Allie Adams was proud of exercising all through her pregnancy and — despite a long and traumatic labour — was counting the days until she could restart her fitness regimen after the birth of her son.
‘I bought into the social media trend of having a fit pregnancy, where you keep exercising to stay fit for pregnancy and birth,’ says Allie, 40, a former marketing director who lives in Beaconsfield, Buckinghamshire, with her husband and son, now aged two.
Allie followed ‘vague guidance’ from her midwife and GP to ‘keep doing what I was doing’ during pregnancy, training three times a week at a CrossFit gym, doing high-impact exercise and weight training.
Despite being ‘completely shell-shocked’ after a 36-hour labour and a birth involving an episiotomy, ventouse delivery and heavy bleeding, Allie bought an online 12-week post-natal exercise course from a reputable company.
Allie Adams was proud of exercising all through her pregnancy and — despite a long and traumatic labour — was counting the days until she could restart her fitness regimen after the birth of her son
Rather than wait, as the course recommended, until cleared to exercise at her six-week post-natal check-up, Allie began her new fitness routine just four weeks after giving birth.
‘I thought I was strong and fit and was itching to get back to exercise,’ she says. ‘But I was naively arrogant about how fit I was and what my body could do and — as it turns out — absolutely clueless about the changes that happen to your body in pregnancy and the impact on your pelvic floor and core,’ she admits.
For on the third day, she tried a move involving a ‘glute bridge’ — lying on the back and raising the pelvis in the air with a small, squishy pilates ball between the legs, equipment she didn’t have.
‘So rather stupidly, instead of using something light like a cushion, I used a 5kg medicine ball,’ she recalls.
Nothing seemed amiss at the time, but she woke the next morning ‘and knew immediately something wasn’t right’.
‘There was an uncomfortable feeling of heaviness in my vagina, as if I’d put in a tampon and it was too low,’ she says. ‘I suspected a prolapse.’
Rather than wait, as the course recommended, until cleared to exercise at her six-week post-natal check-up, Allie began her new fitness routine just four weeks after giving birth
Statistics from the National Institute for Health and Care Excellence (NICE), show pelvic organ prolapse affects up to 50 per cent of all women. This is where weak muscles cause one or more of the organs in the pelvis — such as the uterus or cervix — to slip down from their normal position.
‘Symptoms include a “bulge inside the vagina” — the words used by most women — or a sensation of something “coming down”, urinary, bowel and sexual symptoms, such as problems with penetration and pelvic and back pain,’ says Clive Spence-Jones, a consultant obstetrician and gynaecologist and pelvic floor reconstructive surgeon based at the Portland Hospital in London.
Many women, guided by their specialist, opt for surgery to fix the problem — although NICE guidelines now stipulate they must first have physiotherapy.
The use of controversial mesh implants, that caused debilitating misery for thousands of British women with incontinence and prolapse problems, is now greatly limited and the preferred options are surgical repair or hysterectomy — this followed a Daily Mail campaign and official review.
Even so, ‘there’s no perfect operation and it may cause permanent pain and in 10 to 15 per cent of cases, may lead to leaking of urine in women who didn’t leak before surgery. And, up to 30 per cent of prolapses can reoccur within five years’ says Mr Spence-Jones.
However this year, the first-ever UK guidelines were published that will encourage more women to use pessaries instead of opting for surgery to treat prolapse.
Developed by a multidisciplinary team representing organisations such as the Chartered Society of Physiotherapy, UK Continence Society, and the Royal College of Nursing, the guidelines will provide information for healthcare professionals and women themselves.
Pessaries — devices inserted into the vagina to support it — have been around for many years, particularly the ‘ring pessary’.
Available in many different shapes and sizes, and often made from silicone, pessaries offer a non-surgical solution that allows women to be in control of their treatment. Some can be left in continuously, while others are inserted daily or when needed.
But many GPs and even gynaecologists are unaware of the range available — and the benefits of women using them — ‘which is why they are only recommended sporadically on the NHS’, says Mr Spence-Jones.
NICE guidelines issued in the wake of the mesh scandal stipulate that women with a prolapse should be offered physio before a pessary can be considered.
