Australian women face long waits and stigma for pelvic organ prolapse treatment after childbirth

While other new mums were making friends at playgroups and navigating the demands of early parenthood, Amy Lovell was grappling with the aftermath of a significant birth injury.

After her son Xavier was born in April 2018, Ms Lovell knew something "didn't feel right" but only learned she had sustained a prolapse eight days postpartum after she was re-admitted to hospital.

It took another 11 months for Ms Lovell to learn how extensive her injuries were.

"My diagnosis was a third-degree tear, a uterine and cervical prolapse, a bladder prolapse and bowel prolapse," she said.

"You do expect some change after birthing a child, but you don't expect this degree of injury and restrictions.

Pelvic organ prolapse, where the bladder, uterus and/or bowel protrudes into the vagina, is common in Australia.

Recently, Tasmanian senator Jacqui Lambie shared her own experience of a vaginal and bladder prolapse, which she said was connected to old army injuries.

A Senate select committee on women's health will examine issues affecting women's health, including barriers to diagnosis, treatment and support.

Causes and symptoms of pelvic organ prolapse

Pregnancy hormones and the added weight of carrying a baby can weaken pelvic floor muscles. Pushing during birth further impacts these muscles.

"The tissues have never had to stretch to that degree before, with parts of the pelvic floor having to stretch up to three times their normal length to accommodate the size of the baby’s head during vaginal birth," said Oliver Daly, a Victoria-based obstetrician, gynaecologist and urogynaecologist.

About half of women who have had a vaginal birth experience pelvic floor dysfunction, like incontinence and pelvic organ prolapse.

The risk of prolapse increases if the baby is big, pushing went for a long time, or forceps are used during delivery.

Common symptoms include:

A physical bulge coming out of the vagina

An uncomfortable feeling

Constipation

Trouble urinating

Painful sex.

But it could take 10 years or longer for symptoms to develop, Dr Daly said.

"Pregnancy and birth trauma set the starting position, and chronic loading on already weakened tissue is what stretches the fibro-elastic supports out over the following decades and produces symptomatic prolapse," he said.

Experts say women need more information earlier

Dr Daly said women should be given more information about vaginal prolapse during prenatal appointments so they could prepare themselves physically and mentally and hopefully prevent significant future trauma.

He said this was especially important as most women who gave birth in Australia, 59 per cent, did so vaginally.

"We don't warn women adequately before they go to the birth suite, and we don't warn them about the risks that the health system itself can expose them to," he said.

Birth Trauma Australia director and co-founder Amy Dawes agreed.

A recent report commissioned by Birth Trauma Australia estimated about 407,265 Australian women live with symptomatic pelvic organ prolapse, 219,171 of which are attributable to vaginal birth.

Ms Dawes, who sustained a third-degree tear after her daughter's birth in 2013 and was later diagnosed with a prolapse, said learning about how her own body worked post-birth injury was empowering and wanted other women to have access to accurate health information.

More women waiting for surgery

The treatment for pelvic organ prolapse depends on the severity of symptoms.

Queensland-based urogynaecologist Christopher Maher from Mater Hospital said not all patients needed surgical intervention; many benefited from vaginal pessaries or targeted pelvic floor physiotherapy.

However, it is estimated that about one in five people with the condition will require surgery before the age of 85.

Professor Maher said patients were offered different surgical options, depending on factors including whether they wanted to keep their uterus or remain sexually active.

He said many patients presented "very late" with quite severe symptoms, and he urged people to seek medical help as soon as possible to improve outcomes.

Dr Daly said wait times for both initial consultations and surgeries in Victoria were "definitely getting worse".

"In the public system, you're waiting at least two years [to be seen in an outpatient clinic] then it's another year to get your operation," he said.

"Depending on the service, people are waiting somewhere between 18 months and three years."

Data from the Australian Institute of Health and Welfare (AIHW) shows the median wait time for anterior and posterior vaginal repairs — one type of surgery to fix pelvic organ prolapse — has been trending upwards.

And the percentage of Australian women waiting more than a year for surgery is also increasing.

AIHW data only captures surgeries through the public health system.

Dr Daly said 70 per cent of pelvic floor repair operations in Australia were performed privately, where wait times were shorter but the patient paid more.

A Victorian health department spokeswoman said it did not routinely publish wait times for individual procedures such as vaginal prolapse surgery.

Need for better support amid shame

Michelle Kenway experienced a prolapse after giving birth 26 years ago, and later retrained as a pelvic floor physiotherapist to help others.

She said the "stigma and shame" that clouded her early motherhood still lingered.

Dr Daly said feelings of shame or failure could be even more challenging for people from culturally and linguistically diverse backgrounds, with many unwilling or unable to discuss incontinence or sexual health concerns with their doctor.

"Some of it is embarrassment. If you're leaking, if you're wetting yourself; that's not something you readily admit to people," Dr Daly said.

Ms Lovell, who is still recovering eight years post-birth, said medical care for women recovering from birth injuries needed to be more accessible and affordable.

"The current level of care before and after [birth] is simply not good enough and women are being failed," she said.

Ms Dawes said women should be routinely screened for physical injuries sustained during childbirth, including prolapse.

On a personal level, Ms Kenway said there were a few things women could do, including checking in with a pelvic floor physiotherapist and working to strengthen pelvic floor muscles, no matter what stage of life they were in.

Women urged to share their stories

Ms Dawes urged women to share their stories, loudly and "without shame", to each other, to their doctors and to the Senate inquiry.

"We need to find our voices," she said.

"If men emerged from birth with a condition that completely affected the trajectory of their life, we would have investment in awareness, in prevention, in diagnosis, in treatment, accessibility and research into fixing this problem.

"The only way we can make a real meaningful difference is if they hear our stories, and I really feel that this inquiry could potentially be the tipping point that we need.

A spokesman for the federal department of health welcomed "ongoing public discussion and emerging evidence on birth trauma and women's experiences of maternity care".