I am the last person you could have imagined talking about it,” says Helen Ledwick, from her home in leafy south Manchester.
“I went to a Catholic school in Lancashire so speaking publicly about intimate health is not in my DNA. But the more I do it, the easier it gets – and that’s something we need to talk about.
Helen, 44, a former BBC radio producer, discusses the pelvic organ prolapse she suffered after the birth of her second child in 2015.
This is where the organs in the pelvis slide out of their normal position and into the vagina, causing a feeling of heaviness, bulging, or dragging. Although not life-threatening, prolapse can cause pain, sexual dysfunction, and incontinence.
It is especially common in mothers because pregnancy and childbirth weaken the pelvic floor muscles. But menopause is also a trigger, as hormonal changes can affect the elasticity and mass of pelvic muscles.
New figures suggest that six in ten women live with at least one symptom of poor pelvic floor health, such as urinary incontinence or pelvic organ prolapse – yet 69% have never mentioned them to an NHS professional, according to a recent survey by the Royal College of Obstetricians and Gynecologists (RCOG).
Helen believes that lack of knowledge from the public and health professionals, along with shame and stigma, prevent women from recognizing there is a problem and seeking help. She has now written a book, Why Mums Don’t Jump, to help break taboos around pelvic floor health and share expert advice. This follows the success of his podcast of the same name, which tens of thousands of people have listened to.
Helen does not recall receiving advice on preventing a prolapse after giving birth in 2015, although her risk was higher because she had had a difficult delivery, requiring surgery for a severe perineal tear (tissue damage between the vaginal opening and anus).
“I came out of the hospital after the birth – and the surgery – with no idea that the daily straining, lifting and straining could damage my pelvic floor,” says Helen.
Two weeks later, after lifting her eldest son, then a toddler, and straining to the toilet, she suddenly felt an unpleasant sensation, like “sitting on a doorknob”.
She now knows it was a prolapse — “to think of your insides falling out is terrifying,” she says. “Although this is my second birth, I had no idea prolapse was something that could happen.”
The RCOG also called for better pelvic health education.
“Too few women receive information about pelvic floor health or risk factors,” says Dr. Ranee Thakar, RCOG chair and consultant urogynecologist. “Many women don’t know or are too embarrassed to seek help for symptoms that can have a real impact on their lives.”
Meanwhile, the lack of a standard national treatment pathway – which would require GPs to refer all patients to specialists – means a postcode lottery for affected women: while some may be referred to a gynecologist or for physical therapy, others may be asked to wait to see if the prolapse improves on its own.
Although some minor prolapses may resolve on their own, most cases require medical treatment. Options include vaginal pessaries, which hold the organs in place – or surgery to fix the organs in place.
However, as Good Health previously reported, thousands of women have reported being damaged by a type of prolapse surgery that uses plastic implants.
Following a campaign backed by the Mail, use of the mesh was halted in 2018 by health watchdog NICE, which said it could only be used in clinical trials.
Although there are other forms of prolapse surgery, such as a procedure to suture the pelvic organs in place, according to the RCOG, up to 30% of these are unsuccessful.
“Surgery is not a magic bullet and often fails if the person is active, so it tends to be more successful in older women,” says Tina Mason, pelvic health physiotherapist at Women’s Health Brighton. “If surgery is necessary, a good slow rehabilitation plan is vital.”
This should involve a referral to see a physiotherapist who specializes in pelvic floor exercises, she adds, which can help improve symptoms in up to 70% of cases.
In Helen’s case, the severity of her perineal tear meant she had an automatic referral to see a urogynecologist and a pelvic health physiotherapist. The urogynecologist said she could either have surgery or do pelvic floor exercises and pessaries to control her symptoms.
Helen felt surgery wasn’t right for her at the time – she also struggled to find a pessary that was right for her. Instead, she followed advice to avoid standing for long periods, running, jumping or lifting (official guidelines have since been updated to restrict only “heavy lifting”, acknowledging the importance of staying active).
As a result, Helen was afraid to be active with her children or return to netball and jogging. “I felt like there was a shadow over me; part of me had been taken away and I couldn’t be the parent I imagined I would be,” she says. Frustrated by the poor information given to her, she began posting on Instagram in 2018 about her prolapse.
“It had helped me so much to talk to someone, I really felt like we needed to get rid of the shame around it,” she says.
Within days, hundreds of women messaged to share their experiences with pelvic floor issues – which they had never been able to talk about before. This encouraged Helen to start a podcast, where she interviews experts who share information about symptoms and treatments, as well as patients telling their stories.
She says: “A 59-year-old woman contacted me saying she was furious because she had seen a gynecologist every year of her adult life but was never told about the prolapse – and now she had had one.
“It’s great that I help people, but I’m not a medical expert and they shouldn’t have to turn to a podcast or Instagram for reliable information.”
Helen still experiences occasional discomfort from her prolapse, which she compares to the annoyance of wearing underwear two sizes too small, and finds that her bowels do not always empty completely.
But after implementing a strengthening program of pelvic and abdominal exercises with a private physiotherapist who specializes in women’s health, whom she still sees occasionally, she now feels able to live with her symptoms.
“I run, I dance with my children (now ten and eight),” she says. “I no longer live in fear.”
The good news is that more help is becoming available. Since 2021, NHS England has set up pelvic health clinics to provide women with coordinated support from midwives, doctors and physiotherapists, during and after pregnancy.
And the government’s strategy for women’s health in England, launched last August, raised concerns that prolapse was seen as ‘something to be accepted after childbirth’ and reminded GPs to check health pelvis during postnatal check-ups.
For Helen, change can’t come soon enough. “There are so many women who have been suffering in silence for so long, feeling broken and ashamed,” she says.
“With a little investment, we could give people back their families and their jobs. We could bring them back to life.
Why Mums Don’t Jump (Allen & Unwin, £14.99).