Pelvic organ prolapse and healing the postnatal body

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It was my first walk outside since having him. I carried him in a sling and tried to make my mouth form words when I bumped into people I knew, but it felt rusty, and the right sounds wouldn’t come. Walking was slow progress because my legs felt like stiff, disembodied stalks, and their origin - my core, the power centre that gave the me the strength to set forth - seemed to have been switched off. It felt like I was trying on someone’s else’s body and this unfamiliar set of bones and muscles could not compute my instructions.

I had carried a baby to term and birthed them for the second time in my life, an act that is both ordinary and extra-ordinary. And in the last month of pregnancy, the ligaments and muscles and fascia holding my pelvic organs in place stretched so much that I could feel my organs bearing down into the entrance to my vagina, what’s called a pelvic organ prolapse. When it first happened, I had no idea what it was and I was terrified that I was losing my baby. But afterwards I wondered if it was strange that I could be so clueless about this common occurrence*. I wondered if it was odd that I didn’t exactly know WHAT was WHERE inside that dark cavernous space inside me, or that it was only in my twenties that I could remember the difference between vulva and vagina, or that so many of us obediently do our pelvic floor exercises but are not enlightened exactly as to why we’re doing them.

I wanted to read some real mothers’ experiences of pelvic organ prolapse, so I googled “prolapse + mumsnet” (of course!) I was kind of horrified to see how many women used the words embarrassed, ashamed, grossed out and even disgusted with myself, but I was not really surprised. There is something quite body-horror about prolapse, which in its most extreme case can see the most internal parts of the body moving to the external. The symptoms can include bladder and bowel incontinence, discomfort and pain during sex, which as well as being so embarrassing to us, engender a quite primal fear about losing control of basic function.   

My own feelings of shame had an added layer - that this was happening to me, who taught women how to work with their pelvic floor, who taught women how to feel strong in pregnancy and recover postnatally. I understood the way the pelvic floor worked, or thought I did. I carried my child on my back until she was nearly three. Up until this pregnancy, I had felt strong from the inside out.

At least all this stood me in good stead to deal with the problem once it had arisen. But attempting very candid discussions with my NHS health providers, I discovered that a lot of medical personnel are themselves squeamish about women’s bodies. It was a strange position to find myself in, that I was less embarrassed talking about my body than these doctors and nurses were. It seems bizarre that you can find yourself telling your nurse that she doesn’t have to pull the curtain while you’re putting your knickers back on, because you’re in the middle of asking her something, but she’s scurrying away so she doesn’t have to see you putting your knickers back on, even though she’s just done a vaginal exam on you. I suppose it shouldn’t be surprising that healthcare professionals are not immune to what subjects our culture considers taboo, but somehow I expected more.

It was clear, too, that attention was focused on my baby, not on me. After I’d had my beautiful boy, I was told I could only have an appointment with the doctor by telephone, because of COVID restrictions. But my baby WAS permitted an 8 week check in person, so I called and begged for the doctor to also see me in person bearing in mind I WAS ALREADY GOING TO BE THERE.

They refused, and so I took my baby into the surgery for his 8 week check then had to run home and pick up the phone to speak to the same doctor for my “check” over the phone (honestly, this actually happened). When the perfunctory 5 questions were over - I could literally hear the doctor ticking boxes after I’d barely finished speaking, rounding things off with my favourite question - what are you using for contraception right now? - and I’d asked to see someone in person again, the doctor said “do your pelvic floor exercises, and at your next smear test ask the nurse to have a look. If things don’t improve there’s the option of surgery.”

Being told to “do your pelvic floor exercises” is an instruction, and being told what to do without a clear understanding of why you’re doing it does not exactly empower us. When I asked low pressure fitness teacher Simone Muller for her thoughts, she said: “We need to start thinking of the pelvic floor differently. When we approach it with the understanding that it’s there to support our internal organs, as the foundation of our core and not as a separate forgotten part of our anatomy, we can appreciate much more easily why it’s so important to have it functioning well. When we consider the monumental changes that happen internally to allow one body to grow another, it figures that postpartum we need careful attention and time to readjust and strengthen those tissues that withstood so much stretch to make space and nourish our miraculous creation.”

And the surgical option for prolapse is not ideal - surgery has a 30% reoperation rate, and rehabilitation - not just kegels but a whole body approach - is an excellent first line treatment. So why aren’t women being offered this straight up? I’ve since spoken to many women who were similarly fobbed off, or who have had to beg for a referral to a women’s health physio. And yet I was fighting off health visitors asking questions about my baby (and why I was bed-sharing). And to be fair, they did repeatedly ask about my mood, aka did I have postnatal depression. But this too felt like box-ticking and nothing like the holistic, nurturing support we need to revolutionise postpartum care.

