Life after prolapse: It will be different, but it will still be great

Before I became pregnant with my first child, I was the fittest and happiest I’d ever been. Mere weeks before those two pink lines appeared on the pee stick, I’d completed a nine-day non-stop expedition adventure race, another two-day adventure race in my first elite team, and a 50km ultramarathon. 

Oh, and did I mention I’d once paddled a kayak to Tasmania, bushwhacked for 24 hours through thick North Queensland rainforest, and abseiled a skyscraper in China?

If you hadn’t guessed it, I was an adrenalin junkie; so much so that, six years earlier, I’d quit my media career to run an adventure sports business fulltime with my husband. After a decade failing and flailing through a series of dud relationships and unfulfilling career choices, I had finally found my ‘thing’.

Fast forward to 2:20pm, July 15, 2016. The fateful moment forceps were used to hurriedly extract my imperilled firstborn. The moment a tool I naively assumed had been relegated to the obstetric dark ages partially tore my pelvic floor muscle off the bone.

The moment my world was knocked out of orbit.

By about four weeks postpartum, I knew something was up down there. In the background, behind the sting of my badly stitched episiotomy, was an aching ‘drag’; a sense my insides were falling out. I plucked up the courage to inspect myself with a hand mirror, and what I saw was shocking. Tissue that used to be neatly tucked up inside me was now poking out like two fleshy bubbles. 

Heart in mouth, I consulted Dr Google, and promptly got a crash course in pelvic organ prolapse, a condition I’d barely heard of before. Diagram after diagram of fallen bladders, bowels and uteruses seared my retinas. Dot-point after dot-point told me I was doomed; no more heavy lifting, no more high-impact sport, no running. The oxygen left the room. 

From that moment, I plunged into psychological freefall. Many well-meaning healthcare professionals tried to slow my velocity, but no matter how they spun it – this is normal, it will get better, it’s only mild, do your Kegels, take up yoga, just keep running, wear a pad, it’s psychosomatic, change your mindset, take up swimming, take these pills – my lived experience was beyond their comprehension.

Despite my conscientious commitment to physio, hours of counselling, and packets of sedatives, antipsychotics, and antidepressants, I simply couldn’t trick myself into believing it was all in my mind – and I so badly wished for it to be all in my mind. 

Running felt bad. Jumping felt bad. Lifting felt bad. And I leaked urine, too! I wasn’t imagining it. How could I possibly complete another five-kilometre Parkrun, let alone an ultramarathon? 

My life, as I knew it, was over. Sure, I expected to slow down with a baby in tow, and I was looking forward to the change of pace that comes with family life, but I didn’t expect to lose my athletic ability – my identity – so abruptly. That it was all avoidable added an unpalatable bitterness to my grief (that’s a story for another day).

And it was grief. There was PTSD, there was depression – maybe even a touch of psychosis at my lowest point – but mostly it was raw grief. I grieved for the woman I was and the woman I planned to be. I grieved for long runs in the bush, bombing down black diamond mountain bike trails, burpees, and box jumps. 

I grieved for my athletic community, and the special camaraderie of the adventure racing scene. I grieved for the career I’d risked everything for – the career that had saved me from depression. I grieved for my suddenly frayed connection with my husband, which was woven from our mutual passion for adventure sports. And I grieved for the mother I’d hoped to be; the fit, active mum – the role model – leading the kids in backflips at Bounce.

My grief was so profound and debilitating I was involuntarily committed to a perinatal psychiatric unit a few weeks after my baby’s first birthday. When I eventually emerged five weeks later, blinking into the early September light, I made a resolve to look the beast in the eye and snatch back some of my stolen sunshine.

The first step in healing was to find out exactly what I was dealing with. A year of conflicting advice and diagnoses had played havoc with my mental health. The only thing I knew for sure about prolapse was how little about it – from how it’s diagnosed, to how it’s treated, to how it’s experienced by individual women – is absolute. The closest I could get to objectivity was a 3D/4D pelvic floor ultrasound, and for that I would need to fly interstate.

(Why this simple, inexpensive diagnostic tool isn’t used more commonly is puzzling; why are we relying on fingers and eyes when we have more accurate, less invasive technology readily available?)

As the saying goes, seeing is believing. What I saw on that grainy black-and-white screen, in a utilitarian clinic somewhere in the back blocks of western Sydney, confirmed what I had suspected all along; I didn’t have to be an experienced sonographer to see that half of my pelvic floor was MIA. As I contracted on command, I could see my right levator ani barely hanging on – a thin, atrophied shred of muscle trying valiantly to match its counterpart but falling short. It was partially ‘avulsed’ – torn off the bone.

It wasn’t all bad news. My bladder and bowel prolapses were only mild to moderate, and my urethral hypermobility wasn’t off the charts either, although it did account for why I was consistently wetting myself after 10 minutes of jogging (on a good day). 