‘But for years, doctors have been sending women to have surgery so they keep doing that rather than thinking about an alternative,’ says Mr Spence-Jones. ‘We hope the new guidelines have a great impact on the management of prolapse as this impacts greatly on the quality of life for women.’
After suspecting a prolapse, Allie researched her symptoms and was frightened at what she found.
‘It sounded like my life was over,’ she says. ‘I read horror stories about mesh surgery and that I might need a full hysterectomy, that I wouldn’t be able to lift weights ever again.’
Her GP carried out an internal examination at her six-week check-up, but found nothing wrong and assured Allie she was ‘safe’ to exercise. But convinced something was amiss Allie booked another examination, which revealed a small bulge in the rectum wall.
Allie then went to see a private physiotherapist specialising in pelvic health, who put her on a pelvic floor muscle retraining programme and recommended strength training with a fitness coach. ‘The physio gave me an internal examination and confirmed I had a rectal and bladder prolapse but that it was mild and likely wouldn’t require surgery,’ she says.
‘It took months of work to learn to connect with my pelvic floor and deep core muscles, to work on the alignment of my body post pregnancy and birth, my breathing and to begin strength training to help load my pelvic floor and build strength,’ says Allie, who has retrained as a pre and post-natal women’s fitness coach (Mummy Movement PT).
When the physio told her about pessaries, she was reluctant. But she decided to try one when she was still struggling to return to higher-impact exercise, despite a year of pelvic floor training which had improved her symptoms.
A pessary needs to be fitted initially by a healthcare professional. ‘Rarely do we manage to find the best fit at the first appointment, but almost always we can find a pessary which is comfortable,’ says Mr Spence-Jones.
Some can safely remain in the vagina for several months without removal — even while having sex — ‘others are best removed and cleaned daily’, he adds.
Allie describes it as ‘a sports bra for your vagina — like a hammock that holds everything in place’. Hers is like a 1½-in cube ‘with a suction hole on each side that supports each side of the vagina’.
‘I feel the difference from the moment it goes in. It feels like everything is being held in place,’ says Allie. ‘Not only does it help alleviate the feeling of heaviness, it really boosts your confidence.’
Thanks to the pessary she is back doing the kind of high-impact exercise women with prolapse might think they have to avoid.
In her new role as a fitness coach she has helped dozens of women so worried about further harming their prolapse that they stopped doing exercises altogether.
Allie is now eight months’ pregnant and has used the pessary throughout. ‘After this birth, as well as starting my pelvic floor exercises immediately under the guidance of my physio, I’ll wear the pessary as soon as I am able,’ she says.
‘There is research being done in France where it looks like this is proving to be really beneficial.
‘Sadly, many women are still being told a prolapse is something that they have to learn to accept. Some women I work with have been told their only option is surgery or that if they have a pessary that their sex life is over. For many health professionals, pessaries seem to be an option for an older generation only.
‘I feel incredibly lucky to have found a pelvic health physio who was forward-thinking enough to suggest trying a pessary. It has made a huge difference to my confidence levels and symptoms’.
Storm in a teacup
The downsides of hot drinks. This week: How they can affect your voice
Vocal cords are safe from hot drinks, as cartilage protects them. But hot drinks can burn the pharynx — the muscular tube running from the nasal cavities, behind the larynx (the voice box) and oesophagus (food pipe).
This, says John Rubin, a consultant surgeon at the Royal National Throat, Nose and Ear Hospital in London, can cause a histamine reaction.
Histamine is a chemical produced by immune cells in an allergic reaction. Such a reaction could thicken mucus around the vocal cords, which could affect your voice, as you may need to clear your throat constantly.
‘Vocal cords need runny mucus to function,’ says Mr Rubin. ‘If the mucus is sticky due to inflammation from the hot drink, you will need to clear your throat.’ This will last until the inflammation eases.
Hot drinks can also burn the epiglottis — a flap at the back of the throat that prevents food entering the windpipe and lungs. ‘This can swell and even cause difficulty breathing because of blockage to the airways,’ says Mr Rubin.