Did you know that about 1/2 of women who have had a child will have some level of prolapse? 1 in 5 women will need to seek professional support. That's a whopping 20%!
I am one of those 1 in 5 women. And I've decided to share my story because just like with physiological birth, I feel like our 'system' does not support women's pelvic health. It seems to be a taboo subject. There is not enough awareness or preventative strategies out there to support the needs of women in this space. If 20% of women need support with prolapse, why are we not having more conversations about this?
So I'm starting this conversation - with my prolapse story, because I know I'm not the only woman this has affected on so many levels; physically, emotionally, energetically, as a mother, partner, and the ripple that expands to the family unit.
It starts with my first pregnancy. If you don't know me, I'm a Type A personality. A high achiever. A high achiever in sport. There was no way I was letting my pregnancy 'stop' me from what I loved doing - playing netball and running. So I continued to play netball until around 16 weeks pregnant, and ran kilometers weekly until I was about 32 weeks. I felt great. And in my defence, I thought I was doing all the right things in staying fit for my birth.
Now I'm not saying here that if this is your norm pre-pregnancy, you need to stop all means of high intensity exercise; but it should be modified with support from a women's pelvic health practitioner (a physio, osteo) with a focus on connecting to the pelvic floor. A beautiful, connected home birth had me feeling like I was on cloud 9 (aside from some early breastfeeding hiccups) and I'm ashamed now to admit I was back playing competitive netball by 8 weeks postpartum. My 37 year old self reflects "what the HELL were you thinking!?". Especially because I had my midwives on my case, emphasising how important that 4th trimester was. The honouring of rest and healing. That old 'I've got to spring back into shape' mentality got the better of me. 'Having a baby isn't going to stop me from getting back into it'.
There were signs of pelvic floor weakness, as I was still wearing a pad a year on, whilst playing - but like most women, I stayed silent and did nothing about it.
Fast forward to pregnancy no. 2. We were pregnant not long after Rose turned 1, and I was still stuck in that mentality of feeling like I had something to prove by staying competitive with sport. This time my body wasn't as willing to co-operate and I found I needed to stop netball by around 12 weeks into my pregnancy, and running by 28 weeks.
A week or so before Eve was born, I came home from a long walk with a full bladder. Fluid ran down my legs in the shower. I thought my waters had broken, but no - it was my bladder. The penny still didn't drop. "It's just a pregnancy thing".
Another beautiful homebirth. Breastfeeding was so much easier this time; I was feeling great! Then my world came crashing down at 2 weeks postpartum when I felt like I literally had an orange between my legs, a heavy feeling, like something was about to fall out. A phone call to my midwife in tears, left me impatiently waiting for our next home visit where she confirmed it was likely this was a prolapse. Onto the GP at 6 weeks postpartum, a diagnosed stage two cycstocele prolapse (of the bladder) with a referral to a women's health physio.
After that first physio appointment it dawned on me it was going to be a long rehab process and I could kiss my netball season goodbye. More tears. Sobs in fact. I just couldn't part with the thought of not being able to do what I loved.
The rehab was slow. I was symptomatic for so long. Never incontinent. But just this heavy feeling like there was something between my legs. I couldn't go to the shops and push a trolley with bags, my toddler and my newborn in a carrier without coming home and feeling like my insides where going to fall out of me. It was so uncomfortable.
Aside from the symptoms, the prolapse shook up our family. I felt disconnected from Rose. I was no longer 'fun' as I couldn't 'play' like I had been able to. With any park trips, it was my hubby who was running around after her, playing games whilst I sat on a park bench with our newborn because I couldn't manage anything else. At 23 months old she had no idea of understanding what was going on. Phill really struggled seeing me go from a very capable, independent woman to the place I ended up. He was so loving and reassuring but at the same time didn't really know how to support me. The rehab started with pelvic floor exercises reclined - to sitting - to standing - to eventually running on the spot - to catching a ball whilst running on the spot. The aim was always to get back to running and netball. I had what I perceive as a pretty conservative physio at the time, but knowing my personality it was probably the best thing for me. The slowness frustrated me. By 9 months postpartum I was still not doing much in the form of physical activity. I had lost touch with my netball community, with my outlet. Despite beautiful family and friends who offered plenty of emotional and physical support, it was here where I hit my lowest point. My mood was terrible. Getting out of bed was a task. I was struggling.
I can't remember what the precursor was, but something set me off one afternoon. My girls were happily interacting with one another in the living room and I couldn't find happiness in the moment. In motherhood. I was crippled on the floor of my kitchen sobbing and feeling so guilty at the feelings I had: that as much as I loved my girls, in the present moment I was "just a mum". I had completely lost myself. I recognised I needed help, and called a friend, who dropped everything and came straight over. We chatted whilst my girls kept themselves occupied, I cried and it was then I realised I was probably suffering from undiagnosed PND. I felt so alone. Like no-one really understood. My hubby had his own battles at the time - unexplained pain that was later diagnosed as an autoimmune disease and so as a family we were not in a great place. I needed to find myself again.
The impatience got the better of me, and within days I went for a run. 5 min. Connecting to my pelvic floor. The next time I tried 7min. Then 10min. I was so nervous to go to my next physio appointment and confess that I had started running. To my surprise, she was really supportive and we slowly built up over a period of a few months, to eventually running the length of a netball game. By 13 months postpartum I was back at preseason training. That was big. I became slightly symptomatic with that 'heaviness' initially as my body adjusted to this new level of impact, but by the start of the season I was playing again, symptom free and just so over the moon to be back out on court.
