I have such a clear memory of this occasion. It was after an ‘all out’ interval session on indoor running tracks. This athletics centre was like my second home during many years in my youth.

I started thinking about sports injuries – I may have had a niggle myself at the time that brought it on. I was still a young teenager and not quite ready to think about my future too much yet. But whilst panting with the hands on my knees after the intense workout I just completed I suddenly had this vision in front of me. It was so out of the blue but I saw myself and how I one day would be treating sports injuries. Not everyday injuries/problems and health conditions but sports specific injures. I remember the feeling so clearly, I think because it wasn’t really about a dream profession. It was something I just knew could be my thing. And a decade later I actually did a degree in that type of field.

I guess my background has health and fitness written all over it. On a personal level with running and competing for most of my life. Then working with sports injures, sports massage and in running retail. It didn’t surprise anyone around me when I started pondering the idea of adding a qualification in personal training to my curriculum one day. This could be an excellent combination: being able to both train people and also help them recover from and/or prevent injuries in the first place. What a great idea and how perfect for me!

Well, it used to be a great idea. And then I got a prolapse, and everything changed.

But I couldn’t quite get the thought out of my head…. Maybe one day things will be better. Maybe one day I will get back to fitness again. Maybe one day it will be possible to live an active life both personally and professionally, like I really want. Maybe…hopefully…

Six months postpartum after my second baby. Prolapse symptoms were still horrendous and I was only doing little walks combined with pelvic floor training and light core exercises. Far from exciting in terms of training for me. But my hope was totally there.

So even if I was nowhere near ready at that point I enrolled on a personal trainer course. It was a spontaneous act where an offer I couldn’t ignore presented itself and I saw it as my calling. I knew I wasn’t ready for this challenge there and then – but I also knew that my physical recovery would take time and I was hopeful that over the following months lots could change.

The theory content of the course proved to be (partly) quite straightforward for me considering my previous knowledge and experience in health and fitness. Theoretically I was still a good candidate for this, and I genuinely felt it.

But would my body allow me to actually become a personal trainer!?

— PLEASE NOTE: I am writing about my personal experience here, and my own understanding of the issue…I am by no means a professional in this area, please consult your healthcare professional for advice on your specific circumstances —

I had travelled across London to see a specialist, a consultant who I had learnt so many new facts from. She diagnosed a different type of prolapse I didn’t know I had, a ‘uterine prolapse’. Apparently it was not only my bladder like I originally thought (a cystocele) but also my uterus had lost its original position. It obviously didn’t change my actual and current symptoms, but along with these prolapse news a much more complicated reality hit me..

My takeaway message from the appointment was: The uterus has fallen out of its position and is pushing down on the bladder. What is visible is the frontal wall of the vagina which the bladder is pushing into. The first few professionals I had seen had only identified the bladder prolapse – but basically behind that there is also my prolapsed uterus which sits on top and makes things worse… To do surgery only for the bladder prolapse would be pointless as it would likely make the uterine prolapse fall down even more. To fix the uterine prolapse there are only complex and risky options to consider, procedures that may or may not work at all. The best option would be to have the uterus removed completely (a hysterectomy). But the issue with that is that even if I would consider such a massive thing (maybe not now but in a few years time?) is that even removing the uterus would not be certain. It may help, but there is a big risk that ‘the top of the vagina’ could prolapse instead, in absence of the uterus… basically I could sustain something called a ‘vaginal vault prolapse’ as a result of a hysterectomy.

So many new words to learn. And too many question marks.

Additionally, even if a surgery turns out successful it generally doesn’t seem to mean success for a lifetime. The problems might eventually come back and another surgery (potentially more complex) will be needed – but who knows after how long, would it be after 8-10 years? Maybe less if I would do the repair and then go on to have that physically active life as I would hope. Would it then only last for 5 years? Or 1?! Nobody can tell. And each case is individual anyway of course. There seems to be endless of medical terms and possible diagnosis and so much at risk…

I had (naively) hoped that the consultant could give me an option that might be a big decision but still something that could solve, or minimise my issues. At least temporarily! But all these risks… and the uncertainty of actually making things better at all. What if I ended up with other problems instead, making my situation different but worse than today? It all felt so complicated.

She was walking in front of me and I had seen her many times before
One of those fit and healthy looking mums and impossible for me to ignore. 


Her youngest child in the hand, who must have been around three
 And I had to ask myself if this kind of mum could ever be me? 


They were skipping along while the little one shouted 'more'!
I couldn't help but wonder about the state of the mother's pelvic floor.


I'd expect some things postpartum - temporary incontinence or a sore boob
But I'd never imagine my uterus would need constant support by a cube.


