Pelvic floors, prolapses and pessaries. My 6 week check and journey from there
Updated: May 11, 2021
This post covers my 6 week Pelvic Health Physio check, my GP check (which was very different) and then *spoiler alert* my prolapse treatment and pessary fitting (for running). And ends with me starting to run again! The outline version of this was in the film (link here) but I feel there’s a lot of detail to fill in.
It’s a personal journey and treatment plan and as we know every pregnancy and recovery is different. But there is such a lack of information out there about what happens AFTER we give birth – and to be honest such a lack of support (read on for my disappointing GP check) that I hope this is helpful. In summary – if you are not back to where you want to be after having your baby – get help. We all deserve to live happy and healthy lives.
Ok back to the story of my 6 week Pelvic Health Check – if you want to watch some of mine it’s at 10 minutes in the film (link)
This is a appointment with a specially trained pelvic health physio to see where you are after baby – what the effects of pregnancy and labour have been and then give you a plan on how to get back to you. It’s sometimes called a Mummy MOT in the UK - and you can have one at any point after having a baby - even years later!
For me it’s so important that I have one before starting running again after having Saoirse. Returning to high impact exercise or some of my strength workouts without healing properly could cause problems in the future for me and I want to still be running when I’m 70!
Sadly it is not offered by the NHS to every woman - which is something we need to change.
Mine is of course with my amazing physio Emma Brockwell who supported
me through my pregnancy (and also is the author of an incredible book which covers all of this – amazon link here )
First up, Emma prods my tummy to see what kind of gap I still have. Every pregnant woman will have some kind of gap (Diastasis Recti) but they range in size. Mine is now about 1.5cm at my belly button and smaller higher and lower. Not too bad but a lot of work to do.
She looks at me doing some of the strength movements to see if they cause too much intraabdominal pressure and stress on it (seen by a doming in my tummy). I can’t do a pressup or plank on the floor yet it seems, but I can on an incline (bench) if I breathe out each time and tense my core.
One of the things I find hard with this kind of rehab is that physically, I can perform the exercises. If she asked me to bash out 20 pressups I could - and it wouldn't feel like I was doing anything wrong. But in doing some exercises I might delay the recovery of (or potentially worsen) my core. So I need to be told (explicitly - I have a history of stretching boundaries!!) what I can and can’t do safely now and build up from there as I get stronger.
Next she looks at my general movements – squatting, bending, twisting – all that stuff I do a lot as a mum with a newborn so I need to be doing it properly!! I’m stiff through my upper back (that’ll be hunched over breastfeeding) and have “general global weakness”. Emma doesn’t mince her words. In other words, I’m going to need to really strengthen up my glutes and pelvis to start running decent distances again.
We then move onto my pelvic floor and first up is the hop and jump test. Can I hop on one foot without leaking? Can I bound forward without leaking? These are some of the tests suggested by the return to running guidelines (more on those in my next post). At 6 weeks she’s not surprised I can’t – at least not without squeezing my pelvic floor muscles for dear life. 6 weeks is very early to return to run and she expects to see a lot of improvement in the coming weeks which gives me hope.
I then have the internal exam where she feels what has happened inside after birth – as well as checks I’m really doing my pelvic floor exercises properly! (In crude terms she has to put on a glove and stick a finger inside me. It doesn’t hurt at all – it’s not a sweep!)
The good news is my pelvic floor is working and my squeezes whilst boiling the kettle are paying off. She checks it again when I stand up. But whilst I am squeezing it – I’m only managing to engage the back and not the front. So we change how I stand, my mental cues and make it a lot more effective (I now stand pigeon toed and lean forwards – like I’m doing a snowplough down a ski slope).
She then breaks the bad news. I have a slight prolapse (when the front or back wall or uterus slips down from their normal position into the vagina. It’s classed on a scale of 1 to 4 with 4 being severe and mine is a 2).
I'm not expecting this. I have no symptoms - other than a weak pelvic floor which I've had before. Prolapse is what happens to post-menopausal women right? Wrong it seems.
Emma’s view is that if I hadn’t had one after 3 babies and all the running I do she’d be really surprised. Say what??? So it turns out this is really common. Most women have one after having babies. (in fact 2 studies show 50% of 21 year old women without babies have a stage one).
But as no one talks about it no one realises this. We don’t get checked out even if we have symptoms (such as heaviness). And we don’t get the right support (see my GP check below) which can help strengthen our pelvic floors, reduce symptoms and avoid them getting worse - as well as treatment where needed.
I feel very lucky to have been able to see and realise this. Without it I would have been planning my return to running based on leaking alone otherwise and could have done more damage.
But if it’s so common - and can have such an impact on a woman's life surely this should be screened for at the GP “6 week check”? These “6 week checks” – the ones everyone is scheduled for after giving birth are often deemed to be an exercise sign off. Especially for a return to running. They seem to differ a lot between GPs but here is my experience:
My GP check
I have a 20 minute appointment at 8 weeks, jointly with baby Saoirse, who gets the first half to check her over and discuss her progress. She’s doing brilliantly and is a monster feeder to boot as shes now 4.8kg. My half is just a lot of questions – apart from a blood pressure check. Once she’s established I’m not bleeding anymore and am happy in myself she asks me quickly “bowels, bladder, all ok?”
I tell her I was checked 2 weeks ago and have a prolapse. I say I’m worried about it and how it will affect both my mental and physical health. I’m also worried about my pelvic floor. I also ask multiple times what support is available for me and if I should be checked again. She just gives me a leaflet and tells me to “keep doing my exercises”.
