Prolapse Mom
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Prolapse Mom
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Posted Wed 28 Feb 2018 at 7:02pm Wednesday 28 Feb 2018 at 7:02pm Wed 28 Feb 2018 at 7:02pm , updated Thu 1 Mar 2018 at 4:41am Thursday 1 Mar 2018 at 4:41am Thu 1 Mar 2018 at 4:41am
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abc.net.au/news/prolapse-women-exercise-pelvic-floor-andree-withey/9490508
Posted 28 Feb 2018 28 Feb 2018 Wed 28 Feb 2018 at 7:02pm , updated 1 Mar 2018 1 Mar 2018 Thu 1 Mar 2018 at 4:41am
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Women living with prolapse — the horrific impact of traumatic birth and exercise
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It's like secret women's business that few women know or want to talk about until it's too late.
Prolapse — it is a deeply personal horror story I'm living with along with many others, and I wish I had known more about it earlier.
I feel like I have lost my freedom to do so many things.
After childbirth, the pressure to get your pre-baby body back is intense.
But the desire and need for strong bodies can be fraught with pitfalls, if you don't realise the damage done from childbirth.
I pride myself on keeping fit, I think my love of pilates, yoga and lots of heavy lifting in the garden have contributed to the problem.
According to the Continence Foundation of Australia (CFA), half of all women over the age of 50 who have given birth have some level of prolapse.
That is when the ligaments are stretched or there is trauma to the muscles which allows the bladder, uterus and or bowel to effectively slip down and either protrude into the vagina or press against the wall of the vagina.
Described as a silent epidemic, the CFA said one in five Australian women required medical help for prolapse in their lifetime.
It is an issue that also impacts many younger women resulting in bladder or bowel incontinence.
It can cause an awful dragging feeling that your innards are falling down, and result in a range of urinary, bowel, and sexual problems.
I had my first daughter which required a rotation with forceps, 26 years ago.
I went on to have another two children in close succession and my body was never the same.
About 20 per cent of women who have a vaginal delivery will suffer a levator avulsion, which is when the pelvic floor muscle is torn from the pubic bone.
But those figures double if you require forceps, and if you're a first time mother over the age of 35, you have the same chance of a levator avulsion even without forceps.
My physiotherapist is giving me lots of help and support as I learn to cope with my diagnoses of both a bladder and bowel prolapse and a partial levator avulsion.
I am an avid walker but if I can't go to the toilet beforehand it can be a disaster.
I plot my walks and much of what I do during the day around where I can find a toilet.
I also fear it will impact my ability to work as a journalist, because out on a job you're not always able to access a toilet.
I've been told not to lift heavy things and that I should use a bag on wheels.
It feels like a kick in the guts because I've already hiked 500 kilometres through Spain and Portugal and I have so many more places I want to go with my backpack.
Finding a toilet in a third world country is hard enough but with incontinence it will be so much more tricky.
The shocking thing about a levator avulsion is it can't be repaired at this stage.
Australian researchers recently announced a new experimental treatment , which uses stem cells from a woman's womb combined with nano-biomaterials to repair tissues damaged after childbirth.
The new approach has been tested on sheep but is yet to be clinically trialled.
Professor Hans Peter Dietz from the Sydney Medical School Nepean Hospital is a world leader in the field and is conducting research trials into the issue, with help from six PhD students as well as some overseas collaboration.
The trials have involved about 240 women with avulsion.
"It took 30 years to get hip replacements right and hopefully this won't take that long," he said.
"It is possible but there are still engineering and technical issue to resolve."
While the research has sparked great excitement for the women living with prolapse, the wait continues.
Brisbane mother Amy Dawes eased herself back into exercise after giving birth. But after a run and a yoga session she said something didn't feel right.
"I could feel my bladder where I shouldn't be able to feel it," she said.
Ms Dawes has a similar problem to me, but she has a bilateral or total levator avulsion.
"I was told that I wouldn't be lifting heavy weights anymore. I wouldn't be running and that I should avoid lifting my 16-month-old daughter. I was devastated," she said.
Brisbane cafe owner Corrine is trying to avoid a prolapse after being diagnosed with a levator avulsion after giving birth to two babies each weighing 4.3 kilograms.
"I used to do a lot of dead lifts and squats to keep fit but I now avoid those sort of things so I now do a lot of water aerobics, pilates, yoga and walking," she said.
"Work is now tricky lifting crates of milk and boxes of coffee around the store ... and it's become all about bracing.
"I have girlfriends who have had babies and they have the same thing. It's almost par for the course. One friend is due to have repair surgery and another has a pessary."
While Ms Dawes is waiting for a breakthrough, she has co-founded the Australasian Birth Trauma Association offering emotional and practical support to women and their partners who have been traumatised by a difficult birth experience.
Ms Croft said it was about encouraging women to keep exercising while not compromising their pelvic floor.
"If you go and do just any old thing you are at risk of making prolapse or incontinence worse," she said.
"It's important — particularly after childbirth — to get your pelvic floor assessed so you can learn what damage if any has been done and what exercises are suitable."
Guidelines if you have pelvic floor dysfunction (keeping in mind bodies will respond differently):
Pessaries are a silicone device inserted into the vagina to help provide structure and support while living with a prolapse.
Jan Maessen is calling for mesh implants to be banned, claiming the "simple operation" destroyed her life and left her in chronic, debilitating pain.
They are now the go-to device to help women with prolapse after vaginal mesh implants were banned in Australia.
A class action against mesh manufacturer Johnson and Johnson involving more than 700 women is underway, with legal representatives for the women claiming the pharmaceutical giant did not investigate proper clinical trials on the possible complications of the mesh.
