Sometimes this is what patients feel like when confronted with the changes to behavior necessary to improve their pelvic floor problems or make a decision regarding surgery or no surgery – backed into a corner with nowhere to go. I’ve spoken about the difficulties patients have when hearing that changing to decaffeinated tea and coffee can significantly decrease the irritation to the bladder and therefore lead to better bladder control with leakage, urgency and frequency. Caffeine is such an important part of our culture now and patients can be so dependent on their caffeine hit; but just that one simple change (going decaf) may significantly improve confidence and control.
Similarly, letting go of sit-ups, double leg lifts and high impact exercise, if you have significant levator avulsion leaving you with prolapse or incontinence problems is devastating if you have loved your exercise and envisioned that you would do these things into old age. You may remember I wrote in a previous blog about a patient whose sport was pole dancing and who had major prolapse issues and was really grieving for her loss of having to give pole dancing up. Well I spoke with her again the other day and her pessary is working well and she getting more used to different types of exercise and she rarely gets drag or ache anymore.
Is she still grieving for her lost love – pole dancing? Of course – but she is also realistic and feeling much less discomfort, so is happy to continue on with her different approach to exercise.
In 2012, I attended IUGA (International Urogynaecologists Association) conference and sat through many talks on prolapse surgery and one of the interesting comments made by one of the eminent speakers, Professor John De Lancey, was that Grade 2 vaginal prolapse should be considered normal in a woman who has had two vaginal deliveries. Now I haven’t ever heard it put that way before. The good thing about that statement is many women get very anxious when discovering they have prolapse and feel they are ‘damaged’ and must get urgent surgery to ‘fix things up’. But maybe what they need to do is be very pro-active with prolapse prevention strategies – you know them – brace with increased intra-abdominal pressure, regular pelvic floor exercises, use the new position for emptying your bowels and defecation dynamics, avoid lifting heavy weights, avoid straining at stool, avoid sit-ups and perhaps be assessed to see if a pessary would help.
If we can change our thinking that it is quite normal for a woman who has had two vaginal deliveries to have some vaginal wall relaxation, then I know patients will not be so panic-stricken and anxious about their damage. I am sure they will feel confident that it is safe and even good for them to continue to be sexually active. And most importantly they will be aware and understand their bodies and know the importance of regular monitoring to prevent the progression of that prolapse and continue those preventative strategies for life!
So don’t feel backed into a corner if your GP or specialist diagnoses prolapse. Just getting better with your preventative strategies and make informed decisions about your options are worthwhile considerations. You will find lots to do in the latest editions of my books (which are now up to the 4th Edition -2018 for the surgical book Physiotherapy for Gynaecological and Colorectal Repair Surgery and 3rd Edition – 2018 for Pelvic Floor Essentials
The latest editions of both books updated in 2018