Not only fit mums but also others would affect me time and time again 
Usually runners of course and they were younger, older, women, also men.


It wouldn’t matter if they were keeping a slow or faster pace 
Behind their backs I'd have an angry (or maybe more a jealous) looking face.


Baby weight might be long gone and I was again starting to look fit
But 18 months postpartum I was still not running - not even a little bit.


I'd resent my body and pelvic organs that fell down from their usual place
Not visible for others but with the prolapse I lost confidence and grace.


Who would have thought that I'd loose so much of myself on the way?
But what did you expect after children you might hear some people say. 


Is nobody else struggling physically since their baby was born?
Is it just my body that feels so damaged and worn?


It often feels as if longterm postnatal problems only happened to me
That countless of other women suffer after childbirth is really hard to see.


But that’s why I’m here writing about this and reaching out to you
I aim for a better understanding and to break the pelvic health taboo.

My throat felt swollen and the tears were burning behind my eye lids. But I couldn’t let myself go there….not yet… not yet…

I couldn’t remember which way I had come from or what direction I had to go to catch the bus home. It didn’t matter right now though, this large green space with not so much people around was perfect. I just needed to walk around until they both….yes finally, also the older one was sleeping. I could finally let go.

There I was. Somewhere in a central London park with my hands tightly grasped around the handlebars of the double buggy, where both my children were having an overdue nap. I couldn’t be more grateful for this as I didn’t want them to see me crying.

The explanations, the drawings and complicated words from the consultant that morning went around in loops in my head. Before this appointment I had always heard that ‘they don’t recommend surgery when you are too young’ etc. Now I understood a little more about why. I had a newfound understanding of how complicated it really was.

Before this day I thought the biggest issue with surgery was that it wouldn’t last a lifetime and likely would have to be redone after X amount of years. So I thought: as long as I am aware of that then maybe this could in fact be the answer for me? Maybe I could ‘get fixed’ even if it only was for a few years? But at least it would give me the chance to live my life as I want to live it, now. Now when I am still young, and I am a mother of two young children that I would like to care for and play with without feeling physically limited – and to be able to pursue the active professional career that I really want to do. What if I could get better, at least for now?!

But there was no simple solution. All the different procedures came with so many risks and no option could give me any certainty about actually taking my problem away. And even if a surgical intervention would improve my prolapse, there was a big risk it could cause another problem instead. A problem that didn’t even exist before… There were too many risks and no guarantee a surgery would even get me better than I was today. It was such a disappointment.

I felt stuck.

It was hard to stay positive. Part of me really wanted to stick to the idea of keeping my head high and power through whilst hoping for improvement, but the rest of me was falling apart.. it was as if my symptoms got worse and worse with time.

Four months postpartum I saw the women’s health physio – at last. And I saw her regularly for some time where she helped me to find my pelvic floor strength back and to reduce my severe prolapse symptoms. She got me to try electrical stimulation for the pelvic floor muscles….this was an extremely strange thing where a little device gave electrical impulses to my pelvic floor muscles, helping them to contract. The reason was that they were at the time pretty much useless. It was as if the muscles had forgotten how to contract. They may have been injured/torn? Nobody really knew. But what were they supposed to be doing? The electrical impulses would help them along… I tried this method for some months. If normal pelvic floor exercises are quite easy to get done any time and anywhere (as long as you are determined about it!) this was very different. I had to hook myself up with this little machine and lay down somewhere quiet and be relaxed (and undisturbed) for a good 20 minuted or more. This state of mind and the logistics around it all with two kids to care for was quite difficult to find. Evenings were sometimes an option but the problem for me often comes back to that my pelvic floor is always much more tired in the evening. Ideally I wanted to work on it first thing in the morning when they would be more rested and ready to work. Anyway I gave this all a shot and tried my best for a period of time. And it helped me in the beginning I have to say. And once the muscles had ‘woken up’ a bit and learnt to contract properly again without stimulation I went back to doing my normal pelvic floor exercises.

Another tool was ‘the wand’…. this was also a type of device but a manual one to reduce pelvic floor muscle tension. I have a working background with treating sports injuries and I know too well how that tend to work… it all made so much sense. The muscles strengthening and lengthening relationship and how the muscle can be stretched/massaged out for progressive benefit, and I was partly amazed over the anatomy and physiology of it all. But at the same time I cried inside every time I used any of these pelvic floor tools in my training regime. How did I get to this point???

