Prolapse After Childbirth: Common, Not Normal

 

Many women are told by health professionals - GPs, midwives, obstetricians, and gynaecologists - that prolapse after childbirth is normal. In the vast majority of cases, this is probably intended to be reassuring.

 

It's also true that prolapse after childbirth is common, but there is a subtle but important difference between common and normal.

 

Common means that something often happens. Women do often experience prolapse after childbirth, as a result of labour or of the pregnancy itself. The most recent data suggests that at least 1 in 5 new mums experience prolapse, and this figure is being revised up as more women feel able to seek help for their symptoms.

 

Normal has a different meaning. It suggests that not only is something to be expected, but that it is acceptable and perhaps even inevitable. To a pregnant woman, telling her that prolapse is normal implies that there is nothing she can do to prevent it happening, or to stop it getting worse if it has already occurred. To a mum with prolapse, it tells her to just accept what has happened, and not to bother anyone about it. It implies that prolapse is a normal, but unspoken, part of being a woman and she will just embarrass herself if she brings it up. It tells her that other women just deal with it, and that if she can't face just dealing with her symptoms (however distressing) then she is not a normal woman.

 

Telling a woman that prolapse is normal is giving her a life sentence.

 

If you are a health professional, consider carefully the message that your words give your patients, however unintentional.

 

If you are a woman suffering from prolapse, do not feel pressured into just accepting your condition as it is. Ask for help, and keep asking until someone helps you. A good place to start is the Getting Help and Resources tags on this website.

Women's Health Queensland Prolapse Information Sheet

This series covers information sheets about POP from professional health organisations. These pages, though they don't necessarily go into a great deal of detail, are a good place to start. They help you gain a clear understanding of POP.

The Women's Health website from the Queensland Government has detailed fact sheets on many common health conditions. Their fact sheet on Prolapse can be found here: Genital Prolapse Fact Sheet.

The strengths of this fact sheet include:

• The level of detail it provides
• It includes information about less common forms of prolapse, such as Enterocele and Urethrocele
• Clear diagrams of different types of prolapse, and a diagram showing how a Pessary sits when inserted properly

The main feature of this fact sheet is that it includes a good outline of what examinations your health professional should do when diagnosing your prolapse. This means that you can go to your appointment mentally prepared for the physical examination. It also empowers you to make sure your health professional is doing a thorough job, particularly if you are seeing someone like a GP without specialist training.

RANZCOG Prolapse Information Sheet

This series covers information sheets about Pelvic Organ Prolapse (POP) from professional health organisations. These pages, though they don't necessarily go into a great deal of detail, are a good place to start. They help you gain a clear understanding of POP.

 

 

 

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has put out a short information sheet about prolapse: Prolapse of the Pelvic Organs. 

 

Though it has some information on what is referred to as 'conservative treatment' (which may include monitoring, physiotherapy or insertion of a Pessary), its main focus is on surgery.

 

The main strength of this fact sheet is that it includes a video that explains laparoscopy (a common form of prolapse repair surgery), and shows what happens during a laparoscopy.

 

While I encourage women to be as informed as possible about their prolapse and any treatment they undertake, you know yourself best. If watching a video like this will make you more anxious about surgery, then it may be better to read about what happens during the surgery rather than watching it.

 

Warning: The end of the video shows how laparoscopy can be used to treat Ectopic pregnancy. Stop it before the end, or do not watch it at all, if this will be distressing to you.

The Cost to Society of Leaving POP Untreated

 

Women make up half of the population. Approximately 86% of Australian women will have a baby over their lifetime, and of those, roughly half will experience POP.

 

Many of these women have symptoms such as incontinence or pain that restrict them from doing activities they would like at home or at work. For some women it even prevents them from continuing work, volunteering, or caring for children or other relatives. The unsatisfactory nature of so many current treatments, and the lack of knowledge about the condition, really compounds this.

I have often wondered what the cost is to society of 1 in 5 Australians being so limited in their activity.

 

Deloitte Access Economics was commissioned in 2011 by the Continence Foundation of Australia to try and answer this question. They were looking at all incontinence, not just prolapse - but prolapse is one of the leading causes of incontinence among women, who suffer from incontinence far more than men.

