact that many women suffer life-long disability from hysterectomy. Who can say whether more women are having problems today or that our mothers and grandmothers suffered many symptoms in silence.

No one likes to feel “different” in society. Women urging women to have the surgery is a contributing factor in today’s hysterectomy rate. By age 65, half of all American women no longer have their uterus.