Catherine
Catherine had a uterine prolapse (when the uterus slips down into or out of the vagina) after a difficult birth. She found that prolapse “affected me more mentally than I realised, than physically”. Physiotherapy and counselling have helped her manage her symptoms and the emotional impact.
Catherine is a police trainer. She is married and has a five-year-old child. She describes herself as White British.
Condition: pelvic organ prolapse
More about me...
Catherine had a difficult birth involving a long labour and forceps delivery. Afterwards, she noticed feeling a bulge and a feeling of heaviness, but she wasn’t in pain or having any incontinence. At first, she “kind of ignored it” and was focused on caring for her baby. At a routine cervical smear test, the nurse asked Catherine if she was having any gynaecological issues and suggested she book in to see a GP. At the GP appointment, Catherine was shocked and worried to hear she had a prolapse: “the first thing I thought that my vagina was going to fall out, and you only really associate them with old people”. The GP “told me the process” for specialist support and put in a referral for Catherine to see a physiotherapist.
Catherine’s first experiences with a physiotherapist were a “nightmare”. The physiotherapist “showed no empathy” and, when talking about sex, told her she should “just get back on it”. She also found it “quite intrusive” having internal physiotherapy, especially when the practitioner was asking sensitive questions. The physiotherapist also told her that she needed to stop running, which was a “massive” blow to Catherine as it is a source of enjoyment and escapism for her. She began to dread going to the sessions, and later put in a complaint about how the physiotherapist treated her. On arrival to her third physiotherapy session, the physiotherapist had been replaced by a new person who was “so lovely” and supportive. The second physiotherapist took on board Catherine’s goal of getting back to running. She attended around 10-12 sessions, and now self-manages with the exercises she was taught. Although the symptoms have improved with the exercises Catherine learnt from the second physiotherapist, she still has a dull ache at times and is unsure about what her next steps should be. She has been thinking about going back to her GP to discuss this.
For Catherine, prolapse “affected me more mentally than I realised, than physically”. She felt very “lonely” and “lost”. It also impacted on her relationship with her husband, as Catherine says she “closed down” and “I just didn’t know how to” talk to him about it. Through her workplace, she was able to access telephone counselling services. She attended the allotted amount of sessions, but sensed she was unable to get to the “crux of the problem”. A few months later, Catherine came across self-referral for cognitive behavioural therapy (CBT) on the NHS. At her first session, the therapist suggested Catherine would benefit from seeing a sexual health counsellor and referred her on. Over the course of around six sessions, Catherine talked through her feelings towards having sex again and of blame for not wanting to have a second child. Through therapy, Catherine feels she has become more able to break “barriers down” and talk openly about prolapse. She tries to be open at work and with friends, and has found that people often share similar experiences. She has also started a podcast on experiences of pregnancy, prolapse and motherhood.
Catherine thinks it would be helpful if there was more information about prolapse during pregnancy and postnatally, to better prepare and support women. She emphasises how intensive it is to recover from pregnancy and birth, and that it is easy as a new mum to “forget your identity” and delay seeking help. Catherine has found resources like YouTube videos helpful and notes that, once you “tunnel in”, there is lots of information online. To healthcare professionals, she asks them to focus on “understanding the person” and to have good bedside manner. She would like there to be less onus on patients to navigate the system to get help for prolapse.
Catherine felt shocked, tearful and daunted when she was told she had a pelvic organ prolapse.
Catherine felt shocked, tearful and daunted when she was told she had a pelvic organ prolapse.
So then the appointment came and I guess I was quite shocked when she said it because when you think of prolapses-, I think the first thing I thought that my vagina was gonna fall out and you only really associate them with old people. You know, I’ve heard of old people having prolapses but no-one kind of like my age and within my friendship circle as well, I don’t know anybody else who’s had a prolapse either. So it was all kind of quite daunting really. I admit I did-, once I came home, I did like, I felt quite teary because again I just, it was just the unknown really and I didn’t really know what I was going into.
I think mentally it hit me more. It hit me more mentally than it did physically if I’m honest and I would kind of put myself down as quite a resilient person and I just didn’t know how because obviously because they took away the running side of it I had no escapism.
I felt really lost so I didn’t really know where to turn.
Catherine feels that going to counselling has helped her relationship with her husband reach a “better place”.
Catherine feels that going to counselling has helped her relationship with her husband reach a “better place”.
