My Journey with Pelvic Organ Prolapse – Bronwyn’s Story

I did not get married until I was 28 years old. I had not found anyone that I wanted to share my life with and added to that was my social anxiety making it harder for me to socialise and meet prospective partners. I met my husband through family friends and within 12 months or so, we were married, kindred spirits from the start.

I fell pregnant at the age of 32. It was a fairly uneventful pregnancy, my main issue was my umbilical hernia. When I was born I had an outie bellybutton, my mum used to tell me that she would bind my stomach to try to stop it getting worse and hoping that it would heal itself, which it didn’t. I have never had to worry about bellybutton fluff as it had nowhere to hide. As my pregnancies progressed my bellybutton would get bigger and sorer.

At 39 weeks my daughter was born. She weighed in at a very healthy 4080 grams (9lb), 52cm long and 33.5cm head circumference. I was in labour for approximately 24 hours. It was a spontaneous labour, however, as the labour progressed my contractions would start and then fade away. I don’t have any recollection of my waters breaking and eventually it was decided that I should have an epidural block. I don’t recall the conversations that I had with the birthing staff or when my obstetrician arrived, it’s all a blur. I do recall that eventually I had a forceps rotation and my “big” little girl was born. I had a private room in a private hospital, however, it had a shared bathroom with the room next door. I recall needing to go to the toilet at one time in the days following the birth and as the bathroom was occupied, having to wait. When I was finally able to access the bathroom, I was just like my newborn, I had pooped my pants and had not even realised it.

At the age of 35 I gave birth to my baby boy at 41 weeks. He weighed in at 4205 grams (just under 9 & 1/2 lb’s), 54cm in length and 36.5 cm head circumference. It was a very quick spontaneous 5 hour labour this time, I definitely felt my waters break and gush on the floor and my contractions were strong. No intervention was needed, however, I had a surgical repair of a second degree tear. I do recall a lot of bruising and having sitz baths to help healing. 

I decided that 2 kiddies were enough for me especially as they kept getting bigger each time. After the birth of my daughter I was eventually diagnosed with a hernia, haemorrhoids and a fissure on the front and back of the rectum, however, it was decided to wait until I had finished having children for the repair of the hernia. 12 months after the birth of my son I had surgery – Mesh Hernioplasty for a Ventral Hernia/Divaraction of Recti, to repair the hernia and severe abdominal muscle separation. I have a 17 cm vertical scar running from below my ribs to above the pubic bone. I have a very large piece of mesh covering my stomach area and have lack of sensation over the whole area which I believe to be caused by nerve damage. It is very hard to scratch an itchy belly when you can barely feel anything.

After the birth of my children my body was completely different to what it was prior to my pregnancies. I felt quite open and loose in the vulval area in addition to the changes to breast size and my big belly. Everyone kept asking if I was pregnant, in the end if a stranger asked me, I said I was, it was easier than trying to explain what the problem was. I would wear baggy tops to try to camouflage it. I continued to do what every woman does, look after the kids and husband, do the shopping, cooking, cleaning etc. When my children started school I joined the P&C and was very active in volunteering and also returned to work on a casual basis. I did many years of work that included a lot of standing and heavy lifting.

At the age of 45 when having a regular PAP smear, it was mentioned in passing by my GP at that time that I had a 1st degree leading to a second degree Prolapse. Just over 12 months later when having a Panendoscopy and small bowel biopsy to rule out Celiac Disease, I was told by my Gastroenterologist that I had IBS, a rectal prolapse, vaginal prolapse and haemorrhoids and suggested I have them “fixed”. My new GP then suggested I try Pelvic Floor Physiotherapy before I consider surgery, so at the age of nearly 47 I started Physiotherapy. During this time I was working, active within the P&C and doing all the normal housewife duties, consequently I kept having lower back injuries needing Physiotherapy treatment for that as well. 

At the age of 49 my Prolapse symptoms had become very severe, heavy dragging sensation, vaginal bulging, difficulty initiating urine stream, difficulty in fully emptying my bladder, difficulty with bowel movements and lower back pain. My Physiotherapy treatment was helping but I believe my Prolapses had progressed to the stage that it wasn’t enough. By this stage I had also become Perimenopausal with irregular periods ultimately ending up with a period that lasted 1 month. I was now under the care of another GP (unfortunately it seems just as you find a GP you like and who gets to know your medical history they leave the practice and you have to start all over again). My new GP was very proactive and referred me to a specialist where subsequent tests including a Urodynamics Study, Transperineal and Pelvic Ultrasounds diagnosed a 3rd degree bladder prolapse, 3rd to 4th degree uterine-vaginal prolapse and complete bilateral Avulsions. I then had surgery – Vaginal Hysterectomy, Cystocele anterior repair with uphold mesh, posterior coloperineorrhaphy without mesh, sacrospinous colpofixation vault suspension and perineorrhaphy. In layman’s terms they repaired the front and back walls of my vagina and affixed mesh to the front vaginal wall and the two mesh legs were then sutured to the sacrospinious ligaments on each side to hold up my vaginal vault and my large vaginal opening was reduced. Subsequent pathology tests showed that I had an enlarged uterus with endometriosis and adenomyosis. It was a long and sometimes painful recovery and I was very careful to give my body plenty of time to heal before gradually returning to everyday activities.

I am now 57 years old, my quality of life since my surgery has improved greatly. I have had to be very proactive in my recovery since then. Whilst the surgery repaired the prolapses, I have had to work consistently to improve and increase my pelvic floor muscle strength. Prior to surgery I could barely feel my pelvic floor muscles contract, it was a very slight flicker. Since surgery I have been working diligently every day on my pelvic floor exercises and now can feel a significant contraction of my muscles. I still have pelvic floor insufficiency which I attribute to my Avulsions, as this damage to my pelvic floor which was caused by the forceps rotation was not able to be repaired. I also have a mild bladder prolapse and mild Rectocoele (rectum bulging into the back vaginal wall) and have issues with bladder leakage if my pelvic floor becomes fatigued or if I try to jump or do anything that puts too much downward pressure on my pelvic floor, I also have difficulty with obstructed defecation where the stool becomes trapped in the bulge. I will continue exercising my pelvic floor and my overall body strength for the rest of my life to maintain the strength I have gained, unfortunately as we age muscle atrophy kicks in.

I sincerely believe that if the damage to my pelvic floor had been diagnosed postpartum and I could have started a rehabilitation program then, maybe, my story would be very different and major surgery could have been avoided. I also believe that all the heavy lifting and standing on my feet whilst at work in addition to my normal everyday housewife activities, contributed to the eventual severity of my Pelvic Organ Prolapses. Unfortunately I was not aware that I was at high risk of developing Pelvic Organ Prolapse, you don’t know what you don’t know!

My advice to all women is to be your own health advocate and be proactive in your healthcare. Don’t be embarrassed to discuss issues regarding your vaginal and intimate health. Don’t ignore any symptoms you may have. We are all busy living our everyday lives looking after everyone else to the detriment of our own physical, mental and emotional health.