The box of tissues is always close by in my treatment room.
There’s often tears of sadness- a loss of a favourite exercise that’s not ‘pelvic floor safe’ and therefore has to be dropped from the daily routine.
There’s often tears due to high anxiety when the diagnosis of prolapse is made – damage to my vagina? Can it recover to pre-pregnancy state? What will my husband think?
But this patient story is where there are tears of sadness, anxiety, but mostly anger – read the story Robyn has written for me and share the pain she still suffers so many years down the track.
 “ Pelvic floor problems are an ‘old’ woman’s problem, right?
How wrong was I to think this? I am a 37 year old mother of two beautiful girls (eight and five). I have cystocoele (anterior or front wall prolapse) and bilateral levator avulsion. I never thought that I would be dealing with this at my age. It was something that I would be dealing with in my sixties. No one talks about this. It is very much taboo. I will definitely be discussing this with my girls not to scare them, but to make them aware that this can happen.
Finding out that I had this was just shattering.
I had no idea that your muscles can be ripped off the bone in the pelvis and that it is more common than you think.
I feel very angry that I wasn’t told of this throughout my ante-natal care. If only I was told that this was a risk, then maybe I would have chosen to have my babies via a caesarean.
I would have been able to weigh up the risk and maybe I would have still had them naturally, but that would have been my decision. It would have been an educated decision and it’s cruel that we are lead to believe natural is best, but they never discuss the negative impact on your body. If they did, maybe we would be able to keep a better eye on our bodies and watch for signs and seek help earlier or better prepare our bodies for what is ahead.
I constantly worry whether I am doing enough to keep my prolapse stable.
I constantly worry about the impact on sexual function, urinary function and what does the future install for me.
I live in hope that stem cell research will be able to make me whole again. But will I be lucky enough… for now I have to work very hard to not let this take over my life.
I am very thankful that I have found health professionals who listen to my concerns, understand how I feel and educate about the correct exercises and strategies I can continue to self-manage this distressing condition. I can go back home with confidence that I’m doing everything I can, although I wish I didn’t have this problem.“
Robyn lives deep in rural Queensland. I am sure this adds to the isolation (due to distance from her health professionals she is now seeing in Brisbane) that she may experience at times. Robyn sought lots of advice from quite a few health practitioners over the last five years since the birth of her second child. She has been diligent with following their instructions. And yet the comprehension about what Levator Avulsion means was something that she only realized after her first consultation in Brisbane. As Robyn has now realized, prolapse and other pelvic floor issues are not age related. They are very related to pregnancy and childbirth and so you could be only twenty, have had a baby and have incontinence and/or prolapse.
Anger is an emotion which many women experience on hearing about the severity of their birth damage. They all wish they had known such a thing could happen. And as Robyn said, they still may choose a vaginal delivery but it would be an informed decision based on knowledge of risk, it would be their decision.
What is important however, is to move on from the draining effects of anger, sadness and anxiety and use that energy in living life in a positive and happy way whilst still managing your condition well. Treatment strategies include: pelvic floor muscle training; bracing with increased intra-abdominal pressure; changing activities and movements to being pelvic floor safe; plus important things such as mindfulness, relaxation strategies and if necessary, seeing a psychologist to come to terms with overpowering feelings such as anger and anxiety. Robyn works very hard with living a normal life back at home- but it’s always good to know it’s safe to have a good cry in my office. It’s cathartic, it relieves the pressure (that builds as you are confronted daily with these changes) – as long as the sadness doesn’t overwhelm you.
Robyn is continuing on her journey. She has been fitted with a pessary (rigid as opposed to the flexible ones that can be managed by the woman) to help hold her prolapse up but it is early days. She also works on focusing on her girls, her husband and on trying to enjoy life while she continues with her management plan.
So in this year, 2014, when the Continence Foundation of Australia has designated it the Year of Pregnancy and Maternal Welfare, let’s spread the word about optimal maternal outcomes, preventative strategies for pelvic floor dysfunction and let’s get this conversation going!