Bridge Autumn 2024

AU T U M N

2024 BLADDER & BOWEL CONTROL HEALTH

Pregnancy and your pelvic health

Emma's story Never giving up on your health

Tory Toogood Women's Health Physiotherapist

Georgia's story The importance of pelvic health

2 Autumn 2024 | Bridge

1800 33 00 66

National Continence Helpline A free service staffed by Nurse Continence Specialists who can provide information, referrals and resources 8am - 8pm AEST weekdays.

The Foundation, established in 1989, is a not-for-profit organisation.

Published by the Continence Foundation of Australia ISSN 1836-8107. Online version ISSN 1836-8115.

The Bridge Magazine is published quarterly by the Continence Foundation of Australia. It is supported by the Australian Department of Health and Aged Care under the National Continence Program.

The information in the Bridge Magazine is for general guidance only and does not replace the expert and individual advice of a doctor, continence nurse or continence physiotherapist. The Bridge Magazine cannot be reprinted, copied or distributed unless permission is obtained from the Continence Foundation of Australia.

Advertising The Continence Foundation of Australia appreciates the support of advertisers in publishing the Bridge Magazine. Advertising conforms to the standards required by the Continence Foundation of Australia, but endorsement is in no way implied by the publishing of said material.

References For a list of references for any articles appearing in the Bridge Magazine, please email bridge@continence.org.au Become a member of the Continence Foundation of Australia and receive many benefits including discounted registration to the annual National Conference on Incontinence, free publications and timely information about events and education courses.

Email membership@continence.org.au or Phone 03 8692 8400.

The Continence Foundation of Australia greatly values the stories people share of living with or caring for someone with incontinence. Reading the experience and advice of others can make a huge difference to someone in a similar situation. If you would like to share your story with us, please register on our website.

Go to www.continence.org.au/life-incontinence/personal-stories#sharestory Unless otherwise indicated, the photographs used in the Bridge Magazine are those of models and bear no resemblance to the story.

NATIONAL OFFICE Continence Foundation of Australia Suite 1, 407 Canterbury Rd, Surrey Hills VIC 3127 Ph 03 8692 8400 | Fax 03 9380 1233 | Email info@continence.org.au Web continence.org.au

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Bridge | Autumn 2024

NOTE FROM THE ACTING CEO

IN THIS ISSUE

Welcome to the Autumn 2024 edition of the Bridge Magazine. This edition has a special focus on pregnancy-related conditions that affect continence. We explore topics such as preventative care for childbirth, birth injury and pelvic organ prolapse.

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In this edition, we also share advice from physiotherapist Tory Toogood regarding the prevention and treatment of pelvic floor injuries. We converse with Georgia Triferis, a mother who has experienced pelvic organ prolapse who decided to raise awareness to help other women.

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We offer support to women with pregnancy related conditions on our National Continence Helpline on 1800 33 00 66. This is a free and confidential service, staffed by Nurse Continence Specialists who offer information, advice and support. They also provide a wide range of continence-related resources and referrals to local services.

Finally we would like to take this opportunity to farewell Rowan Cockerell, who served as the Foundation’s CEO for the last eight years and for over 50 editions of the Bridge Magazine. The progress the Foundation has made under Rowan’s leadership has been inspiring and with great fervour continued building a community free of the stigma and restrictions of all aspects of incontinence across the lifespan. Thank you Rowan.

Paula Hay, Acting CEO, Continence Foundation of Australia

Note from the Acting CEO

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About the Foundation

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National Public Toilet Map

Pregnancy and your pelvic health

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Emma's story – Never giving up on your health

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Tory Toogood – Women's Health Physiotherapist

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Georgia's story – The importance of pelvic floor health

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ABOUT THE FOUNDATION The Continence Foundation of Australia is the national peak body promoting bladder and bowel control health. Our goal is to eliminate the stigma and restrictions of all aspects of incontinence through research, advocacy, consumer education and professional development.