This probably explains the gap between baby no.2 and 3. My hubby wanted to try again long before we did. I wasn't sure we'd have another. The emotional toll that second postpartum took on my mental health - I had never experienced such a low point in my life and I wasn't sure I could go back there again. I wasn't sure WE could go back there again. A 3rd pregnancy terrified me, and the impact that would have on my body, my postpartum, my family. I realised I needed help shifting these fears around the time we decided to try for another, and so I sought help from a kinesiologist. I wanted to enjoy a 3rd pregnancy and not let that anxiety get the better of me. I can't even put into words the shifts that occurred as a result from those appointments.
I also checked back in with another physio before we conceived to get some feedback on my pelvic floor. I'd maintained my strength and endurance that I had worked at re-building, so that was really reassuring.
My 3rd pregnancy was different. I was much more connected and in tune with my body. I kept in contact with the physio throughout. I stopped netball at 8 weeks and running no longer felt manageable by 16 weeks. I walked alot, but even that became hard towards the end and I stopped my long walks early in my 3rd trimester. I commenced Pilates this pregnancy and maintained that right up until everything shut due to COVID lockdown. Lenny didn't engage in the pelvis until right before birth, which did my pelvic floor a world of good (unlike the girls who were in the pelvis from 34 weeks). A 3rd homebirth. Present. Connected. So intuitive. We were on the biggest high.
It was a conscious postpartum. A healing postpartum. For the first time, I felt comfortable accepting and receiving all the love and support, and really honouring the rest and healing needed in that 4th trimester. We were still in lockdown, so there was no pressure of visitors, however we had regular meal drops which meant we didn't have to cook a dinner for around 5 weeks! I spent a good two weeks horizontal. I became symptomatic with that heaviness soon after birth and so I saw a physio very early at 2 weeks post birth. It was way too early but for my mental health I needed reassurance that I my prolapse was not any worse. She confirmed a slight drop that would likely resolve as my hormones changed which gave me the reassurance I needed and I focused on connecting back in with my pelvic floor. My midwives referred me to another physio they highly recommended who has been a god send. She has given me a new level of understanding of what is going on in my body. A mind-body-soul approach. It's not just about your pelvic floor - but there's too much to cover there for this post.
I found some days to be worse than others, and then some days I was symptom free. By 8 weeks postpartum I'd reflect at the end of the day that I had chased the girls on their bikes, with Lenny in the pram, and I had no heaviness. By 3 months I was running small distances again. I was shocked at how well I recovered. Was it the fact I was so much more in tune with my needs? That I honoured my healing? Or was it just pot luck? Who knows? But I feel it was Option A).
I continued physio rehab for quite some time, and still check back in with her, when I feel the need to.
These days I'm pretty much symptom free. My pelvic floor strength is exceptional, however the damage to the soft tissue will always be there. I feel so incredibly lucky. I go about my days unaware that the prolapse is there. My only complaint is a tiny bit of stress incontinence when I take a hard landing from a big jump at netball. But I can live with that.
Menopause worries me. I've been told that as the vaginal tissue atrophies, the prolapse can go one of two ways - be pushed up, or further down. Time will tell.
I feel pretty vulnerable sharing this, as when I look back on my 10 year younger self, I can see the many mistakes I made and the traps I fell into. I'm embarrassed to admit these, knowing what I do know. But when we know better - we do better. And so my aim is to lift the veil on this conversation and educate others on how to support their pelvic health, because it's not routine practice. And it need to be.
Here's a few things I have learnt along the way:
- Connect in with your pelvic floor. Learn how to activate and release it properly. Pilates can be really helpful in this space.
- See a pelvic health practitioner to assess what your pelvic floor is like. They will tailor a program to your unique body, to prepare for birth.
- If you're continuing high intensity exercise or weight training, ensure you're supported by a pelvic health practitioner.
- You may consider internal release work. To release any tension and/or trauma in preparation for birth. We carry so much in our pelvic space. From a TCM or a metaphysical perspective, the pelvis can store fear, anger, sadness, jealousy, grief. Letting go of these emotions, of this tension can can make birth so much more easeful.
- Aim for a physiological birth. We know many forms of intervention place strain on the pelvic bowl.
- See my previous post "Setting yourself up for a supported 4th trimester", but in summary:
- Honour you postpartum. Have reverence for the rest and healing needed. You have wound the size of your placenta on the inside of your body. You NEED to heal.
- Spend time horizontal, in bed, connecting with your baby.
- Accept help: meals, cleaning, laundry, help with other children, so that you can focus on rest and recovery.
- Have your partner save up as much leave as possible, so they are there to help you whilst you rest.
- Connect in with your breath, core and pelvic floor and slowly build from there, listening to your body.
- See a pelvic health practitioner around 6 weeks postpartum for rehab post birth, and to help guide you in your return to physical activity.
- If you have any pelvic health concerns. Don't stay silent. SEEK HELP.
If you too have experienced prolapse and want to connect, please feel free to reach out.
If you've got any stories to share or pearls of wisdom, please comment below.
Let's start this important conversation...