Mother of three Emma Britton has been experiencing incontinence since the birth of her first child. She says women would benefit from receiving advice to see a pelvic floor physiotherapist who is knowledgeable in postnatal women and can give you guidance on how to rehabilitate.
Before giving birth to her three children, special education teacher Emma, says she had never experienced incontinence.
“When I fell pregnant with my first son, pretty much everything fell apart straight away,” Emma says. “My whole pelvis, everything fell apart. My joints were dislocating. It was really awful.”
Her son was born in four hours and weighed over four kilos. After the birth, the midwife mentioned that Emma may have a fourth-degree tear. Once clinical staff confirmed, she was rushed for an emergency surgery.
“My son was born in the bath and because of his size he got stuck. The midwife said it was an incredibly rare thing to happen,” Emma states. “I was then told I could have incontinence and was recommended not to have any more vaginal births as I may end up with a colostomy.”
Emma then saw a women’s health physiotherapist who told her she has Ehlers-Danlos syndrome.
“All these factors all kind of played into what are probably the reasons behind, or a couple of the reasons behind, having a fourth-degree tear.”
Emma continues, “it was very confronting. Not something that I think I was in the brain space to even contemplate at that point in time. I had just given birth to my first child.”
“After I had my first son, my leakage wasn’t so bad. It was not what I'm used to, and I recovered from his birth. It took 12 months of recovery from the tearing. It was quite different to what I was expecting. I didn't realise it was going to be so hard,” Emma says. “I suffered a prolapse at the same time. And while I was seeing physiotherapists and GPs, I still had stress incontinence all the way through.”
Emma tried to restart all the activities that she used to enjoy but wasn’t able to. Going back to work at the school was also difficult. Emma says she couldn’t do all the things that she loved to do with the students that she worked with. She couldn’t jump on trampolines or run around and chase her students.
“The second that I would jump or even make a heavy step, I would leak. It was just this overwhelming feeling of just leaking constantly,” Emma says. For ten years, she has managed the leaking with pads.
While pelvic floor physiotherapists have helped with incontinence and her pelvic floor muscles, clinicians see her as a bit of a medical question. For her second child, Emma had IVF and was told early in her pregnancy she would have to have a caesarean. Emma believed that she wasn’t going to have a vaginal birth and that her symptoms wouldn’t get worse, however after giving birth, she had similar experiences as her previous birth.
“It was quite intense,” Emma says, “I straight away went to see my second physiotherapist regarding the leakage and it improved somewhat, but not completely.”
Colostomy?
A colostomy is an operation where an opening is made to the large bowel on to the surface of the tummy. Waste is collected using a bag called a stoma pouch.
Ehlers-Danlos Syndrome?
Ehlers-Danlos syndrome is a group of disorders that affect connective tissues in the skin, joints and blood vessels which can impact on many organs and tissues. Defects in connective tissues cause the signs and symptoms of these conditions, which range from mildly loose joints to life-threatening complications.
What is Stress Urinary Incontinence?
Stress urinary incontinence is the leaking of urine during activities that increase intra abdominal pressure and push down on the bladder. Stress incontinence can happen as the result of physical activity or actions such as coughing, sneezing, running, heavy lifting or laughing. It occurs mainly in women often in relation to pregnancy and childbirth as well as menopause, it can also occur in men, such as after prostate surgery, plus with people who experience chronic constipation and strain at the toilet, chronic cough and obesity.
When I fell pregnant with my first son, pretty much everything fell apart straight the leakage and it improved somewhat, but not completely.”
Shortly after her second birth, she had her third son and straight away went to see the physiotherapist to find the best solution for her incontinence.
Emma recalls when she was heavily pregnant and was on playground duty at work, “I sneezed. It must have missed the pad and my colleague was concerned because she thought my water had broken,” Emma says. “I just told her it was ok, I had peed myself. My colleague said it was ok and that it happens to all of us. But I feel I am just lucky because it didn’t happen inside the classroom on the carpet. I can laugh about it now, but I was in my early 30s and this was something that should not be happening.”
Emma had tried to remain positive, putting her experiences down to pregnancy. She kept thinking it will get better, but admits that as time goes on, with her youngest being three years old now, her experiences are getting worse.
Emma spoke with the physiotherapists at the hospital and explained her history. The physiotherapists then offered her a pessary (a device which fits into the vagina to provide support to tissues displaced by pelvic organ prolapse).
The first and second pessary devices didn’t work and trying the two other types of pessaries made her symptoms worse. Her care pathway led her to a urogynaecologist who recommended surgery, but with her history of treatments not working like they were supposed to, she is reluctant to follow suit without a second opinion.
After I had my first son, my leakage wasn’t so bad. It was not what I'm used to, and I recovered from his birth. It took 12 months of recovery from the tearing. It was quite different to what I was expecting. I didn't realise it was going to be so hard.''
I've had to be my own advocate, very determined and persisting to get more answers and not take no for an answer.”
Emma thinks surgery is probably going to be the next step and then whatever rehabilitation she might need after that with her physiotherapist who she says she still sees regularly.
Emma reflects that her condition still feels like a bit of a mystery to a lot of doctors and physiotherapists. The proposed solutions should work, but often they don’t. It’s why she says being your own advocate and being determined is key to finding the right solution for your health.
"I've had to be my own advocate, very determined and persisting to get more answers and not take no for an answer.”
“Particularly in my case, where symptoms have not been fixed by textbook treatments, I need to continue building knowledge to eventually come to the most effective solution. If I wasn't so determined I think I'd still be in the same position,” states Emma.
Emma reflects she is now open and determined to talk more about her experiences to actively create change. “There is so much stigma and shame and concern and worry.”
“There are people out there who have no idea about a pelvic floor physiotherapist,” Emma continues. “This is not something you should be ashamed of and hide. It happens to so many women and it's just not fair that we must feel like we can't talk about it and that we can't do something about it. I want other people to feel like it's okay to go and get help.”