Pelvic Organ Prolapse – Breaking the Stigma!

There's still so much stigma around prolapse, around discussing your genitalia and that doesn't allow for people to go see a doctor.

Natashja Wilson

I was watching the news in the week when an article came up about Pelvic Organ Prolapse. If you’ve read my blog for any great length of time, you’ll know I live with a Consultant Physiotherapist who specialises in pelvic health so, as the article continued, and, I have to say, got more and more horrific, I started to feel a real sense of pride in my adopted sister! The article went on to say how this kind of Physiotherapy revolutionised people’s lives – and yes, men can be affected by this also!

So, to highlight this taboo subject, I want to focus my post today on the article I watched!

Pelvic organ prolapse occurs when the group of muscles and tissues that normally support the pelvic organs, called the pelvic floor, becomes weakened and cannot hold the organs firmly in place. It causes one or more of the organs to move down from their normal position, leading to a bulge that can be felt inside or outside the vagina. This can be the womb, bowel, bladder or top of the vagina. Many women are unaware they have a prolapse or only have mild symptoms, but for some it can have a real impact on their quality of life.

Symptoms can include a heavy dragging sensation or feeling of something coming down the vagina - which is sometimes described like a feeling of 'sitting on a tennis ball' as well as bladder and bowel issues and discomfort during sex. Pelvic floor exercises and lifestyle changes can help to improve symptoms, but sometimes medical treatment is needed such as vaginal pessaries or surgery.

Causes of prolapse include genetics, heavy lifting, constipation or a persistent cough, however, the biggest cause is through pregnancy and childbirth which increase the risk of prolapse, particularly after a difficult labour.

Women are also more likely to develop prolapse as they get older, especially after the menopause.

Barriers to Care

According to the National Institute for Health and Care Excellence (NICE) one in 12 women report symptoms of pelvic organ prolapse but on examination it is present in up to 50% of all women!

Research yet to be published by Stirling University indicates that embarrassment, lack of awareness and a fear that symptoms won't be taken seriously, all act as barriers to women seeking help for pelvic health problems. The study looked at papers from 24 countries including the UK over the past 20 years, taking in the views of more than 20,000 women.

Researchers Clare Jouanny and Dr Purva Abhyankar said: "There is a large body of evidence from the UK and similar countries across the world that women still face many barriers when it comes to seeking help for women's health issues like prolapse.”

"We need to focus not only on increasing awareness and education among women and clinicians, but more importantly we need to work with clinicians to change women's perception that clinicians don't take them seriously with pelvic health symptoms."

Pelvic health physiotherapist Suzanne Vernazza, (not my friend but a close colleague), who was filmed as part of the article is on a mission to educate women about their pelvic health. She is the founder of the not-for-profit company Know Your Floors and her daily “SqueezeAlong” pelvic floor exercise tutorials which have more than 600,000 followers on TikTok.

She says it is important for people to raise pelvic health concerns with their GP.

"If you've been feeling something that at any point doesn't feel quite right, whether you're pregnant or postnatal, raise it and ask the question because more than likely, you're right that it's not right - and you can have support for you to be able to manage that," she said.

The Royal College of GPs said its doctors are well trained to diagnose and care for people affected by prolapse.

RCGP Scotland deputy chairman Dr Chris Williams said: "GPs are aware of the embarrassment or stigma that can be associated with this condition and strive to ensure women feel comfortable and empowered to seek support if experiencing symptoms."

Sam Hindle experienced bladder prolapse after the birth of her son 24 years ago and has been incontinent ever since.

"It was that bad that my two-year-old son was having to go and fetch mummy clean pants, clean trousers," she said. "It was embarrassing to have your two-year-old run about and say ' Oh Mummy's had an accident, I need to help'.'"

The 47-year-old, from Edinburgh, was one of tens of thousands of women in the UK to have transvaginal mesh surgery to treat prolapse and incontinence.

Its use was halted in the UK in 2018 due to the life-changing side-effects many women suffered. Sam said she had been left in constant pain and suffers from PTSD as a result of the procedure.

She hopes to have her mesh removed by a specialist in the United States and is currently on a waiting list for assessment in Glasgow. She said it was important for people to talk about pelvic health.

“Just like menopause, it’s a subject that we need to remove the stigma of and talk about and let people not feel embarrassed about this so they will go and seek help,” she said.

“You look at other females in the family who are having children and you think, ‘Oh I’d better warn them, I better make sure they know about pelvic floor exercises and they know how to avoid possibly getting into the mess I did with bladder prolapse.”

Natashja Wilson, who writes very popular blog called “Living With Prolapse”, said; prolapse affects women of all ages and it does not discriminate.

"I noticed my symptoms when I was 18 and when I went on Google it was only telling me that elderly women were impacted," she said.

"The doctors were so shocked that someone of my age had prolapse and it made me feel very isolated."

Natashja said she is now feeling positive about the future.

She has been working with a pelvic health physiotherapist and uses a vaginal pessary, a device that helps to support the vaginal walls and pelvic organs, which means she feels more confident doing exercise.

She said the support and advice of the online community had also helped her to cope.

"If you have just been diagnosed with prolapse, it's important to know you do not have to go through this alone," she said.

"There is an army of women out there willing to support you and help you through your journey and they can understand what you're going through and help you through it."

If this little article has resonated with you, as Natashja says, there is a world of support out there waiting for you to reach out to them. As the article highlights, you need to seek medical advice as soon as possible! Here’s a few links to get you started;

Living With Prolapse Natashja’s Story

The POGP, Pelvic, Obstetric & Gynaecological Physiotherapy website

The APTA, American Physical Therapy Association website

MASIC

If you’re in the UK, there’s a fabulous short documentary you can find here

Please – if this article has resonated with you, Please seek help!

What’s on this week?