This includes providing high quality continence resources, education and services. The Foundation advocates for policies and programs that consider the needs of people affected by incontinence and supports research and professional education in incontinence.

Continence is the ability to control your bladder and bowel. Incontinence is the involuntary loss of urine and faeces. In many cases incontinence can be prevented, better managed and even cured.

Who we support: We support people of every age, gender and cultural background. Incontinence affects women, men and children of all ages, physical abilities and social and cultural backgrounds.

How we can help: We have resources for individuals and for health professionals.

• If you need support for yourself or a family member, the Continence Foundation of Australia’s National Continence Helpline 1800 33 00 66 is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support. It operates 8am to 8pm AEST, Monday to Friday • Our website includes a wide range of helpful information, self-help guides and tips on getting support. You can also download or order paper copies of resources.

Health Promotion Initiatives: We lead initiatives aimed at improving both public health and community accessibility, such as Pelvic Floor First, promoting pelvic floor exercises and BINS4Blokes, encouraging the installation of incontinence product disposal bins in male toilets.

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SCAN HERE TO GO TO THE MAP

The map includes

NATIONAL PUBLIC TOILET MAP PLAN YOUR HOLIDAYS WITH THE NATIONAL PUBLIC TOILET MAP Need to take the children to the toilet, change a baby’s nappy or find an accessible facility?

The National Public Toilet Map (NPTM) shows the location of more than 23,000 public toilets across Australia, including adult change and baby change facilities. It has proven to be a vital resource for all Australians, especially those with incontinence, travellers and young families.

More than just a directory, the NPTM allows individuals to filter and search for specific toilet features, including opening hours, wheelchair accessibility and adult change facilities.

• The location of the nearest public toilet • Details of opening hours, accessibility, parking and many other features • An option for you to add and update public toilets to further expand the map • The ability to create and share your own specialty maps. Specialty maps can be shared as a URL or QR Code, so you can email, print or share it on social media • Distance by route, which shows the quickest route to a facility, on foot or by car. This ensures that distances include factors such as one-way roads and building access.

WHERE TO FIND THE NATIONAL PUBLIC TOILET MAP

Access the map via toiletmap.gov.au You can also download the app from Google Play or the Apple App Store.

The icon looks like this.

The National Public Toilet Map is proudly managed by the Continence Foundation of Australia and funded by the Australian Government Department of Health and Aged Care as part of the National Continence Program.

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6 Autumn 2024 | Bridge

PREGNANCY AND YOUR PELVIC HEALTH

BY JANIE THOMPSON, NATIONAL CONTINENCE HELPLINE MANAGER There is a lot of advice on what couples should do to prepare their bodies before they start trying to have a baby and when they get pregnant, such as avoiding alcohol and taking vitamins. What about your pelvic floor health? This is something you should also look into as pregnancy and childbirth have a huge impact on a woman’s or birthing person’s pelvic floor.

The pelvic floor has a big role in pregnancy and childbirth. It helps to support your uterus (or womb) as well as your bladder and bowel. Pregnancy hormones and changes in hormone levels as a result of pregnancy and childbirth, have an impact on most parts of your body including your pelvic floor. They help to relax and soften your pelvic floor muscles and ligaments to allow you to accommodate your growing baby and this is further increased during the birth of your baby.

Pelvic floor exercises have been shown to decrease the risk of urinary incontinence when you are pregnant or after having a baby. This is especially true if you are continent, or don’t experience any leakage of urine, and you exercise your pelvic floor muscles in the early stages of your pregnancy.

SO HOW DO YOU KNOW HOW TO DO PELVIC FLOOR EXERCISES? Doing pelvic floor exercises correctly can be tricky as they are not obvious muscles you can see. Have a look at the Continence Foundation of Australia’s website on pelvic floor exercises including this 3D animation video as well as the Pelvic Floor Health for Expectant and New Mums booklet. This information will help you understand what pelvic floor exercises involve, how to squeeze or contract your pelvic floor muscles and what a pelvic floor exercise program looks like. Chat to your obstetrician or midwife about pelvic floor exercises to make sure you are on the right path.