 

The figure they came up with was that incontinence cost the Australian economy $42.9 billion a year, not including the cost of actually treating or managing incontinence.

 

Considering this figure, prolapse and other conditions that cause incontinence (many of them, like prolapse, often related to childbirth) need to be a much larger focus of research and public awareness campaigns. The economic cost, and the human cost, is too high.

A Tool to Help you Gain Confidence if you are Incontinent

Leaving the house can be daunting when you are incontinent, let alone going on long trips. This can affect your family life, your relationship with your partner, and your career.

One tool that may be useful if you have a smart phone is an app showing you where the nearest publicly-accessible toilet is at any given time. Many of these apps are free, and show toilets in places like parks, town halls, libraries, medical centres and shops.

To find these apps, go to the iTunes store (for Apple), the GooglePlay store or the Android AppStore (for Android), and use search terms such as "toilet finder". Each app should tell you its price (try looking for ones that are free), and also have a summary of its features and ratings from users.

Some Australian apps (all free) are:

• Aussie Loo - this app has three options: "I'm busting!" which gives you directions to the nearest toilets; and two search options (using the map or entering an address) which allow you to plan ahead.
• Street' Loo - lists the opening hours of toilets, and has an 'emergency' button you can press to get walking, biking or driving directions to the nearest toilet. It also has a search feature.
• Toilet Finder - tells you the 10 nearest toilets in either a list or a map.

The great thing about these apps is that you don't have to plan your trip as closely as you may otherwise have to. At any time you can take out your smart phone, open the app, and be directed to the nearest public toilet. For someone who has urge incontinence this can greatly increase the number of places they can travel to.

If you are in Australia and do not have a smart phone, you also can access this information on the following webpage from the Department of Human Services: National Public Toilet Map. You will need to plan your trip ahead if you want to use this resource.

For people who are not incontinent, this can also be a useful resource if you have a toddler who is toilet training.

If you know of any resources like this for your country, please share them in the comments below.

Prolapse Management: Are you Eating Enough Fibre?

Eating brown bread instead of white is a simple way to increase the amount of fibre you eat

 

As I pointed out in the earlier post "Are You Going to the Toilet Correctly?" managing constipation is a really important part of preventing prolapse from becoming worse. Straining to defecate puts a lot of downward pressure on the pelvic floor, which may cause further damage.

 

A big part of preventing constipation is having a high fibre diet, which doesn't necessarily mean using supplements or additives.

 

The Australian Government's health resource, The Better Health Chanel, has put together a great resource about dietary fibre: Fibre in Food.

 

This resource includes information on:

• The importance of getting enough fibre
• How much fibre is enough
• The two types of fibre and the different roles that they play
• How to make the best use of the fibre in your diet (for instance, drinking enough water)

Perhaps the most useful part of this page is a comparison between a sample low fibre diet and a high fibre diet, showing how you can make a few simple substitutions to improve your fibre intake without radically changing your whole diet.

Where to Find Information on Prescription Medications

One of the benefits of taking prescription medications rather than alternative remedies is that drug companies are obliged to produce detailed up-to-date information about each of their products.

 

You can access this information as a consumer on a number of websites:

• Medicines.org.au (which has a policy of adding new information immediately after receiving it from drug companies, and is therefore very up to date)
• Medicines Guide (produced by the Australian Government's 'Better Health Chanel')
• NPS Medicinewise (produced by a coalition of healthcare professional organisations)

An example of an information sheet for a drug commonly given to patients with prolapse is Lactulose (a laxative). The drug information sheet for Lactulose on Medicines.org.au can be found here: Duphalac.

 

These websites are not a substitute for professional advice from a pharmacist or doctor, but they can be useful to 'fill in the blanks' or to give you additional information that a GP may not be aware of (considering the variety of medications that they deal with on a daily basis).

 

If you are unsure about something you have read, you can call an information line such as Medicines Line in Australia (1800 633 424) to speak to a pharmacist. If the information on these sheets conflicts with information a health professional has given you, you can go back to them to seek clarification, or get a second opinion.