Helen Ledwick’s second baby was just two weeks old when she realised something was very wrong – not with her newborn son, but with her vagina. “I remember it really distinctly. I’d lifted my toddler and felt a twinge, and then I’d had a bit of a strain on the loo. Almost immediately I felt a bulge, like I was losing a tampon, and nothing felt right,” she recalls.
Sitting on her bedroom floor with a mirror in one hand and her phone in the other, Helen turned to Google and was horrified to learn she had a prolapse.
“It was just so shocking to me because this was my second child and I’d never even heard of this condition before,” she says.
Officially known as a pelvic organ prolapse, what Helen experienced affects as many as 50 per cent of mothers and birthing parents to some extent. Prolapse is when one or more of the organs in your pelvis – the bladder, bowel and uterus – slip down from their usual position and bulge into your vagina, causing a heavy, bulging or dragging sensation.
It’s just one of the issues that can develop after childbirth, caused by changes to your pelvic floor – the hammock of muscle that supports these pelvic organs. Other common issues include urinary incontinence, affecting an estimated one in three mums, while around one in 10 will experience faecal (poo) or flatus (wind) incontinence, or painful sex.
Seven years on from her son’s birth Helen, now 43, runs the Why Mums Don’t Jump podcast, sharing her own and other women’s experiences to raise awareness of these issues.
At the time, she says, like most new mums she had a vague awareness of her pelvic floor and had been reminded by her midwife to do her pelvic floor exercises. But she didn’t really understand what that meant, how vulnerable her body was after pregnancy, childbirth and a third-degree tear, or why those pelvic floor exercises were so important to her postnatal recovery.
For 29-year-old Jess, having children has exacerbated issues she already experienced because of her disability. Jess lives with Ehlers Danlos Syndrome, a chronic condition that affects connective tissues, making them softer and stretchy – which isn’t what you want from your pelvic floor. As a result, even pre-pregnancy, Jess experienced a bit of leaking when she coughed or sneezed (known as stress incontinence).
“It definitely got worse during and after my first pregnancy, to the point where I had to consciously squeeze my pelvic floor to stop myself leaking if I stepped over anything or picked up anything heavy,” she says.
In her second pregnancy, three years later, things became even worse. “This time I got urge incontinence as well, where I’d suddenly, urgently need to pee and my entire bladder would empty if I didn’t make it to the toilet in time. If you’re in public that’s a major problem because it’s an entire waist-down outfit change.
“My condition also causes chronic pain, so I can’t move very quickly, and I was constantly working out where the nearest toilet was,” Jess explains.
Although Jess’s experience is quite extreme, it’s not uncommon for pelvic floor problems to begin during pregnancy. “These issues can affect anyone, regardless of the type of birth you have. Most dysfunction occurs because of the strain put on your pelvic floor during pregnancy itself,” says Aby Tobin, a specialist women’s health and rehab physiotherapist and training tutor for physiotherapists The Mummy MOT.
However, suffering a third- or fourth-degree tear or having an instrumental delivery (where forceps or a ventouse – a vacuum cup – are used) does increase the risk of developing issues postnatally. Genetics also play a role and, if you have pre-existing issues like Jess then you’re more likely to see a worsening of symptoms if they haven’t been resolved beforehand.
For this reason, Aby adds, the best advice is to “prehab” to build strength during your pregnancy.
For anyone who is affected, the important message is that there is hope, says Professor Vik Khullar, a consultant urogynaecologist at Imperial College Healthcare Trust. “For too long women have been told it’s not important, but there are services out there and treatments available – the first of which should always be pelvic physiotherapy,” he explains.
Eighty-four per cent of women with incontinence and most women with a prolapse see a significant improvement with this treatment alone, says specialist women’s health physio Emma Brockwell, co-founder of campaign group Pelvic Roar and author of Why Did No One Tell Me? How to Protect, Heal and Nurture Your Body Through Motherhood.
For those who don’t see improvement with this treatment, Prof Khullar explains there are pessaries that can be inserted into the vagina to provide support for prolapses, as well as drug treatments and bladder injections for urinary problems.
There is also a more invasive surgical procedure, which uses stitches to create a hammock around the bladder neck. This, he adds, is very safe and effective at stopping leakage, and the controversial mesh implants – which caused complications in many women – are no longer used in any of these procedures.
Awareness and education around pelvic health are also still desperately needed. Prudent Haughton, 34, says she wishes she’d known more before having her son eight months ago. Like Helen, Prudent was a second time mum and thought she knew what to expect but was blindsided by a bladder prolapse following her son’s traumatic delivery.
“I’ve been in lots of pain with it, particularly on super busy days, which is hard with two children. My daughter is seven, so I’ve got the school run to do as well as looking after my baby. Often by the end of the day I have a lot of lower abdominal pain and the only way I can get some relief is by laying down with my feet elevated, which means I literally can’t get on with anything,” Prudent explains.
The embarrassment and stigma surrounding postnatal pelvic floor issues means many women suffer in silence, either too ashamed to speak out and seek help or because they’ve been led to believe their symptoms are to be expected after having a baby.
The mental-health effects of this shouldn’t be overlooked. Although Prudent is now receiving pelvic physiotherapy and beginning to see improvements, she says it took her a long time to get over the emotional toll and accept what had happened to her.
“It’s so important that women are better informed so they know what they can expect, but also that these symptoms are common but not normal and you shouldn’t have to put up with them. If a doctor tells you it’s part of being a mum, that’s not an adequate answer and you can seek a second opinion.”