The Continence Foundation of Australia will hold its fifth state conference in Brisbane on March 9 with the diagnoses of Levator Avulsion being top on the agenda.
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When I had my son 17 months ago, seasoned moms everywhere warned me about the standard things. The never sleeping again thing, the sore nipple thing, the "you're going to poop on the table" thing.
My son was a behemoth of a baby, so he was delivered via C-section. No pooping on the table for me. My milk never came in, so my nipples were salvaged. I lost the battle when it came to sleep, but I figured two out of three isn't so bad.
Fast-forward to the present when the floor literally went right out from underneath me—my pelvic floor that is. That was something no one ever warned me about it. It's hard to identify your situation when you don't even know the situation you have exists.
My initial symptom was a feeling that I wasn't quite emptying my bladder. I dismissed it at first as post-pregnancy bladder. Then it got to be persistent—irritatingly and insanely persistent. It didn't hurt to go, but I just wasn't really going. A pelvic ultrasound, CAT scan, misdiagnosis of urinary tract infection (UTI) and then overactive bladder, two unnecessary prescriptions, two urologists, and so many trips to the bathroom later, a urologist said to me, "I think you have a prolapse."
Pelvic organ prolapse (POP) occurs when there is a drop of the pelvic organs caused by the loss of normal support of the vagina. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, intestines, and rectum. All of these organs are supported and held in place by the muscles in the pelvic floor. When those muscles become weakened, stretched, and fail to tighten back up—like they sometimes do during and after pregnancy—that's when a problem may arise.
For me, it felt like my prolapse came on rather suddenly, but according to Daun Hooley-Miller, a women's health nurse practitioner at Ascension St. Vincent in Carmel, Indiana, there really isn't anything sudden about it. "Many women may suddenly feel symptoms, but it usually takes months or years to work its way to where you notice," says Hooley-Miller. "Women do not become symptomatic till the organs come near the vaginal opening."
Symptoms will look and feel different from person to person, stage to stage, and may vary based on the type of prolapse they are experiencing, adds Hooley-Miller.
Prolapse can also happen in men—of the rectum or bladder—but it is much more common in women. About 50 percent of women have prolapse to some degree, but do not let that frighten you. While prolapses can be uncomfortable, upsetting, and frustrating, they shouldn't hurt and are not life-threatening.
According to the American College of Obstetricians and Gynecologists , there are several types of pelvic organ prolapse:
There are a variety of factors to why a prolapse can occur, but "childbirth is the leading contributor to pelvic organ prolapse," according to Hooley-Miller. That said, prolapse can happen for other reasons, too.
"People who have never been pregnant can have pelvic floor prolapse," says Hooley-Miller. Reasons include constipation, straining to urinate or defecate, coughing, genetics, and repetitive heavy lifting. "Squatting when lifting may be good for your back, but not your pelvic floor," adds Hooley-Miller.
There are a variety of symptoms that may come along with POP, says Bri Grogan, P.T., DPT, a physical therapist and founder of FemFusion Fitness , a digital platform for at-home fitness and pelvic health.
"Some women complain of feeling a golf ball in their vagina," says Dr. Grogan. "There is also sometimes pressure or heaviness in the pelvis. Anytime you bear down for any reason you will notice it. Or you will notice it after you have been lifting things, such as your baby, all day. You may also feel pressure on the bladder; a feeling that you always have to go."
Some may not even notice their prolapse, while others will experience a range in symptoms and severity depending on the stage. Stages one and two are considered mild to moderate, while stages three and four lean toward a more severe prolapse.
There are things to do that may prevent prolapse, including avoiding constipation/straining, not pushing to urinate, and lifting correctly (think weights, kids, bags, and boxes). But sometimes even the most fit people experience it—yes, it can just happen!
Severe cases of prolapse may require surgery. In other cases, some opt for pessaries , a device inserted non-surgically into the body to support the vaginal tissues. For other instances, there are ways to ease the symptoms. "We can do management," says Hooley-Miller. "We try to avoid things that will make the prolapse worse."
Lifestyle changes can go a long way in addressing the symptoms of prolapse, says Dr. Grogan. How you transition from sit to stand, bettering your diet and exercise, giving up smoking, and taking your time to use the bathroom are just some lifestyle adjustments that may have a positive impact on prolapse symptoms.
Health care providers commonly recommend Kegel exercises to strengthen those weakened pelvic floor muscles. Dr. Grogan also notes the benefits of Kegels, but endorses them with a hint of caution. "They have to be done right, gradually, progressively, and done by people who know how to release their pelvic floor muscles," she says.
Before you begin the process of bulking up those muscles, Dr. Grogan encourages patients to first give them a much-deserved breather. "You can't go wrong with pelvic floor relaxation ," says Dr. Grogan. "Learn how to relax the muscles of the pelvic floor so that you can know when you are truly contracting them."
As for me, I am taking Dr. Grogan's advice and am working on relaxing what I have found to be a very tense pelvis, as well as setting an appointment with a pelvic floor physical therapist who will help assess and treat my prolapse. Before this whole saga began, I didn't even know such a therapy existed, but it is out there, and it is covered by my insurance.
For those of you who do not have coverage or do not have a pelvic floor physical therapist in your area, there are some helpful pelvic floor workout videos available on YouTube, such as those on Dr. Grogan's FemFusion Fitness and Pelvic Health channel .
It's daunting, and it doesn't sound like I will be Kegeling my way out of this situation overnight, but I am encouraged and a little less terrified after speaking with the experts. At the very least, now I know I have options and things that I can try to help manage the situation. That alone makes me feel a smidge better.
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