Around seven months after Caroline McShane had her second daughter in 2010, she realised something wasn’t right. The social media consultant, then 35, felt an uncomfortable bulge at the entrance of her vagina but she ignored it, hoping that it would go away.
“I wish someone had checked me at that point and explained it wasn’t normal – and how important it was to get it properly sorted,” she says.
Like all mums in the UK, Caroline’s final official postnatal check-up with her GP had been months earlier at the six-week check – and she didn’t want to bother the doctor again.
But when she finally saw him again around a year after birth, she was diagnosed with a slight prolapse, a condition where damage to the pelvic floor (the layer of muscles and ligaments inside the pelvis) causes the bladder, uterus or bowel to move out of place.
Symptoms can include incontinence, pain, sexual dysfunction and an unpleasant heavy or bulging sensation in the vagina.
It is often caused by pregnancy and birth, because of the strain put on the pelvic floor.
At menopause, hormonal changes can also reduce muscle elasticity and mass, and worsen existing problems which have gone untreated, as Caroline discovered.
After she was diagnosed at 36, the married mum-of-two, from Cirencester, Glos, was told to do pelvic floor exercises (also known as Kegels), which helped a little. But she was never properly assessed or shown how to do them correctly.
She lived with her symptoms for more than a decade, finding it didn’t stop her from enjoying hobbies like cycling, swimming, paddle-boarding and horse-riding.
But when she started to develop menopause symptoms, such as heavy periods, in her late 40s, her condition deteriorated. The bulge extended outside her body, causing severe discomfort. She also leaked urine.
“I felt like an old lady,” she says.
Caroline twice went back to her GP but was again told to do pelvic floor exercises – which studies suggest may have little effect on severe prolapse.
Eventually, she saw a private women’s health physiotherapist who helped her get an urgent referral through her private health insurance to see an NHS gynaecologist. He explained the damage from childbirth hadn’t been properly managed and had been aggravated by menopausal hormonal changes, causing the ligaments holding up her organs to collapse.
Now 49, Caroline has had major repair surgery, including a hysterectomy to remove her womb and ovaries, then her internal organs were stitched into position in three different places. She is slowly building her pelvic floor and core muscles with gentle exercises, to regain strength without risking damaging her stitches.
“Everyday life is better now. I just need to get back to being my old active self,” she says.
“But if I had been checked much earlier, that could have made a big difference and stopped more damage being done,” she says.
“I wish someone had explained at the time that I needed to take care of my pelvic floor on an ongoing basis because, if not, this is what could happen.”
Now, growing numbers of medical experts and charities are calling for mums like Caroline to have a second health check, including a pelvic health assessment, in the year after birth.
They say better postnatal checks would help nip pelvic floor issues in the bud before they become established and prevent women from experiencing more serious problems at menopause.
An estimated six in 10 women have at least one symptom of pelvic floor dysfunction, including prolapse, yet two-thirds have never sought help, according to the Royal College of Gynaecologists and Obstetricians.
In some other countries, such as France, all mothers are given a series of postnatal pelvic health physiotherapy appointments in the months after birth – but no such service exists on the NHS.
GP Dr Sarah Andrews believes the postnatal period is the ideal time to educate women about pelvic floor health, so they can flag up any concerning changes.
“It’s important we enable women to understand and recognise pelvic health issues as early as possible to help prevent complications later down the line, especially when they hit menopause,” she explains.
“I see a lot of post-menopausal women with a pelvic health problem who have been living with it since a difficult birth 30 years ago. For them, things could have been a lot easier, and they could have had a much more successful outcome without needing surgery, if they’d been referred to see a pelvic health physio earlier.”
Tina Mason, specialist pelvic physio at Women’s Health Brighton, says: “If every mother was assessed by a pelvic health physio around six months after birth and taught how to do pelvic floor exercises properly, it could prevent so many problems. Once you have learned to do them, you have that skill for life.
“I regularly see women in their 50s and 60s with pelvic floor dysfunction which could have been prevented – or prevented from deteriorating – if they had been given the right treatment and information after they’d had their babies.”
Helen Ledwick, author of Why Mums Don’t Jump: Ending the Pelvic Floor Taboo, believes routine pelvic checks for mums could also improve mental health, as many women with the condition struggle psychologically.
“There are so many women who have been suffering in silence for so long, and we’re not giving them the help to get back to the best that they can be,” she says.
Caroline adds, “Everyone I’ve spoken to who has gone through a similar thing says, ‘If only I had known’ or ‘I thought it was just one of those things that happens to mums’.
“It’s so important women are told you should be able to lift things or jump on a trampoline – and if you can’t, there are things you can do which can help.”
Rosie Taylor is the host of Mother Bodies, a podcast about why postnatal health matters: podfollow.com/mother-bodies