But my levator hiatus – the gap the pelvic organs, and babies, pass through – was abnormally distended. After a vaginal birth, a ‘normal’ levator hiatus is anything under 25cm2 – mine was 32cm2.

This partially explained why I was so symptomatic despite being consistently told I had clinically mild prolapse. My distended levator hiatus meant there was a lot of dynamic movement when my pelvic floor was under load, and since ‘under load’ was my way of life, I perhaps felt it more keenly than others might. Every time I attempted the things I loved – running, jumping, lifting heavy weights – I could feel my organs slump into my vagina, making me feel like my very bodily integrity was under imminent threat. My fight-or-flight response would then kick in, leaving me crippled with panic.

The chronically ill often describe relief at a diagnosis – confirmation they are not insane or imagining things. While I don’t want to compare my plight with theirs, I did experience a sense of calm – even satisfaction – that day in Sydney. I finally had permission to stop playing mind games with myself. I wasn’t mad, I was right. I was right about my own body. Who woulda thunk it?

From here, I could begin to move forward, and set realistic goals and expectations. First, I found a urogynaecologist I trusted and, importantly, didn’t trivialise my symptoms (and I had to kiss a few frogs, believe me!) He was equal parts reassuring and realistic. Up until that point I’d had too much of the former and not enough of the latter. I’m an optimistic person by nature, and a doer, but I’m also very pragmatic. While in the psych hospital, I had very rationally concluded my elite adventure racing days were over, and to find joy in life again, I needed to make peace with that. I didn’t want smoke blown up my arse about how I could do anything I “set my mind to”. That kind of self-delusion would only set me up for ongoing anxiety and disappointment. 

Instead, I wanted to embrace my ‘new normal’ and make that as happy, healthy, and athletic as possible without exacerbating my symptoms or stressing about wet patches on shorts. I wanted to find my safe limit – the place where I could get the runner’s high without the running. I also wanted to preserve my remaining function for as long as possible – I didn’t want to hasten the need for surgery. Importantly, I wanted to be physically and mentally strong for my family.

To this end, my specialist didn’t rule in or out any activity, but instead encouraged me to be guided by my symptoms. If it didn’t feel right, I wasn’t to push it, but equally, I shouldn’t be afraid to try something purely for fear of making things worse.

To help alleviate my symptoms during exercise I was fitted with a somewhat crude, but very effective, cube pessary. (I had already been using a traditional ring pessary, but it was the wrong shape and several sizes too small). With my cube in place, I felt confident to resume a gentle exercise regime. After more than a year paralysed by pathological fear of movement, I badly craved the heat of exertion in my limbs; a heart racing from effort, not anxiety.

I joined a local reformer Pilates studio and got busy reforming. I was pleasantly surprised. I’d always (erroneously) regarded Pilates as a bit ‘soft’. Not enough pain and exaltation for this adventure athlete! But that studio became my church. I religiously rocked up three times a week to squeeze, lift, brace and hold my way back to better function. 

During my workouts, I concentrated on engaging my entire core through the effort – particularly my pelvic floor and transverse abdominus – while simultaneously exhaling to reduce intra-abdominal pressure. Slowly but surely, some tension and tone began to return to not only my pelvic floor, but also my abdominals. My amazing Pilates coach found I had significant diastasis recti (I thought I just had garden variety mum-tum) and pointed out this was almost certainly contributing to my pelvic floor symptoms – these areas work in unison and weakness in one can lead to weakness in the other.

Through this dedicated training, the act of lifting, bracing, and exhaling through effort – even through mundane tasks like closing my car boot – became second nature, and the persistent sense my insides were trying to escape my body became less pronounced. Importantly, as I gained more confidence in my body, I fixated less on my symptoms. The less I fixated on my symptoms, the less they bothered me.

Indeed, the mind-body connection in pelvic floor dysfunction is huge. The pelvic region is such a personal, intimate, and culturally ‘loaded’ part of the female body. When something goes wrong down there, it is felt four-fold. And if birth-trauma is involved, there’s a constant somatic reminder of the panic, chaos, and fear of that awful event.

To help with the psychological aspects of my injury, I eventually found enormous benefit in therapy, although it took a while to find the right therapist. From the big stuff of processing my birth experience, down to the little cognitive behavioural tactics to get through highly symptomatic days, my psychologist was just as important as my Pilates coach in getting me moving without fear. 

Also critical to my recovery was peer support through the Australasian Birth Trauma Association. Their Facebook support group was my refuge in a world that, sadly, didn’t get physical birth trauma, or why I was so sad. When close friends and family wished for me to “suck it up”, those beautiful strangers on Facebook reminded me I wasn’t alone, and my feelings were valid.

After a few months of concerted rehab and therapy, I decided it was time to get back on the bike, literally. Perhaps, more than running, I missed mountain biking. Pre-baby I was a pretty serious amateur racer and enjoyed not only the endurance aspects of the sport, but also the technical challenge. But the jarring, high intensity nature of it had deterred my comeback.

Until Christmas Eve, 2017.