It can be very helpful to see a continence healthcare professional, such as a pelvic health physiotherapist,

especially if you are unsure how to do pelvic floor exercises or if you are experiencing any incontinence or have a bladder or bowel control issue. They will be able to check that you are squeezing your pelvic floor muscles correctly and give you an individualised exercise program based on your muscles strength and stamina. They will determine how strong your squeeze is and how long you can hold the squeeze for. They will also check to make sure you are able to relax your pelvic floor muscles well between

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any squeezes. A healthy pelvic floor is important preparation for having your baby.

Once you have your pelvic floor exercise program worked out, you will need to look at how you are going to incorporate these exercises into your daily life. There are various apps around that can help you remember to do your exercises which can be either pelvic floor specific or a timer such as a simple reminder on your smart phone.

Therefore, don’t forget to include your pelvic floor health in your preparation for having a baby. Get support if you are unsure of what to do or where to go. You can call the Continence Foundation of Australia’s National Continence Helpline on 1800 33 00 66 and speak to a Nurse Continence Specialist for free and confidential advice regarding your bladder, bowel and pelvic floor health. The nurse can also assist you to find a continence healthcare professional near you.

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8 Autumn 2024 | Bridge

EMMA'S STORY NEVER GIVING UP ON YOUR HEALTH Mother of three Emma Britton has been experiencing incontinence since the birth of her first child. She says women would benefit from receiving advice to see a pelvic floor physiotherapist who is knowledgeable in postnatal women and can give you guidance on how to rehabilitate.

Emma Britton and her children

Before giving birth to her three children, special education teacher Emma, says she had never experienced incontinence.

“When I fell pregnant with my first son, pretty much everything fell apart straight away,” Emma says. “My whole pelvis, everything fell apart. My joints were dislocating. It was really awful.”

Her son was born in four hours and weighed over four kilos. After the birth, the midwife mentioned that

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Emma may have a fourth-degree tear. Once clinical staff confirmed, she was rushed for an emergency surgery.

“My son was born in the bath and because of his size he got stuck. The midwife said it was an incredibly rare thing to happen,” Emma states. “I was then told I could have incontinence and was recommended not to have any more vaginal births as I may end up with a colostomy.”

Emma then saw a women’s health physiotherapist who told her she has Ehlers-Danlos syndrome.

“All these factors all kind of played into what are probably the reasons behind, or a couple of the reasons behind, having a fourth-degree tear.”

Emma continues, “it was very confronting. Not something that I think I was in the brain space to even contemplate at that point in time. I had just given birth to my first child.”

“After I had my first son, my leakage wasn’t so bad.

It was not what I'm used to, and I recovered from his birth. It took 12 months of recovery from the tearing.

It was quite different to what I was expecting. I didn't realise it was going to be so hard,” Emma says. “I suffered a prolapse at the same time. And while I was seeing physiotherapists and GPs, I still had stress incontinence all the way through.”

Emma tried to restart all the activities that she used to enjoy but wasn’t able to. Going back to work at the school was also difficult. Emma says she couldn’t do all the things that she loved to do with the students that she worked with. She couldn’t jump on trampolines or run around and chase her students.

“The second that I would jump or even make a heavy step, I would leak. It was just this overwhelming feeling of just leaking constantly,” Emma says. For ten years, she has managed the leaking with pads.

While pelvic floor physiotherapists have helped with incontinence and her pelvic floor muscles, clinicians see her as a bit of a medical question. For her second child, Emma had IVF and was told early in her pregnancy she would have to have a caesarean.

Emma believed that she wasn’t going to have a vaginal birth and that her symptoms wouldn’t get worse, however after giving birth, she had similar experiences as her previous birth.