It’s definitely helped it’s definitely got me to kind of understand why I kind of feel that way and I think without my husband kind of needed to do, needed to do his part as well, it’s like I don’t know, I don’t know whether it was kind of from a male, he didn’t quite know what to do or how to kind of react to it and obviously he just thought that I just wasn’t kind of talking to him and I didn’t talk to him after every session either because I think sometimes you just need time to reflect on your sessions and kind of just work out what you, what you need, what you need to do and this is what I found the hardest really is like he needed to kind of meet me halfway where I felt I was doing my part and he kind of needed to kind of do his I suppose. You know, he never really asked about, sometimes I didn’t tell him when I was going because he never really asked about or showed an interest so that kind of annoyed me and I was like I’m going through this and I feel like I’m going through it on my own. But we are in a better place now, that’s, you know, that’s for sure.
Running is important to Catherine so being told to stop was devastating.
Running is important to Catherine so being told to stop was devastating.
So I’m a runner and I teach quite a lot of fitness classes and the first physio was like, “You’ve got to stop running,” but to take that away from me is massive and I don’t think she realised like the impact that had on my life because all of a sudden I can’t do what I love and I don’t know what else to do to kind of you know, for fitness so again I did put on weight during and that kind of worried me as well because of taking away something that is my release to life I suppose. And I take classes so I had to reduce my and I understand that I had reduce my weight classes as well. I didn’t stop teaching because I don’t, financially, I needed to. Obviously, I just made adaptations and then obviously people in class were asking and I was quite, I didn’t really, initially I didn’t say, I just said, “Oh I’ve got a bad back, I’ve just got to be careful. I’m having physio” because again you don’t really know, no-one really speaks about it as though all of a sudden it’s very kind of, puts in a little bit of a different world I suppose.
The nurse at Catherine’s smear test suggested she see a doctor about her concerns.
The nurse at Catherine’s smear test suggested she see a doctor about her concerns.
I went to my first smear test after having my daughter and then the nurse was like, “Oh have you got any gynae problems?” I was like, “Well I haven’t really got any gynae problems but I’ve kind of got this bulge and I don’t quite know what it is, you know, it’s not caused me any discomfort or pain but I think I should get it seen to” and she kind of said, “Yeah actually I think you should like it, while you’re here book in to see a doctor-, female doctor,” which I did after the appointment and basically it wasn’t until that appointment that I got diagnosed with the prolapse.
Catherine was “shocked” when she was told that she had prolapse.
Catherine was “shocked” when she was told that she had prolapse.
Then the appointment came and I guess I was quite shocked when she said it because when you think of prolapses, I think the first thing I thought that my vagina was gonna fall out and you only really associate them with old people. You know, I’ve heard of old people having prolapses but no-one kind of like my age and within my friendship circle as well, I don’t know anybody else who’s had a prolapse either. So it was all kind of quite daunting really and I admit I did, once I came home, I did like, I felt quite teary because again I just, it was just the unknown really and I didn’t really know what I was going into.
Catherine learnt to listen to her body after having her baby, and to take things at a slower pace.
Catherine learnt to listen to her body after having her baby, and to take things at a slower pace.
I remember the one thing that my physio and it really-, my second physio said was, “Never underestimate the power of walking,” and it’s so true. So because I couldn’t run, I was just walking every, so I was on my, when I was on my maternity leave, was I still on my maternity, even my maternity leave I was walking, it was just nice just to get out the house. And obviously my maternity leave was through the summer, so I was able to do that. But, you know, it’s like, certainly it certainly helped me, and I tell people that a lot as well particularly if they’re in the same situation. It’s like, yeah, you know, there is a light at the end of the tunnel but you’ve gotta be, it is a slow process and you are gonna have rubbish days but you just kind of got to take it kind of steady and slowly and I think that’s the thing is when you don’t realise that your body can take up to a year to go until you’ve actually get, recover from pregnancy because you can’t see it, it’s not like a broken leg where you know you’d had like the plaster and then you have physio, then you’re kind of good to go. You kind of think you’re good to go and then you do something because obviously you’ve got the pro, hormones still in your body and they can react very differently with like less elasticity within the joints and things like that and people, you know, and I’m one of them, I put my hands up, you wanna go back to how you were pre-baby but you forget that you’ve kind of had a baby if that makes sense and obviously things, your body had changed, you’ve got bigger boobs, your hips are now wider. It’s, it’s getting used to that side of the change in your body as well as well as everything, and if you’re breastfeeding, again you’re gonna have the milk still there as well and that can affect, you know, not the, affect the exercise but obviously you’d need more of the supportive bra. You might not be willing to do high impact exercise. Again, if you’ve got the prolapse and you’re incontinent, you might not want to do and again it’s those kind of things that I think we need to be more aware of I think.