After a few months of hard work the physio said it might be a good idea for me to see a consultant and discuss my options going forward. She meant that we had tried everything we could in terms of physio work, and all I can do now is to continue with my pelvic floor exercises. She was by now confident I knew what I was doing and that I wouldn’t really need her anymore. It was in a way positive to know that I did things correctly and didn’t need her supervision anymore in my pelvic floor training, definitely. But on the other hand it was comforting seeing her on a regular basis. Not that the sessions themselves were comfortable – (not at all!) – but I liked the idea of working with this actively and together with someone professional that I felt I could trust. And I guess it kept my hopes up that the physio and my determination would help and improve the condition – much more than it actually did this time around. It was now nearly a year postpartum and I still experienced major symptoms and discomfort from my prolapses – even after all the manual physio work, pelvic floor training (with and without devices) and the cube pessary….. So it was a bit disheartening when she discharged me – well of course it was: She didn’t discharge me because I was problem-free and ready to move on with my life. She did it because my problem was too severe and she couldn’t help me anymore….

So the next step was to see the consultant, to discuss surgery….

I had promised myself to stay positive and give myself time to heal without stressing out too much. I cannot say exactly for how long this lasted but I realise now it didn’t last for that long. Soon enough I entered a quite distressing time in my life. I came to realise just how much the prolapse had in fact worsened after the second birth, and that for now there was not much I could do about it. Life had to go on in a very different way this time. I now had not only a newborn baby but also a 3 year old in his best days to take care of. I had to get back to more daily activities sooner than when he was a newborn. Sure, we lived a pretty quiet lifestyle the first weeks and months but life as a mum of 2 simply needed more from me. Thankfully I had some help from family the initial weeks. And the cube helped me a lot still even if I could feel it didn’t fully support me anymore. It was an essential gadget for me though to decrease the worst of my symptoms. But every time I removed it (i.e. every evening) I got a constant reminder of how bad things really were down there. Every time I stood up my pelvic organs would fall down far out of their original position, so much more than after my first birth… It was a nightmare. How could this have happened!? I thought I had been so careful. Done my research. Weighed birth options back and forth. Was told numerous of times by health professionals that often a prolapse doesn’t necessarily get worse after a second birth. So why did it happen to me? I so much loved this birth experience but should I actually have opted for a c-section? Of course these were completely useless thoughts to even be thinking. I couldn’t change the past. But of course the thoughts were there anyway. And of course the guilt was there. What had I done wrong?

It upsets me that there is no straight forward care for women following childbirth. There must be so many suffering postnatal problems in silence. A lot of the time I suspect new mothers wouldn’t seek help unless they are offered. And in my case even if I tried asking the GP, my problem was at first completely disregarded. Imagine I wouldn’t have had the knowledge I actually had. A new mum who may have no idea about what a women’s health physiotherapist even is, would probably just have moved on and dealt with her issues in yes, silence. Maybe for years, maybe forever… When my GP acknowledged I needed help, all she could do was giving me a name of a women’s health physio I could go and see privately. That was if I wanted to see someone earlier than my already booked appointment (in 4 months time). So there is definitely a glitch in the whole system. The physio I have been seeing (on and off for years) is incredibly stretched and she cannot help she doesn’t have much availability. She’s on her own on that hospital!!! Taking care of all women is similar positions like me and of course any other women’s health related problems. But why is she on her own? It must be because it’s an area not prioritised, right?!

Women give birth. They may get problems after. Life goes on. Deal with it. 

In some countries every woman will see a women’s health physio postpartum. I SO wish that this was the case everywhere! All women would benefit from it. With problems/pains or not, but for their future pelvic floor health. We can all benefit from learning correct pelvic floor training. Because believe me, it’s actually not as easy as it seems! And I put my hands up, I was not doing my exercises correctly until I first saw my physio. There is so much more to it than just squeezing. It’s all about squeezing the right muscles, relaxing the right muscles and breathing in the right way. Every new mum could learn from at least one postnatal check up. And in an ideal world also an appointment before giving birth… Amazing would be to have a regular checkup for the pelvic floor during life, starting from a young age and then continuously throughout life, having had children or not. In an ideal world. Because of course there can be problems also if you haven’t gone through pregnancy and labour. The focus in my writing is to do with postpartum problems, as that’s what is relevant for me, right now. But the above is what I truly wish for. For all my sisters out there.

In an ideal world.

