When told she could no longer exercise, run or even pick up her toddler, Pilates instructor Holly Puddephatt thought life as she knew it was over.
The fit and active 37-year-old from Leeds was diagnosed with bladder and uterine prolapse 18 months after giving birth to daughter Thea, now three – and was told that she had to “live with it”.
“My GP sent me away and told me to go home,” she says. “I couldn’t believe I was treated so badly.”
A prolapsed uterus (known medically as uterine prolapse) is where the muscles and tissues that support the uterus weaken, causing it to slip into the vagina.
“In severe cases, the uterus may even protrude from the vagina,” says Dr Shazia Malik, consultant obstetrician and gynecologist and UK medical director of virtual women’s health clinic Daye.
This condition is part of a group of pelvic floor disorders collectively known as pelvic organ prolapse – where the supporting tissues have weakened so that the organs of the pelvis, including the bladder and rectum, fall out of place. their normal position in the vagina.
Pelvic organ prolapse affects one in ten women over the age of 50, according to the Royal College of Obstetricians and Gynecologists.
It can be caused by a number of factors: aging (when muscles lose their elasticity); diseases that weaken connective tissues (including genetic disorders); pelvic floor injuries; and having had a hysterectomy.
Pilates instructor Holly Puddephatt thought life as she knew it was over when she was diagnosed with a prolapse.
But less is known about the important role that childbirth – particularly a natural vaginal birth – plays in otherwise fit and healthy women like Holly.
An American study, published in the International Urogynecology Journal in 2013, suggests that vaginal birth significantly increases the risk of prolapse in women. Up to 50 per cent of women may experience some degree of prolapse afterwards, says Jo Dafforn, a physiotherapist specializing in women’s intimate health and head of the pelvic health clinic at Nuffield Health.
Many affected people may not even realize it and “could walk around without symptoms,” she adds.
But one in 12 women with pelvic organ prolapse will report symptoms – such as vaginal “heaviness” or dragging feeling, a lump inside the vagina, lower back pain and difficulty controlling and/or to empty their bladder or intestines – explains Ms. Dafforn.
And too often, women are not informed that help is available, adds Dr. Malik. A pre-print (meaning not peer-reviewed) study published last year found that pelvic floor muscle training combined with counseling on how to significantly improved the symptoms and quality of life of women with mild to moderate pelvic organ prolapse.
But women are often too embarrassed to ask for help. “It is very important not to feel ashamed or reluctant to seek specialist advice,” adds Dr Malik. “It’s common and there are many ways to help and no one should have to suffer in silence.”
Holly’s problems started after Thea’s birth – which ended up being a long time coming. She had an epidural, which meant she couldn’t feel anything when the midwife asked her to push. Her little girl was finally delivered by forceps.
Nevertheless, Thea was in good health. Holly was just relieved it was all over and determined to get on with life as a new mom when they were both released from the hospital a few days later.
Holly’s problems began after the birth of her daughter Thea – which ended up being long. She had an epidural, meaning she couldn’t feel anything when the midwife asked her to push.
She felt “heaviness at the bottom” over the next few weeks – which she now realizes was a symptom of prolapse. But, at the time, she blamed it on the stitches (for an episiotomy during forceps delivery).
But things have not improved. In fact, Holly had trouble even walking properly. She mentioned heaviness at her eight-week check-up, but her doctor simply advised her to do some pelvic floor exercises.
As her stitches healed, Holly began to feel a little better. “I thought I was going to get through it,” she remembers. She and her partner, Curtis, 33, a gym manager, threw themselves into parenthood and life went on.
Then, when Thea was 18 months old, Holly started feeling strange again. “It was hard to explain,” she says, “but it felt like I had a tampon stuck in me, even though I didn’t.”
She even asked Curtis to check it out. “There was nothing, but it felt like something was stuck or hanging out of me.”
Worried, she visited her GP and explained the problem in tears. She recalls: “I saw a female doctor and thought she would be friendly. But she asked abruptly: “Why are you crying?
The general practitioner carried out an internal examination shortly after diagnosing a prolapse. Holly was then told that nothing could be done – that she would just have to adapt to it – and that there was no point in being referred to a specialist. “I left in tears,” she remembers.
The problem got worse: “At certain points in my monthly cycle, it was worse and even painful. When I walked, I felt like my insides were going to fall out. Sometimes if I moved, I would leak urine.
Holly benefited from pelvic floor exercises and continues to practice them a year later.
Symptoms can come and go like this, says Jenny Pullen, pelvic floor physiotherapist at Nuffield Health Haywards Heath Hospital. She adds: “Many women report that it gets worse towards the afternoon and evening – if they have been up or carrying their baby a lot that day. It can also get worse when estrogen levels are low and at different times in the cycle.
Indeed, estrogen is essential for the strength and flexibility of tissues.
Low levels – during breastfeeding or at certain times of the month, for example – can weaken them and also make the vagina drier, making the “heavy” feeling of prolapse more pronounced.
Additionally, hormonal changes during pregnancy, as well as the weight of the growing baby, can put strain on the pelvic floor, says Dr. Malik.
The onset of labor, and especially a vaginal birth, further stretches these support structures. As the baby passes through the birth canal, it stretches the surrounding muscles and tissues beyond their normal capacity.
Although the body has an amazing capacity for recovery, some women’s pelvic floor never fully returns to its original strength, says Dr. Malik. However, subsequent births generally have a marginal effect.
She reiterates that although half of women who give birth vaginally may have some degree of prolapse, “it is important to note that not all cases are symptomatic or serious.”
And while some women, like Holly, notice symptoms immediately after giving birth, for others, there can be a “years-long” delay between the birth of a baby and the first symptoms of prolapse, explains Dr. Malik. menopause, being overweight, chronic cough or regularly lifting heavy weights can have a cumulative effect over time.
Holly eventually went to see a private gynecologist who confirmed that in addition to uterine prolapse, her bladder had also partially prolapsed into her vagina.
A physiotherapist specializing in women’s health gave Holly exercises to strengthen her pelvic floor, which can be very effective in reducing prolapse symptoms.
But it is important to get help from a specialist, adds Dr Malik, particularly to check that the exercises are being done correctly.
Guidelines from the National Institute for Health and Care Excellence recommend four months of pelvic floor training for women with pelvic organ prolapse – “however, some women will begin to see an improvement in their symptoms after a few weeks,” explains Jo Dafforn.
In severe cases, surgery – to stitch the supporting tissues to the strong bones or ligaments of the pelvis – may be suggested. Although it can be effective, as with any operation, there are some risks.
And it’s possible for the prolapse to return, says Dr. Malik. She adds that taking probiotics can help, as they maintain a healthy balance of bacteria in the vagina and urinary tract, which can reduce the risk of infections (such as urinary tract infections (UTIs), which can exacerbate symptoms of prolapse.
Good digestive health helps reduce the risk of constipation, which can also contribute to symptoms.
Holly benefited from pelvic floor exercises. She continues to practice them a year later. She also uses an internal vaginal pessary (a removable device usually made of silicone) to support the pelvic organs, and has been able to start exercising again, lifting weights and picking up Thea.
She has now opened her own Pilates studio to help other women improve their pelvic floor. “I wish I had more support and been encouraged to get help sooner,” she says. “I wish other women would understand that they are not alone and that no one should tell them to put up with a prolapse.”
You can find Holly’s story on Instagram @hollyandthea.