“It was quite intense,” Emma says, “I straight away went to see my second physiotherapist regarding

WHAT IS A COLOSTOMY? A colostomy is an operation where an opening is made to the large bowel on to the surface of the tummy. Waste is collected using a bag called a stoma pouch.

WHAT IS EHLERS-DANLOS SYNDROME? Ehlers-Danlos syndrome is a group of disorders that affect connective tissues in the skin, joints and blood vessels which can impact on many organs and tissues. Defects in connective tissues cause the signs and symptoms of these conditions, which range from mildly loose joints to life-threatening complications.

WHAT IS STRESS URINARY INCONTINENCE? Stress urinary incontinence is the leaking of urine during activities that increase intra abdominal pressure and push down on the bladder. Stress incontinence can happen as the result of physical activity or actions such as coughing, sneezing, running, heavy lifting or laughing. It occurs mainly in women often in relation to pregnancy and childbirth as well as menopause, it can also occur in men, such as after prostate surgery, plus with people who experience chronic constipation and strain at the toilet, chronic cough and obesity.

When I fell pregnant with my first son, pretty much everything fell apart straight away.''

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the leakage and it improved somewhat, but not completely.”

Shortly after her second birth, she had her third son and straight away went to see the physiotherapist to find the best solution for her incontinence.

Emma recalls when she was heavily pregnant and was on playground duty at work, “I sneezed. It must have missed the pad and my colleague was concerned because she thought my water had broken,” Emma says. “I just told her it was ok, I had peed myself. My colleague said it was ok and that it happens to all of us. But I feel I am just lucky because it didn’t happen inside the classroom on the carpet. I can laugh about it now, but I was in my early 30s and this was something that should not be happening.”

Emma had tried to remain positive, putting her experiences down to pregnancy. She kept thinking it will get better, but admits that as time goes on, with her youngest being three years old now, her experiences are getting worse.

Emma spoke with the physiotherapists at the hospital and explained her history. The physiotherapists then offered her a pessary (a device which fits into the vagina to provide support to tissues displaced by pelvic organ prolapse).

The first and second pessary devices didn’t work and trying the two other types of pessaries made her symptoms worse. Her care pathway led her to a urogynaecologist who recommended surgery, but with her history of treatments not working like they were supposed to, she is reluctant to follow suit without a second opinion.

After I had my first son, my leakage wasn’t so bad. It was not what I'm used to, and I recovered from his birth. It took 12 months of recovery from the tearing.

It was quite different to what I was expecting. I didn't realise it was going to be so hard.''

I've had to be my own advocate, very determined and persisting to get more answers and not take no for an answer.”

Emma thinks surgery is probably going to be the next step and then whatever rehabilitation she might need after that with her physiotherapist who she says she still sees regularly.

Emma reflects that her condition still feels like a bit of a mystery to a lot of doctors and physiotherapists.

The proposed solutions should work, but often they don’t. It’s why she says being your own advocate and being determined is key to finding the right solution for your health.

"I've had to be my own advocate, very determined and persisting to get more answers and not take no for an answer.”

“Particularly in my case, where symptoms have not been fixed by textbook treatments, I need to continue building knowledge to eventually come to the most effective solution. If I wasn't so determined I think I'd still be in the same position,” states Emma.

Emma reflects she is now open and determined to talk more about her experiences to actively create change. “There is so much stigma and shame and concern and worry.”

“There are people out there who have no idea about a pelvic floor physiotherapist,” Emma continues. “This is not something you should be ashamed of and hide. It happens to so many women and it's just not fair that we must feel like we can't talk about it and that we can't do something about it. I want other people to feel like it's okay to go and get help.”

Always rushing to the loo?

It doesn’t have to control your life One in three women experience leakage from the bladder or bowel (incontinence).

There is help available – you’re not alone. In many cases, incontinence can be treated, better managed or even cured.

Speak to a Nurse Continence Specialist for free, confidential advice.