Imagine you go through a pregnancy, labour and give birth to a little human being. Your world is turned upside down and from this moment on your life has basically changed forever. In a lot of ways! You are happy. Exhausted. Scared. Worried. Excited. You feel every possible emotion and it all goes around in circles while you are trying to figure out what this new life is actually going to be like. You are now a mum. You have given birth to a person who you now have full responsibility for 24 hours a day and in a way all you can do is to focus on this little one and everything that comes with them. But all of a sudden you get reminded of your own body, but wait a minute! It’s not the same body you once had?? It has changed – Dramatically! You have concerns, complications, pain. You may struggle with going to the toilet properly. You have questions. Wondering if what you experience is actually normal? But it’s all a bit private and difficult to talk about. Since your midwife discharged you day 5 post birth nobody has checked your healing or asked you anything so you assume it’s only you thinking too much. Maybe you have to expect certain things after giving birth, maybe every mother has their bladder positioned on the outside of their body by now? 6 weeks postpartum you have the baby and mother checkup at the GP booked. A chance to get some answers!

This is my story in the doctor’s office. And it went literally like this:

All the mandatory baby checks were done. My little girl was alert, healthy and everything was positive. The GP made her notes. Then turned to me: 

GP: ‘And how are you doing mum?’

Me: ‘Well. Not so good to be honest. I’m suffering a lot from two things – one being my coccyx which is an old injury. Although not as extremely after this birth as after my first – it was still aggravated I am in quite a lot of pain from it and struggle to sit too much which is hard when i feed the baby etc.. 

Secondly there’s the prolapse which is my biggest problem at the moment. I originally got it after the first birth but I think it’s been worsened after this as it feels very low… it definitely feels worse than last time and I’m struggling to…….

//I get interrupted//

GP: ‘Why are you telling me this?? There’s nothing I can do about that! That’s normal after giving birth!’

…………………………………………………….

She actually said those words: ‘Why are you telling me this?’

WHY AM I TELLING YOU THIS?????!!!!!

Well – I am at my postnatal checkup and you asked me how I am doing postpartum. I am sorry if you were hoping for me to say that I’m doing ok so that you could tick that box and move on to the next patient. I am actually clenching my jaw in anger as I am writing this and reliving the moment…!! The room around me got dark as I quickly snapped back at her that:

Me: ‘I didn’t actually expect you to do anything at all about it. But I thought that you as my GP could send me to the right person who might be able to help ’.

I think she then realised that I might not be that mother. That mother who would now say ‘ok thank you’ and leave and her GP life could go on. She mumbled something in a somewhat nicer tone. And moved on to if I wanted her to examine me. Again – excuse me but why is this a question? Of course I should be examined! Why wouldn’t she want to see that the healing is going the right way (even if I had come in without any concerns/symptoms) it’s 6 weeks postpartum!! So early days! I was so annoyed and angry at this point so I wryly replied to her that:

Me: ‘If you cannot do anything anyway, what is the point of you doing a vaginal examination?’

She would do one she said to at least check stitches etc. So even if I was very put off by the situation I agreed for her to do it. And here’s to the ironic bit. Upon examination she very soon realised that: 

GP: ‘Oh. You’ve got a quite severe prolapse here. You need help with this.’ 

…………………………………………………….

I just hope she regretted in that moment what she had said earlier. And that she will never say something like that to a new mother ever again.

It didn’t take long before I understood that the pelvic floor had taken a massive toll from the birth of my second baby. I knew my body so much better now and a bit more about what to expect (and what not to) after giving birth. 

But I also knew that even if the prolapse felt very low initially after the birth it didn’t necessarily mean it was a long term worsening. So I stayed positive. I didn’t want to ruin the good emotional feelings from the birth experience and I really wanted to just enjoy the moment. I tried to put any thoughts about my pelvic floor to one side for the time being, there would be time later to deal with my physical side of things..

Of course it wasn’t entirely easy to ignore my body, especially because that cough I suffered before labour kept lingering. And of course kept affecting the pelvic floor and my stitches.. Soon enough I ended up on antibiotics because of a diagnosed chest infection. At least that meant I could finally start to recover from that bit.

Midwife J came to do my Day 3 checkup at home. She straight away identified that my cervix was positioned too low to be considered normal at this point and referred me to women’s health physiotherapy. And that would be to the same physio I had seen lots both before and after my previous baby. 

However, there is really not enough of these type of professionals out there, and I assume there are not enough fundings for this area, women postpartum are basically not very much prioritised. This means that those few that work with women’s health get very, stretched. To give you an idea: I had my baby end of May, the referral to physio was sent through in the very early days of June. I got my physio appointment the 22nd of October…

Lucky for me that this was my second baby and I had done so much pelvic floor physiotherapy in the past so I kind of knew a lot of what I needed to do. Plus I had the cube to go back to eventually. But for a first time mother who may have no idea at all, and might be experiencing prolapse issues or other pelvic floor problems – imaging having to wait for that long to get any kind of help!!!? 

In my next post I will tell you what my GP said at my 6-week postpartum checkup.