Most women would just have replied yes to her question – that they were fine. It was a closer not an opener. I guess I wanted to test where it went. But even asking for support – which most women don’t (it's hard to talk about this stuff!) – I was dismissed. We all know that most women do their pelvic floor exercises wrong. I still was even after seeing physios before. It’s hard to know if you’re doing something right if you can’t see it working. PTs have enough problem teaching people to squat and we can see how it looks in the mirror!
Her real focus seems to not be on my health, but ensuring I don’t have another baby too soon. I’ve been reading a lot about hormonal contraception in athletes and say I want to establish my cycle back before I decide on longer term contraception methods (I hope to breastfeed for about a year again and it didn’t come back before I stopped the last 2 times). This apparently is not good enough for her as she asks me perhaps 4 times to make a decision on something maybe a year away. Yet she does not want to engage in discussion about my pelvic floor – which impacts my life in a very real way now.
I hope this isn’t most women’s experiences but from my DMs I feel it might be. GPs CAN refer you for support so please fight for it. With only 800 registered pelvic health physios in the UK and 700,000 births a year there might be a bit of a wait (they treat us for life, not just after having a baby!) – so if you can afford a private appointment (usually about £60-100) it’s definitely worth it.
So What Next?
There are a lot of positives for me after my appointment with Emma too (we’ll just forget the GP “check” ever happened). My pelvis is more stable with no pain unlike last time - all the work in pregnancy has paid off! My DR is smaller too (not doing pullups whilst 8 months pregnant helped - like I did in my second pregnancy here).
I didn’t have pelvic pain in pregnancy really compared to last time and certainly nothing post partum – one of my main UTMB worries was running down a hill as my pelvis would hurt.
But there’s a lot of work to do to get where I want to be. I need to strengthen my tummy back, strengthen my body – as well as rehab my hamstring. For the last few weeks I’ve been doing the initial strength exercises quickly not thinking – trying to rush to get all the sets in before Saoirse wakes up or cries. It’s not the point. It’s far better to do half properly. Forget about heart rate, forget about calorie burn. This is rehab. I need to rewire my brain!
This is my plan for now which will progress over the coming weeks as I get stronger: (disclaimer - these are of course individually prescribed for me)
Abs: Side plank and straight plank – arms on a bench. Deadbugs. From a V sit leaning back until I see doming.
Emma shows me how breathing out while squeezing my PF in is not only a way to work PF muscles - but it supports my whole core to do an exercise, preventing doming. Win win win.
Strength: Deadlifts – normal with weight (not single leg...!). Lunges – forward and back. Squats, single leg knee bend with running arms, calf raises, tricep dips
Hamstring work: Double leg bridges (slowly as also for core). Single leg on bench. Band adductor to the side
Stretch set: My hips are a real mess – the treadmill and bike have seized them up so much that they feel slightly pinched. And just as during pregnancy, I need to do the “thread the needle” pose to unlock my spine.
The whole thing takes an hour. Which seems overwhelming but it isn’t like a HIIT workout – it can be broken into chunks with the same effect. A lot I can do out with the kids with Saoirse in the carrier – lunges, squats, calf raises etc. Other bits I can do whilst the kettle boils or in front of the TV.
The Pessary Fit
In just the same way I’d wear a knee support to run with a rehabbing knee, I’m now going to wear a support whilst my undercarriage rehabs. It’s an internal device called a pessary, which is like a tampon except it’s made of medical grade silicon and comes in lots of different shapes and sizes.
Emma sends me to Tracey Matthews (@prolapsestrength on IG) to be fitted. It’s a longer appointment - fairly similar to my 6 week check at the start then I take time to try a few different pessaries for size and shape. Tracey is a former GB rower, and so understands that my goal isn’t just being able to go about normal life pain and leak free. It’s being able to run high impact long ultramarathons!
She also tweaks my pelvic floor technique again to get more engagement. These exercises are for life and if I do them properly then I’ll limit risk of further prolapse – as well as hopefully reducing the grade of mine over time which is the goal of course.
Tracey usually gets women to jump up and down to test the pessaries but I instead I’m sent out for a run on the streets (very exciting) as it’s more realistic for the stress my body will face. It’s the first time I’ve really run since giving birth and of course I stretch my legs. And its incredible. Sudddenly I don’t feel at all worried about leaking. This little cube of plastic is genius!! It does look like a teething toy though so will make sure its kept well away from Saoirse.
I go home slightly elated. It hasn’t fixed my prolapse of course (though wearing it can strengthen my pelvic floor) - but it has materially improved my symptoms – and opened up a path to me returning to running. For now I’m going to wear it just for long hikes when I have Saoirse in the carrier, then runs when Emma gives me the sign off (she wants to check it in a week or so first). Times when I’m putting my pelvic floor under the greatest strain and it needs the support. But I do want to be running without it in a few months – save maybe for very long races.
When I went for my 6 week check with Emma I didn’t expect to be given the sign off to run straight away (I was hoping though…). But I certainly didn’t expect to have a prolapse! I now feel well armed – both with knowledge about my body, a strength plan, and Poppy my pessary (yup I gave it a name).
And *drum roll* at 9 weeks (after another checkup from Emma) I’m allowed to start slowly returning to running (which I’ll cover more in my next post) - with Poppy of course.
Since I’ve gone through this and been so public in the film, several of my friends have told me they have prolapses, gotten checked and found they have one – or been fitted with pessaries as a solution they never knew about. If more than half of mums have a prolapse, this knowledge should be part of our prenatal training. It should be part of our postpartum support. It should be something we talk about with other mums. And campaign to be given the right rehabilitation to get us back to where we want to be. Whether that’s running after our kids, or running ultramarathons.
If you’ve had a baby – no matter how long ago – and aren’t where you want to be, please get checked out and get the support you need. You deserve it.