Catherine tells us about two very different experiences of physiotherapy and why the clinical relationship is so important.
Catherine tells us about two very different experiences of physiotherapy and why the clinical relationship is so important.
My first physio was a nightmare if I’m honest and it, as a result I did actually end up going to counselling so she just showed no empathy or kindness, she was very factual. I know you have to be factual, but she was, this was very much how she kind of said things so the first-, there were a few things that kind of really stand out about it. One of which obviously I was saying there, she was asking about sex, not having sex and I just didn’t feel like I wanted it and she’s like, “Oh it’s okay, you just have to get back on it,” and I was like, “What does that mean, you know, I don’t, how do you do that?’ I don’t, I’m so lost now,’ I didn’t, I don’t, I think I lost myself as well within the whole process as well and so she said about coming off contraception which I because I was on the pill and I did because she said, “Oh yeah then it will just kind of come back,” and it’s like ‘Oh right, okay,’ so I just did that and her bedside manner was not very kind I suppose or it wasn’t, it wasn’t unkind, I think it was more empathy towards it because obviously you’re going in there, it’s quite, it’s quite daunting, it’s quite embarrassing. I wasn’t really expecting the physio that I had. I mean, I’ve had physio before from sport injuries and I just assumed, whether I didn’t read the letter properly I don’t know, but obviously it was internal physio and I found it quite intrusive.
The second physio, it wasn’t patronising or anything like that but she just, she just made me feel comfortable. I don’t know how she done it, she just made me feel comfortable. She didn’t do anything physically different to what the first physio done, she was still examining, examining me internally, it was just her way she did it and explained it, I think. Where the first physio was very direct and very blunt and this is it, it’s like black and white. Whereas sometimes you need that pink and fluffy because it’s quite undignified, when you have, when you know you’re pregnant, it does become undignified because everyone has to look up there, you know, everyone you kind of that bit kind of goes out the window.
Catherine “switched off” when she was told she had prolapse. She would have liked some further information and links to resources to read later.
Catherine “switched off” when she was told she had prolapse. She would have liked some further information and links to resources to read later.
The information was verbal so, you know, they told me information about it but it, yeah it wasn’t, it was still a bit vague if I’m honest but I don’t know whether when you suddenly are told that you have got a prolapse you don’t, I switched off I think in the appointment because all that’s, all I could think of is like, ‘Oh my god, everything’s gonna fall out, I’m gonna now start weeing myself. I’m gonna like-, what do I need to do?’ Oh my god am I old? Am I broken?’ you know, and I think there wasn’t, I’m not gonna say old school but there wasn’t really like leaflets, or anything given or anything or they didn’t say, like they didn’t kind of take you towards a website or a resource I suppose.
Recovery after childbirth can be a long process, says Catherine.
Recovery after childbirth can be a long process, says Catherine.
I tell people that a lot as well particularly if they’re in the same situation. It’s like, yeah, you know, there is a light at the end of the tunnel but you’ve got to be, it is a slow process and you are going to have rubbish days but you just kind of got to take it kind of steady and slowly and I think that’s the thing is when you, you don’t realise that your body can take up to a year to go until you’ve actually get, recover from pregnancy because you can’t see it, it’s not like a broken leg where you know you’d had like the plaster and then you have physio, then you’re kind of good to go. You kind of think you’re good to go and then you do something because obviously you’ve got the pro, hormones still in your body and they can react very differently with like less elasticity within the joints and things like that. And people, you know, and I’m one of them, I put my hands up, you want to go back to how you were pre-baby but you forget that you’ve kind of had a baby if that makes sense and obviously things, your body had changed, you’ve got bigger boobs, your hips are now wider. It’s, it’s getting used to that side of the change in your body as well as everything, and if you’re breastfeeding, again you’re going to have the milk still there as well and that can affect, you know, not the, affect the exercise but obviously you’d need more of the supportive bra. You might not be willing to do high impact exercise. Again, if you’ve got the prolapse and you’re incontinent, you might not want to do and again it’s those kind of things that I think we need to be more aware of I think.