I am lucky that my symptoms were fairly mild and I could afford to refer myself for a private physio session, which meant information and an active plan for my recovery. My therapist did an internal examination (which means checking inside your vagina to assess the position of your pelvic organs and the strength of your pelvic floor), told me exactly how I should be doing pelvic floor exercises and also recommended I attend Simone Muller’s amazing low-pressure fitness classes online. This kind of pelvic floor examination is paid for by the state in in France, with an additional 10-20 pelvic rehabilitation sessions offered - a preventative approach to deal with dysfunction before it gets worse. But in the UK many women are living with physical symptoms with a mental health element - a 2011 study found that women with urinary incontinence after birth were twice as likely to experience postnatal depression*.

A doctor telling you this is normal and to wait for a surgical option partly represents NHS funding challenges but also speaks of the limits of Western medicine, its failure to see our bodies and minds as an entirely interrelated system - that is, to make the link between our mental and physical health. My experience saw me going from confident in my body to cautious and anxious (kinaesphobia, which is a fear of movement, is common with prolapse). The problem with not moving is the way we get stuck in a cycle - my body felt like a stranger to me so I felt less confident to move it, therefore I felt more achy and stiff and my body felt like even more of a stranger to me.

Once we understand that both our anxieties and our joys shape the way our bodies are and the way they feel to us, it becomes clear that dealing with fear can be the first step to recovery. Fear plays a big role in healing, or not healing - fear about exactly what’s going on in our bodies, fear that it won’t ever change. We heal faster if we really believe in the possibility of getting better. Feeling safe to move freely, to move in a variety of ways, to not be so cautious that we get stuck in a fear cycle, invites this. Movement is change in action, healing in action; movement shows us the possibility of change, it is the proof.

I understand that strengthening my pelvic floor through practising a mechanical lift will help, but I sense that this alone won’t bring me to an optimal sense of health and vitality. But I think moving from a truly embodied place will. Re-finding the joy of movement, the re-learning of the small, subtle miracles of the body, the way everything is connected is the gold that can come out of a period of injury, trauma or extended rest, of which pregnancy and postpartum are kind of all three. Western medicine frequently fails to facilitate an active role in our own healing, so we have to look elsewhere for the support we need to do this (that is, if we have the money, the knowledge and the energy to look for the therapists, the doulas, the postnatal fitness specialists to help us do what the state are currently not doing).

I have days of wondering if I’ll ever feel really strong again, of desperately missing my body as it was, of feeling triggered by others’ yoga practices or the way they run and jump freely. This is part of the journey to recovery in all senses, and postnatal recovery can be slow, because postnatal women are tired, their resources are being depleted elsewhere, and they're time-poor. So it matters even more to have someone to support us and help us trust the process.

Trauma theory tells us that the events of our lives are imprinted in our tissues, that we hold the patterning of our nervous systems inside us. We can be activelyinvolved, therefore, in the reimagining of our bodies and our lives. This is what I feel about my body:

My body is not and never was a set of symptoms. My body is not and never was the sum of its most painful, disobedient parts. My body is a seething, trembling mass of cells and molecules and chemicals; it has strength and stretch and weakness and space and density and length and breadth and meaning. It moves in straight lines and circles and waves of distraction and exhaustion and energy and attention and love and grief. It co-created and carried two beautiful humans. As a container, it both holds and allows things to move through. As a bearer, it both remembers and lets go. 

In his book about pain in the body, Steve Haines said:

“Anything that de-threatens the sensations you are feeling and supports new possibilities will break the pain habit. Sell yourself more beautiful, elegant and accurate stories.” 

I want everyone who has given birth and felt grief at the loss of an old self to sell themselves better stories, to own and honour them and re-tell these stories, because this is how we understand, metabolise and move on. I want them to know the balm that is stopping to come home to your body, to listen in, to know it is a haven and is capable of great things, to feel excited every day to see what story their bodies will write. But this is not happening anywhere near as much as it should. There is pain and fear and a sense of brokenness much more than there’s a sense of joy, of freedom. We deserve better.

Resources


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References

These NICE guidelines reported that in the UK, 8.4% of women reported a vaginal bulge or lump, and on examination prolapse is present in up to 50% of women. One in 10 women will need at least 1 surgical procedure, and the rate of re‑operation is as high as 19%. It’s expected that pelvic floor dysfunction will become more prevalent due to our ageing population.

Research by Sword et al in 2011 found that women with urinary incontinence after birth were twice as likely to experience postnatal depression as those without. Research by Ghetti et al in 2015 showed that prolapse significantly affects women’s emotional health and subjective wellbeing (thanks to Emma Brockwell aka @physiomumuk for sharing these stats - Emma is also a fantastic resource for prolapse info)

Chloe George