Don’t know what prolapse is?
I didn’t either!
Let me tell you about how I learned about it…
Nearly twenty years ago, I was in a pretty bad place. My husband had moved out and in with his girlfriend of 6 weeks, I was 7 months pregnant with our second child. We had newly shifted countries away from my family and connections. I had few friends.
My husband leaving represents the worst and the best thing that has ever happened in my life.
I self-medicated with exercise and can quite honestly say that exercising every day saved my life. I returned to my career of teaching and although I have always loved teaching, I struggled with the politics of school. Throw into the mix the difficulty of being a single mum of a toddler and baby. So every day I was employed as a relief teacher, I died a little bit inside.
So I decided to become a Body Pump Instructor!
However, something was else happening to me… every time I worked out, I leaked a little wee. To begin with it was just the odd occasion and then gradually it was every time. Panty liners and then fairly heavy-duty pads graced my weekly shop. I noticed that classes like Body Attack were worse and I joined the throngs of women who left the class to empty my bladder before the superman moves, so less would fall out of me.
Returning to study to gain my Cert 3 & 4 in Fitness was fantastic. I have always loved learning and I hoped that perhaps I would learn more about what was happening to me. I never used the word “incontinence” and apart from sharing knowing laugh with other women, never really discussed it.
However, not only was incontinence (the reasons for it and how to avoid or fix it) missing from the fitness curriculum, pelvic floor as a muscle was not even mentioned as part of our anatomy training! And to be honest, in a sea of 17 and 18 year olds, I was just too embarrassed to put my hand up and ask “Is it normal to wee yourself when you work out?”
The crunch came about a year later when I achieved my goal and I was on stage with an incontinence pad and a microphone, teaching my beloved Body Pump when I said to myself… Enough is enough! This is not going away, this is getting worse, especially now I have a sea of people who are eye level with my crotch!
I would like to add that I was also working as a Personal Trainer and building my body of clients, who were mostly mums like me. I naively thought that being a mum myself, more than qualified me to work with them…
An appointment with my GP, lead to an appointment with a Women’s Health Physiotherapist. I proudly told her that I was a Personal Trainer, specializing in working with women and loved working out but this “thing” was happening to me. I would not have done anything about it, but I was noticing that it was getting much worse and the pads I was wearing just for the gym, were now part of my daily routine.
She examined me and curtly replied through pursed lips, like she was extremely annoyed with me personally… although I had no idea what I had done wrong!
“You are on the verge of a prolapse. If you don’t stop exercising the way you do, you will end up having surgery to fix it.”
And my reply was:
“But what’s a prolapse?”
Hand on my heart. I had never heard of this term before.
So here is Prolapse 101
Prolapse literally means to fall out and while that is a very simplistic meaning – there are many variations on what can fall out and where it falls.
The vaginal wall certainly takes some wear and tear whilst birthing a baby (though please don’t think that because you had C-sections that you will avoid prolapse) and make it susceptible to the weight of the bladder – which can fall into the vaginal wall and out, or the bowel, which can also fall into the vaginal canal and out.
Or to complete the trilogy, the uterus can fall through the vagina and out.
TIP: Don’t google prolapse images or video. Turst me on this.
Obviously, our knickers were not designed to catch this sort of stuff and that is why we have our pelvic floor! A healthy functioning pelvic floor that is able to both contract and relax is pretty vital to keeping the internal organs up and in the right place.
Our bodies are pretty well designed on the inside to keep stuff at all the right angles, in order for them to work correctly. But when prolapse first happens your first signs might be that of leaking (either wee or poo). But because the prolapse is in its first stages, you may not feel anything and just reason you have a weak pelvic floor. You may not feel this is of concern. And certainly with the growing euphemisms such as LBL (Light Bladder Leakage), many women believe this is just a normal and natural part of motherhood and politely ignore it. (BTW, it’s not!)
But as a prolapse progresses, south bound, your bits that are suppose to be on the inside, start to pop out to the outside.
Many women first discover their prolapse when washing themselves in the shower and can often attribute it to specific act (boot-camp, lifting something heavy – as a once off or as a repetitive action).
Is prolapse painful?
Well not really.
Many women describe it as a heavy or dragging sensation and it is usually worse at the end of the day (Gee, thanks gravity!). However when the prolapse starts protruding significantly out of the body it can become very sensitive, as the bits that normally don’t see the light of day starts to rub against your knickers. As you can imagine… that’s going to be incredibly uncomfortable.
When prolapse reaches this stage, things start to get a whole lot more complicated. You see, your pelvic floor is quite unable to contract functionally, when there is something hanging in the way! And where a little bit of incontinence here and there can easily be ignored… this is much harder to. In over a decade of working with women, most of them admitted to me that they wouls spend most of their waking thoughts thinking about their prolapse. They have to renegotiate how they do things to accommodate it. Lifting makes prolapse worse and when you have a baby and perhaps a toddler and do stuff like shopping and washing, this can become quite a drag… literally.
Prolapse also affects self-confidence and many women tell me that they don’t like their husbands and partners to look at them “down there”. And if a new mum didn’t have enough road blocks, like tiredness to enjoying their mojo and getting their sexy on… this can put a serious spanner in the works.
Can prolapse kill you?
But obesity, heart disease and all the other diseases that are associated with lack of activity and perhaps resulting addictive behaviour, can. We also know that exercising positively impacts on postnatal depression, mental health and positive self-image.
It’s ok! I’ll just get surgery to fix it!
Not so fast…
Sure surgery may be able to help you… but there are two very important things to understand about surgery.
Firstly: Surgery does not last forever. That’s right. Just like getting a knee or hip replacement it lasts for about 8- 10 years. So you may not want to use this option too quickly.
Secondly: Surgery is simply not a case of have it done and forget it. You will still have to adjust your lifestyle and learn to care for your pelvic floor to maximize the life of the surgery. I have seen many women who have had very little post operative care and have re-prolapsed and had to go in for more surgery. And this is not simple surgery. (This deserves a new blog on this subject!).
Now my question for you:
How many women do you think are affected by prolapse?
You can pick your jaw up off the floor now.
For many women, (who just have incontinence) prolapse may be waiting for you during your menopausal years. Due to the loss of oestrogen – the hormone which encourages our muscles to snap back into place – many women find that this is the straw that breaks the camels back… so to speak.
But what can be done to help my prolapse?
Actually quite a bit. There are pessaries that can be fitted and even an oestrogen cream that many women call magic cream… but all of this is a specialists’ bag of tricks and a Pelvic Health Physiotherapist is a great start to finding out the best way forward for you. Please note that not all physios are equal – it is essential that you see a pelvic health physio, sometimes referred to a women’s health physio. They must believe in your right to remain active.
Experiencing prolapse does not have to mean the end of living a full and active life.
But it does mean you need to choose your exercise options wisely. All women. At every stage of life.
Watch out for more blogs on this subject!
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