Call National Continence Helpline

1800 33 00 66

Scan the code for further information or visit continence.org.au The Continence Foundation is a not-for-profit organisation and peak body promoting bladder and bowel control health.

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TORY PELVICTOOGOOD HEALTH WOMEN'S HEALTH PHYSIOTHERAPIST PHYSIOTHERAPY Tory Toogood has been a pelvic health physiotherapist for 20 years. She works in private practice and spends some of her time teaching Masters of Physiotherapy students at Flinders University. She is passionate about helping women maintain the ability to engage actively throughout their lives and to have enough physical strength and fitness to do the things that they love doing.

It was a lived experience that influenced her to work in the area, having been an athlete. Her career started as a musculoskeletal and sports physiotherapist. “I was sure I was going to be a sports physio,” Tory says. “But as I was working and then had a family, I saw the gaps in knowledge, awareness and in comfort in talking about issues related to bladder and bowel control.

Issues to do with pelvic health are so personal and private, but at the same time they're almost universal.”

HOW DOES BEING PREGNANT AND GIVING BIRTH IMPACT A WOMAN'S ABILITY TO BE CONTINENT? Pregnancy comes with enormous hormonal changes and weight distribution changes, as most women will gain between 10 to 15 kilograms. On a smaller frame this could be an additional 20 or 25 per cent of body weight, normally happening over only six months. It's a very dramatic change in weight in a short period of time. Most of the weight is concentrated in the abdomen and within the pelvis, on top of the pelvic floor and the bladder.

There is also an increase in progesterone (a type of hormone). Progesterone relaxes the smooth muscles to help manage all the extra blood that is flowing around, to help this little life form get all the energy and nutrients and waste removal that the baby needs. Progesterone helps manage blood pressure in the first trimester by relaxing the walls of the blood vessels. It also means that your bowel wall relaxes.

This can tend to make you constipated, so you may not be as regular as you were. If you're constipated, you may strain to empty your bowels and that puts a lot more pressure on your pelvic floor muscles and can cause some stretching and damage if it goes on too long.

Tory Toogood

Giving birth results in significant stretch to pelvic floor muscles, or to surgery on the abdomen. This level of stretching, or of stitches and surgery creates changes in how the muscles usually work, which can affect continence.

WHAT ARE SOME THINGS THAT WOMEN SHOULD LOOK OUT FOR THAT CAN AFFECT CONTINENCE? Movement is important to consider, so include regular exercises to suit your body and pregnancy.

However, certain strenuous movements can contribute to excessive load on the pelvic floor and on the supports for the bladder, which may cause some loss of urine.

Be aware of the sort of activities that you're doing.

Whether that's heavy lifting or substantial exercise, which puts more pressure on your pelvic floor muscles. Then if your pelvic floor muscles aren't quite strong enough, the extra weight of the baby and uterus, combined with the activity, might be a bit more than the muscles can cope with. So, specific strengthening would help manage that and ensure a return to more vigorous activity when the muscles are performing better.

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If you've got any issues or concerns, it’s well worth addressing that before childbirth so you have strategies in place. Know how to seek support that is around you, from the midwives or the birth team.”

Vomiting from morning sickness can also have quite an impact on the pelvic floor, because it is usually so forceful and again, may be frequent.

There are many messages to drink a lot of water but it's not often that I'll see somebody under 60 who doesn't drink enough. If you are overloading your system with too much water, that can be an issue, in terms of going to the toilet often and electrolyte imbalances such as sodium levels.

I say to every patient, as you feel comfortable, tell your friends, speak to the women that you're with, family members, that they don't have to put up with this. Know that you are not alone, and that help is available. Being continent or finding a continence product (that works well as an interim measure) have such an impact on women's ability to participate in life, whether it's participating in sport, whether it's feeling comfortable to leave the house, even to be able to work, to be able to volunteer, to be able to socialise or to be able to care for other people.

