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 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.
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.
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.
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.
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 first birth. I wish that everything that I did to prepare for the second birth, I did for the first.”
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?
- 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
- 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.
GET HELP AS SOON AS POSSIBLE!
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.
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.