Prolapse after childbirth: what heaviness or a bulge means, what helps and who to see in Singapore

Heaviness, dragging or a bulge in your vagina after the birth can be prolapse after childbirth: your bladder, womb or back passage has dropped and presses into the vagina. SGH calls it common and says it's often managed effectively. A lump at your belly button or C-section scar is a different thing, possibly a hernia, and your doctor should check that too.

What to do about prolapse after childbirth, step by step

1. Notice what you feel and when. SGH says heaviness often gets worse as the day goes on or after exercise. KKH says many symptoms ease when you lie down.
2. Start pelvic floor exercises early. KKH advises them soon after delivery, and SingHealth says to keep going for at least 4 months. Our postpartum pelvic floor guide shows you how.
3. Keep your stools soft and don't strain. KKH tells new mums to avoid bearing down and constipation. SGH suggests high-fibre food, plenty of water, and stool softeners if your doctor advises them.
4. Lift your baby the way SGH teaches. Hold the load close to your body and bend your knees. Breathe out as you lift so you don't bear down.
5. Let your helper, partner or family carry the groceries, the laundry basket and older children while you're in confinement. Heavy lifting can make a prolapse worse, KKH says. SGH adds high-impact sports to the list.
6. Check your belly button and C-section scar for a soft lump. NUH says hernia symptoms get worse with standing, walking or straining, so show your doctor any lump you find.
7. Bring it up at your six-week postnatal check. Ask to be examined, and ask about a women's health physiotherapist. SGH says pelvic floor physio is essential for every grade of prolapse.
8. Call 995 if a hernia lump gets more swollen than usual or changes colour. Do the same if it comes with very bad tummy pain or vomiting.

Why birth raises the chance of prolapse

Your pelvic floor is a hammock of muscles, ligaments and connective tissue that holds up your bladder, womb and bowel. SGH calls childbirth the single biggest risk factor for prolapse. A large baby, long pushing, or a forceps or vacuum delivery can stretch and tear that hammock. KKH puts it simply: birth can overstretch the tissues.

Prolapse is common. SGH says up to 50% of women who have had children show some degree of prolapse when a doctor examines them. Only about 10 to 20% seek treatment for symptoms that bother them.

A caesarean doesn't rule it out. SingHealth says childbirth may weaken the pelvic muscles even after a caesarean, and over the years that can lead to prolapse. Anything that pushes down on the pelvic floor again and again adds to the load. KKH names constipation, a chronic cough and heavy lifting, and SGH adds excess weight.

Heaviness, a bulge or a lump: what it may be and who to see

Only an examination can tell what a lump is. Use this to describe what you notice and pick your first stop.

Hernia after pregnancy: belly button and C-section scar

NUH describes a hernia as a bulge where the tummy wall muscles have a weak spot or a tear. NUH says umbilical hernias are more common in women, likely because of a previous pregnancy. The NHS lists multiple pregnancies as a cause in adults.

An incisional hernia forms at the site of an old operation, such as a C-section scar. NUH says it can appear weeks, months or years after the surgery. Our C-section recovery guide covers lifting and wound care in the first months.

The NHS says umbilical hernias are usually painless. Adults are usually offered surgery, because the hernia is unlikely to get better by itself. NUH says a doctor can usually diagnose a hernia by examining you. A binder or truss is only a stopgap while you wait for surgery, it adds.

Tummy separation feels like a gap down the middle of your tummy. The NHS says the two muscles that run down your stomach often separate in pregnancy. The gap usually closes by the time your baby is 8 weeks old. Our guide to exercise after giving birth covers it, and when to start running again.

How doctors treat pelvic organ prolapse

Your doctor will ask about your symptoms and the birth, then examine you. KKH says you may lie on your side and then your back, and be asked to cough and bear down. Treatment depends on how severe the prolapse is, your symptoms, your health and your own preferences, SGH says.

• Pelvic floor physio: a specialised physiotherapist teaches the right technique and sets a programme. SGH calls it essential for all grades, and the NHS says pelvic floor exercises can improve prolapse.
• A pessary: a removable silicone device placed in the vagina to hold the organs up. KKH says it relieves symptoms but isn't a cure, and you'll need regular checks to change it.
• Surgery: an operation to put the organs back in place and restore support. KKH calls surgery curative, and your doctor will advise which operation suits you.

In Singapore, KKH's Urogynaecology Centre and SGH's Pelvic Floor Disorders Service both treat prolapse. SGH's team brings urogynaecologists, colorectal surgeons and women's health physiotherapists together. Our guide to leaking urine after pregnancy has their contact details and how referrals work.

If the toilet is painful because of piles, our guide to piles after giving birth has steps that help, and keeping your stools soft eases both.

When to see a doctor

See your GP, polyclinic doctor or gynae soon if:

• You can feel or see a bulge at the opening of your vagina. KKH says to get advice early, because prolapse can be treated.
• The heaviness or dragging hasn't gone by your six-week check, or it's worse. Heaviness is the most common prolapse symptom, SGH says.
• You struggle to empty your bladder or bowels, or you press on the bulge to finish. SGH and KKH both list these as prolapse symptoms.
• You find a lump at your belly button or C-section scar. The NHS says to see a GP, and the same goes for any lump that's painful, hard, getting bigger or won't move.
• The gap down the middle of your tummy is still obvious 8 weeks after the birth (NHS).

Get help the same day if:

• You can't pass urine. KKH lists difficulty passing urine as a prolapse symptom and says long-standing untreated prolapse can hold urine back. KKH's Urgent O&G Centre, a 24-hour walk-in centre at Basement 1 of the Women's Tower, sees post-pregnancy problems.
• A hernia lump is more swollen than usual or has changed colour, or comes with very bad tummy pain, vomiting, or not passing wind or stool. The NHS calls a strangulated hernia a medical emergency and says not to drive yourself. NUH says a trapped hernia can block the bowel. Call 995, which NUH says is the number when you need immediate medical attention.

For heavy bleeding, fever, a hot red wound and the other warning signs after birth, use the full list in our postnatal recovery guide.

Frequently asked questions

Why do I feel heaviness in my vagina after birth?

It can be a sign of pelvic organ prolapse: SGH says heaviness is its most common symptom. Pregnancy and childbirth are the highest risk times for pelvic floor damage. Start pelvic floor exercises, avoid straining on the toilet, and ask your doctor to examine you at your six-week check.

What is the bulge after giving birth?

It depends where it is. A bulge in or at the opening of your vagina may be a prolapse. A lump at your belly button or scar may be a hernia. A gap down the middle of your tummy may be muscle separation. A doctor can tell them apart by examining you.

Does pelvic organ prolapse after birth go away?

It can be treated, and the first steps start at home: pelvic floor exercises and soft stools. KKH says a prolapse won't correct itself once it has happened, so get it checked instead of waiting. Physio, a pessary and surgery are the options, and KKH calls surgery curative.

Can you get prolapse after a C-section?

Yes. SingHealth says even a caesarean birth may leave the pelvic muscles weaker, and over the years that can lead to prolapse. It advises pelvic floor exercises for at least 4 months after any birth.

Can you get a hernia after pregnancy?

Yes. NUH lists pregnancy among the things that raise hernia risk. It says umbilical hernias are more common in women, likely because of a previous pregnancy. A C-section scar can also develop an incisional hernia, sometimes years later.

Is an umbilical hernia after pregnancy dangerous?

Most aren't painful, the NHS says, but in adults they're unlikely to go away without surgery. The risk is the hernia getting trapped. Very bad tummy pain, vomiting, a colour change over the lump or not passing wind or stool means call 995.