We need to recognise that there is so much work and contribution that women make and much of it falls to her being physically capable and not being restricted by feelings of discomfort around the perineum or in the vagina, or by issues with the bladder or bowel.

WHAT ARE THE MOST COMMON SYMPTOMS OF INCONTINENCE THAT WOMEN EXPERIENCE AFTER GIVING BIRTH? There can be several different ways that you could be incontinent of urine • A little bit of urine may come out when coughing, sneezing, bending over and reaching out. This is because when you create more pressure on your tummy and if pelvic floor muscles are not well coordinated or strong enough, there may be a little leak of urine • Very early on after giving birth, due to the stretch of the delivery, there may be a little bit, almost unnoticeable, loss of urine. If that's persisting after the first few days, speak to your healthcare professional as this needs to be investigated. There may be a nerve problem or something else • With bladder urgency, it should be investigated what the mother is drinking and how often; whether you are either not drinking enough or drinking too much. If that is okay, a care provider may do an ultrasound to check that the bladder is emptying properly.

Constipation can also occur. Providing support to the pelvic floor for the first bowel movement after childbirth is important.

You can ask yourself, am I feeling • Urgency to empty my bladder or bowel • Leakage on the way to the toilet • Leakage when coughing or sneezing, or from vomiting during the pregnancy • Not feeling my bladder or bowel is fully empty after going to the toilet.

The aim is to feel that you can contract the pelvic floor muscles, that you could stop or prevent the flow of urine. So regular check-ins with your physiotherapist before the pregnancy or during the pregnancy is valuable.

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WHAT ARE SOME WAYS TO MANAGE INCONTINENCE FOR PREGNANT WOMEN? The number one thing is pelvic floor muscle training and in particular strength training of these muscles.

It is supported by a lot of research. This way you can

• Better understand where these muscles are in the body • Do a controlled, correct pelvic floor muscle squeeze and relax • Hold this squeeze for long enough, or being able to do it quickly and in a coordinated fashion • Make sure that there is adequate strength, endurance and coordination in these muscles.

Look at bladder habits, for example relaxing and taking your time on the toilet, waiting for a good urge before going to the toilet, fluid intake and perhaps make some changes. This could include some bladder calming strategies or bladder training, for example deep breathing and pelvic floor contractions to control urgency.

Diet is important too. If you are constipated it tends to impact the bladder as well as the pelvic floor muscles. Make sure you have a balanced diet which includes a variety of fibre and follow good bowel habits, for example not ignoring the urge to use your bowels, getting to a good toileting position leaning forward with elbows on knees and tummy relaxed and not straining.

WHAT ADVICE WOULD YOU GIVE TO WOMEN WHO'VE JUST FOUND OUT THAT THEY ARE PREGNANT? If you have questions or concerns, or if something hurts, it's worth checking out to see what you can do about it. If you know that you can do a good pelvic floor muscle contraction and can also relax your muscles well and can practice your pelvic floor exercises every day, you're going to be in a really good position for your post-natal period or after childbirth. It's always nice if there's a physiotherapist you've already met, somebody you already trust.

It makes it much easier to discuss new problems.

If you have any concerns around your bladder, bowel, vagina or ability to have sex, a pelvic health physiotherapist is a good person to see.

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WHERE CAN WOMEN SEEK SUPPORT IF THEY ARE EXPERIENCING INCONTINENCE? • The Continence Foundation of Australia is a very important source of information and has a Service Directory to help find a pelvic health physiotherapist near you • Call the Continence Foundation of Australia’s National Continence Helpline on 1800 33 00 66 for free and confidential advice and information from a Nurse Continence Specialist, including information on your local pelvic health physiotherapist • Speak to your birth healthcare professional (your doctor or midwife) is often a good first step to find local support and services • Your hospital may have a Nurse Continence Specialist who will be able to provide support and access to the Physiotherapy Department.

