By Jen Pinarski
At my six-week post-partum checkup after the birth of my daughter Gillian, my OB/GYN confirmed what I’d been fearing since the day I left the hospital: my vagina had fallen out.
Technically, it was a cystocele: a condition where the muscles and tissues in my pelvic floor and abdominal cavity had become so weak that they could no longer support my bladder, causing it to bulge into my vagina.
Along with pelvic pressure and stress incontinence, my cystocele brought embarrassment.
Later that day I timidly asked a girlfriend (and a mom of five) if the same thing happened to her.
“It happens to almost all of us,” she said. “We just don’t talk about it.”
What to watch for
Unfortunately, pelvic-floor dysfunction does happen to almost all of us. According to a study evaluating the presence of any symptom of pelvic-floor dysfunction, most of the female participants displayed signs of at least one of the following:
Other warning signs shown by research participants included:
Early detection of these warning signs—and medical intervention—can easily correct the symptoms and prevent development of further pelvic-floor dysfunction.
The study's findings, published in the January 2015 International Urogynecology Journal, shows that high prevalence of pelvic-floor dysfunction symptoms matched with low levels of pelvic-floor health knowledge.
By the middle of this century, 58.2 million women in the U.S. will have at least one pelvic-floor disorder, the American Urogynecologic Society estimates.
Pelvic-floor dysfunction knows no age barrier, says Carolyn Vandyken, a Pelvic Health Physiotherapist at the Centre for Pelvic Health in Cambridge, Ont. Many teenage girls struggle with painful periods, and women may suffer from sexual dysfunction or organ prolapse as they age.
In fact, if you had painful periods in the past, you may be at higher risk for pelvic-floor dysfunction.
Most of us in our childbearing years first experience pelvic-floor dysfunction during pregnancy, when the muscles, tissues and ligaments are stretched to their limits.
“Pregnancy and childbirth can traumatize the pelvic floor muscles, causing all kinds of unknown and uncomfortable symptoms for women after they give birth,” Vandyken says.
Difficult deliveries—those involving forceps or vacuums, grade 3 or 4 episiotomies, big babies or pushing for more than two hours—put a post-partum woman at higher risk for developing pelvic-floor dysfunction.
Bladder issues, and reparative surgery
While pelvic-floor dysfunction includes a broad spectrum of health concerns, bladder issues are the most common.
In Canada, one in three women in middle-age or older is affected by urinary incontinence.
If you’ve ever crossed your legs before laughing, pee frequently, or refused to jump on the trampoline with your kid in order to avoid wetting your pants, you are part of the statistic.
“Urinary incontinence is particularly common in post-partum moms,” says Vandyken, adding it can last beyond the first six months, or can strike later.
The risk of urinary incontinence also increases with each pregnancy, like it did for Winnipeg mom Nancy Dekker*.
“Anytime I would lift groceries, exercise, laugh or sneeze, I would leak. The bladder protection I needed [incontinence pads] just kept increasing in size,” admits the mom of two.
Dekker tried both a specialized physiotherapy program and a pessary before deciding on transvaginal mesh surgery after her nurse declared her an excellent candidate for the procedure.
Dekker had her surgery two years ago, when lawsuits against transvaginal mesh manufacturers were making headlines. She says that while the media coverage was unnerving, it didn’t dissuade her.
“I was fortunate that my doctor specializes in surgical management of urinary stress incontinence. He explained everything in advance and I was confident in him,” Dekker says.
Her surgery was straightforward: a 20-minute procedure requiring only half a day in the hospital, plus two weeks of recovery at home.
The procedure improved the quality of her life, with Dekker returning to running and cycling, activities that were not enjoyable post-partum.
Catch it earlier, avoid surgery
Not every woman who has urinary stress incontinence as a pregnancy souvenir needs surgery.
Dr. Kelli Berzuk, a pelvic-floor physiotherapist whose 20-year career has focused on the prevention and correction of pelvic-floor dysfunction, works alongside her patients and sees surgery as a final option.
The condition is curable and there is a wide range of conservative treatment options, like specialized physiotherapy, medication or pessaries, Berzuk says.
Referring to the study in the International Urogynecology Journal, Berzuk says that when knowledge regarding healthy bladder and bowel diet, proper pelvic-floor muscle exercise and correct toileting were given to study participants, pelvic-floor dysfunction symptoms significantly decreased.
In fact, many women were able to complete correct their pelvic-floor dysfunction without surgery.
Getting past the embarrassment
The first step—talking to your family doctor—is sometimes the hardest to take because embarrassment often keeps women from seeking help. Poor self-esteem and depression are tied to incontinence, and Berzuk sees these symptoms when women first visit her office.
“Twenty years ago, doctors and other medical professionals rarely talked to new moms about their pelvic floors, and treatment would be just a pad,” Berzuk says.
“We are seeing a lot more discussion about this important area of the body now and because of this women are being referred for pelvic-floor physiotherapy much earlier in the development of their symptoms.
Vandyken agrees that embarrassment keeps women from talking to their doctors, but awareness is growing in Canada.
She points to France, where an internal pelvic-floor assessment is included in a new mom’s post-partum checkup.
“We need to start bringing these problems out into the open. . . . Our basic needs in life need to be met before anything else can be achieved in life. When the pelvic floor isn’t functioning, neither is the woman to her best capacity.”
There is hope and positivity for women, with 90 per cent of patients noting significant improvement once they start treatment, Berzuk says. “Leaking, even a little, isn’t normal and we should fight back against the stigma,” she says.
“Be proactive, talk to your doctor, seek good advice and know you’re not alone.”
(* Name changed for privacy)
Find a specially trained pelvic health physiotherapist in your city:
Canadian Physiotherapy Association, Women’s Health Division
Jennifer Pinarski is the community manager of momstown Kingston, the writer of the Run-at-Home Mom blog for Today's Parent, the mother of two children, and a bravely outspoken voice for women's health. Help us end the stigma: Talk to a health-care professional if you're concerned about your pelvic health. Remember, they've seen it all.