Why is no one talking about prolapse?

In the months after I had my son, I saw countless healthcare professionals for all the requisite check-ups and visits. Do you know how many mentioned the words “prolapse” or “pelvic floor” to me? None.

Even when I confided in my health visitor and the GP that things didn’t feel right “down there” and that I was leaking a bit when I coughed — or sneezed or jumped — I was told it was normal after giving birth and that I couldn’t expect “things” to be the same as before.

I wasn’t examined or referred. I wasn’t told about all the things that can be done to improve symptoms. It’s been nine years since I gave birth and I still want to know: why is no one talking about prolapse?

Pelvic organ prolapse is when one or more of the organs in the pelvis (the uterus, bowel or bladder) slips down from their normal position and bulges into the vagina.¹ Symptoms include a feeling of heaviness, discomfort during sex, feeling or seeing a bulge in your vagina and problems when you wee.

In the UK, 8.4% of people report seeing a doctor about a bulge or lump in their vagina — and it turns out to be pelvic organ prolapse in up to half of them.² The risk increases after childbirth for those who delivered vaginally and who needed forceps.³

There’s still a stigma around prolapse that can prevent people from getting the care they need

When my symptoms started, I felt embarrassed. The mums I met at baby groups were all exercising again, but I felt a heavy, dragging sensation every time I walked. But it wasn’t until I scoured the internet that I learned it wasn’t just me who’d experienced problems after giving birth.

Gaynor Morgan, who provides training courses for medical professionals on pelvic floor management, says that there’s still a stigma around prolapse that can prevent people from getting the care they need. “There has been a culture of silence that historically left women embarrassed and uneducated,” she says. “Some women who sought help postpartum were told prolapse and incontinence are normal and others have been put off by the mesh surgery scandal.”

Morgan would like it to be mandatory for all GPs, nurses, and women’s health physios to learn how to fit a range of pessaries — a prosthetic device inserted into the vagina to help hold its structure — and about their benefits. I’ve seen pessaries be referred to as “sports bras for your vagina” on social media, and I know from personal experience how hard it can be to access one on the NHS.

There’s also a need for healthcare professionals to be more informed about prolapse in general. A study by the University of Stirling found there to be a lack of awareness among GPs about pelvic organ prolapse — and that their dismissive responses to women seeking help for their symptoms contributed to delays in receiving care.⁴

“Help is available. There is so much we can do to help women alleviate their symptoms and get them back to doing what they love”

Physiotherapist Eve Ashton-Monteiro at Aston Physiotherapy in Devon says that she wishes more people knew how to spot the signs of prolapse and what can be done to help. It’s important for everyone to have a pelvic floor assessment after giving birth so that any issues can be diagnosed and treated, she adds.

“Help is available. There is so much we can do to help women alleviate their symptoms and get them back to doing what they love,” says Ashton-Monteiro. “As well as specific pelvic floor treatment, symptoms can be improved by addressing lots of factors including stress, tension, fatigue, fear of prolapse and leaking, lack of exercise, deconditioning and poor nutrition.”

Similarly, Nutritional Therapist Linnéa Skea has helped to people to manage their prolapse post-birth through changes in diet that aim to improve gut health, reduce inflammation, balance the vaginal microbiome, and eliminate constipation. “[This] has had a positive impact on their prolapse symptoms,” she says. Both Ashton-Monteiro and Skea point out that personalised treatment plans are always the most effective, as everyone is different.

We can talk about prolapse openly and honestly, giving people the information and support they need to get help

In October 2023, the NHS set out guidelines for a plan to improve how pelvic health problems are treated and identified during pregnancy until at least a year after giving birth.⁵ This is brilliant, but it will inevitably take time to impact people’s lives in practice.

So, what can we do about it now? We can talk about prolapse openly and honestly, giving people the information and support they need to get help.

As for me, when I finally discovered that women’s health physios existed, I went to see one. Nine years later I am now symptom free 99% of the time. I run again, lift weights, and play netball weekly – all things that google told me I couldn’t do with a prolapse. But it has taken a lot of work to get here. And time. And it is something I still manage with diet and exercise.

I believe knowledge is power. We shouldn’t feel ashamed to talk about our bodies or name our symptoms. And perhaps most importantly, this can save millions of others from feeling like I did: angry, ashamed, and alone.
 
 
Featured image is an illustration of a woman performing a pelvic floor exercise by sitting on a Swiss ball. Her legs are spread wide apart and her hands are resting on her knees for support
 
 
Page last updated December 2023