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GEORGIA'S STORY THE IMPORTANCE OF PELVIC FLOOR HEALTH

I said, you know what, I’m going to do all the exercises, do all the stretching, do the massaging, do everything I can do, and let's see what happens. I did everything that I needed to do.”

Georgia Triferis

Georgia Triferis is a Merchandising Manager and a mother of two who lives in Victoria. Her first birth in 2020 was a difficult one, as it involved the use of forceps and resulted in a birth injury.

She noticed problems with her pelvic area shortly afterwards.

The first sign that something might be wrong, was when she went to use a tampon during her period.

She had waited for several months to recover from the birth, before trying to use a tampon, but when it came to using one, the tampon would not go in. She thought her body must still be healing, so she waited and tried again the following month. This time it slightly went in, but it didn't really sit right.

She had heard of pelvic organ prolapse (POP), and so she went to the doctor and asked her to check if she had one. The doctor ordered an ultrasound, and gave her a physical examination, and told Georgia that everything was fine. “So, I kind of just went on with life thinking I'm fine but I thought, I'm never wearing a tampon again I guess.”

Georgia became pregnant with her second baby in 2022. In November 2022, at 11 weeks pregnant, she noticed something unusual. “I started getting a little bit of a bulge in my private parts. I was just drying myself after a shower. I just kind of ran my hand over something and I'm like oh, what is this?” Georgia had heard of Kegels or pelvic floor exercises, so she tried doing them and it worked, the lump seemed to go back in.

A few weeks later Georgia noticed the lump had returned and could feel it through the day and at night it would go back in. She knew she had a prolapse.

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Georgia kept trying to find help, and she started going onto social media and finding influencers that had prolapses. She joined Australian social media prolapse groups to try to learn more about prolapse.

At her first neonatal appointment with the hospital, Georgia told the midwife what she was experiencing, and the midwife suggested they do shared care with an obstetrician-gynaecologist. At 22 weeks pregnant Georgia saw her new obstetrician-gynaecologist at the hospital and got an accurate diagnosis. “I told her my whole situation and she said, don't say anymore, I'm going to take a look and I'm going to tell you what it is,” Georgia mentioned.

“I love this woman, she helped me so much. She immediately told me you have a stage four uterine prolapse. She even drew me a picture to help me understand.”

The obstetrician-gynaecologist arranged an appointment with a urogynaecologist. “He said, in my 40 plus years of doing this, I have never seen a stage four uterine prolapse in a pregnant woman. He had never seen it before,” states Georgia.

WHAT IS A PELVIC ORGAN PROLAPSE? The pelvic organs, which include the bladder, vagina, uterus and bowel, are held in place by the pelvic floor muscles and supporting tissues such as ‘fascia' and 'ligaments'. These help to join the pelvic organs to the bony side walls of the pelvis and keep them in place.

Your pelvic floor muscles also work to support the pelvic organs from underneath. If the supporting tissues are torn or stretched, and your pelvic floor muscles are weak, then the pelvic organs may not be held in their right place.

Pelvic organ prolapse (POP), occurs when one of the pelvic organs sags and may bulge or protrude into the vagina.

WHAT ARE THE RISK FACTORS?

One of the strategies offered was the use of a pessary.

A pessary is a device that is placed into the vagina to support the uterus and/or bladder and rectum.

Georgia found that a pessary gave her a lot of her life back. Before she got one, the bulge would sometimes be so large she would cry over what underwear to wear. Trying to find underwear that supported the prolapse, while fitting around her pregnant belly proved extremely difficult. Before she tried the pessary, she was no longer enjoying day trips with her family, because she was in pain and had to keep sitting down. She describes the pain as being like period pain aches, with a heavy dragging feeling.

• About half of all women who have had a child have some degree of prolapse, but only one in five women need to seek medical help

Georgia assumed she would have to have a caesarean section for her second baby. To her surprise, both her obstetrician-gynaecologist and her physiotherapist said it was possible for her to have a natural childbirth (vaginal delivery). Georgia was delighted. She says that the key to her success was arming herself with all the right information and taking a determined attitude.

