This week's episode of C4's Embarrassing Bodies illustrates the reality of pelvic organ prolapse following vaginal birth with the following case study: "Cat, who at just 24 is struggling daily to keep her waterworks under control." The programme follows her story through from initial examination and diagnosis, to prolapse surgery lasting two-hours.
This (series 5, episode 1) is really worth watching - not because it scares viewers about childbirth, but because it is making a genuine effort to confront issues head-on that are affecting more women than we might realise.
One thing I thought while watching was how terrible it is that this poor woman was suffering with this condition for more than a year before finding help, and how many more might be suffering in silence, long after their six-week postpartum check-up is over.
Please note that the programme contains 'full frontal nudity, intimate examinations and graphic scenes of surgery', but it also contains some useful stats and clear explanations about what prolapse is (for blog readers outside the UK, I have transcribed the contents of the programme below).
Introduction voiceover and vox pops on the street:
One in five women over 40 suffer from some kind of urinary incontinence. So we're talking bladders today... ever had any problems?
Lady 1: Just a leaky bladder. If I need the toilet then I need to go.
Dr: A little bit of wee when you sneeze or when you giggle - have you ever suffered with that?
Lady 2: Oh yes! I have! Unfortunately... usually when somebody says something to you and it is really, really funny. Or if you're not very well and you have a REALLY bad cough.
Dr: After you had your babies, did you ever have any problems with leakage?
Lady 3: Yes, a little bit, especially after the third one.
In the clinic, Dr Dawn's ready to see Cat...
Cat: Quite recently I was in my local shop and I coughed a bit too hard and I wet myself and that was really... that was quite a low point. I think i have a prolapsed uterus - something of that description.
Dr: And what is your experience, what do you feel?
Cat: I feel quite a lot of pressure downstairs and I get pains in my groin. I get shooting pains that stop me in my tracks.
Dr: And how long has this been a problem?
Cat: I had a little boy thirteen months ago and it's been since quite soon after delivery.
Dr: Do you ever find that you leak urine?
Cat: Oh yeah. I generally have an accident every day.
Dr: Do you?
Dr: Do you mind if we have a little look?
Cat: Yes, that's not a problem.
Dr: Ok, come with me. Ok Cat, if I can get you to pop your ankles up for me like you're going to have a smear, right, let your legs relax open. That's great. Well done. Ok, and would you just strain down for me. well done. And give me a cough. [coughs] And I can see that you do have quite a weakness there in the anterior vaginal wall. It's starting to prolapse down into the vagina. All right. And that, I'm afraid, is a direct result of having had your baby (smiles and laughs sympathetically and knowingly)
Voiceover: Cat's problem isn't uncommon. In childbirth, the pelvic floor muscles can often weaken, causing the uterus to fall into the vagina, known as a prolapse. Up to half of mums get this to some degree.
Dr: In most instances, if you do pelvic floor exercises, you can tighten all that up again. It's like any other muscle; you can tone it and train it. Once everything has been stretched so far that you're actually proplapsing, you can do pelvic floor exercises until the cows come home but they won't actually improve that proplapse. Ok. So i think i'm going to get you to see a gynecologist about a little op. yeah?
Cat: Ok, thank you very much. Thank you.
Voiceover: To solve this, she needs an operation to repair the prolapse and bulk out her bladder wall.
After stitching back the collapsed muscles of Cat's vaginal wall, Mr Fayyad starts keyhole surgery by pushing three tubes known as ports into her abdominal cavity. A camera at the end of one of these shows Cat's prolapsed uterus, and using a mesh, Mr Fayyad pins it back into its normal, higher position. The other end of the mesh is stapled to the sacrum, the large bone at the bottom of the spine. This method will hold Cat's uterus permanently in place and it will also enable her to have more babies, but she will have to have a c-section delivery. Finally, to help with cat's stress incontinence, gel is injected into the bladder neck, which will bulk out the area and help to keep the wee inside. The operation has taken just over two hours...
Cat: I had the surgery about six weeks ago; and it's going pretty well to be honest. I'm just waiting for my 12 weeks to be up.
Dr: The last time I saw you, poor you, you were leaking urine all the time and living in pads. How are you now?
Dr: Do you wear pads at all?
Dr: Not at all?
Dr: Excellent. And are you doing your pelvic floor exercises?
Cat: Yeah, every day.
Dr: And that's a lifelong commitment really because it's important that you keep those pelvic muscles toned to support your bladder.
Dr: So do you feel you're getting back to a normal life now?
Cat: Slowly but surely. I'm - obviously I've only just started to feel better but I'm looking forward to being able to do things that normal people do, and enjoy my little boy the way everyone else enjoys their children. and get out there and do things with him. I'm just really pleased with the effects, so far, and can't wait to go back to work.