GET HELP AS SOON AS POSSIBLE!

The physiotherapist recommended pelvic floor exercises, exercise ball work and perineum massages.

Perineum massages may help to prevent or lessen tearing during childbirth, and Georgia wanted to avoid the tearing and the forceps delivery she experienced during her first birth. “I wish it was my

• Prolapse can run in families. It is more likely after menopause or if you are overweight, but it can happen in young women right after having a baby • Prolapse can also happen in women who haven’t had a baby. Causes may include coughing with a chronic lung condition, straining on the toilet e.g. with constipation, or lifting very heavy loads.

The most important thing to do is get help and the sooner the better. Most healthcare practitioners would agree that the prognosis is almost always better the sooner a person seeks help and support.

The main treatment options for women with POP are: Î Lifestyle modification Î Pelvic floor exercises Î Pessaries Î Surgery

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first birth. I wish that everything that I did to prepare for the second birth, I did for the first.”

All the hard work paid off and the additional knowledge Georgia had gathered about birth proved valuable. “I stayed on my feet the entire labor because one of the things I read was to avoid lying on your back. The control that I had standing, being on my feet, was next level. I felt like a warrior, so powerful and so strong. I just felt amazing being on my feet. Swaying and doing circles. I gave birth to her on my feet too.”

For her second birth, Georgia had no intervention, no epidural and only a first-degree tear. “Mentally I'm just constantly going back to the worst of it. I'm saying to myself I'm not going to go back there, I'm not going to go back there. But every day, you kind of check yourself and I have my moments where I'm scared, because it's dropped a little lower. I think I'm probably going to feel like that for a very long time,” reflects Georgia.

Georgia talked about her experiences on social media, and suddenly other women started telling her that it had happened to them too. She discovered that some of her relatives had experienced prolapse, but they had never talked about it. “All of a sudden, all these women were coming to me and saying, me too. I'm like, are you serious? Why didn't you tell me?”

Georgia continues to state. “This is the reason why I want to raise awareness. Women should not be shy about this. If I had known a little bit more about it, if I had known women in my life that had the same thing, you know, maybe I would have felt better about it.”

Georgia’s prolapse has now improved and she plans to continue the exercises to keep getting stronger.

“I'm looking forward to the 24-month mark because that's when they say you truly kind of heal. So, I'm looking forward to seeing what that is going to be like.”

It helps that Georgia’s husband is very supportive, wants to be informed and comes to appointments and asks questions. Georgia mentions that the emotional impact remains and the worry about whether the prolapse will worsen again.

Georgia notes that it can be difficult for women to know if they have had a thorough assessment for prolapse and that it is important to be persistent if

All of a sudden, all these women were coming to me and saying, me too.'' you’ve sought help and something still doesn’t feel right. One of the reasons Georgia talked about her experiences on social media was so that the women who follow her social media posts know that if it happens to them, they do know someone they can come to with questions.

Going back to work will be the next challenge, but Georgia’s physiotherapist will be there to support her.

“I work as a Merchandising Manager, so that includes a lot of heavy lifting. I'm getting prepared, thinking, if I lift that box, will I be okay? My physiotherapist says she is not going to discharge me until she’s supported my return to work. She said she doesn’t want to stop seeing me until I’ve started living my real life.”

Georgia is very happy with the support she has now, but she says that there is a gap in the information that is provided to new parents. Georgia states, “can we please talk about it. Don't be shy. I completely understand that it can be embarrassing. But if I was armed with the information that I have now, I probably would have done a lot of things differently, even before thinking about getting pregnant.”

Georgia believes that some foundational information for women before they get pregnant would be extremely useful. More information and more awareness about prolapse among both pregnant women and healthcare professionals, would address many problems before they start. She says that its particularly important that medical professionals know where to refer women because currently it can take too many appointments to be referred to the correct healthcare professional.

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