Helen Gets a Pessary - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump - busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about. Incontinence, prolapse, pelvic pain - problems that affect millions of women, one in three. I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child five years ago. And if you'd told me then I'd be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hi! Welcome back. Totally different episode this week. Yep. There we go. I'm on a train because I'm on a location...also known as, it's the Easter holidays, and we're with the kids in London staying at my sister-in-law's. And while we're here, I am taking advantage of the situation, and I'm off to meet a physio called Tracey Matthews, who has very kindly offered to give me a pessary fitting.

I don't know how many of you have been following my pessary saga. I mean, it's not exactly Netflix drama, but in brief, I tried a few ring pessaries a few years ago, and the first one fell out in the hospital car park. But eventually I found one that seemed to fit, I wore it for a while, but I didn't really notice much difference. Couldn't get to grips with taking it in and out, so I kind of gave up.

And then after making a podcast, I decided to give it another go. So I asked the GP last April for a referral to a pessary clinic, and that ended up coming through. But not being for a pessary clinic, being for a urogynaecologist, so I'm not really sure why that would be. Maybe it's just part of the process, maybe it's the pathway, I don't know. But...so I saw her. She was very lovely, and she referred me for a pessary appointment. So that was, I don't know, six or eight weeks ago. And that did come through, to be fair. But guess what? It was for this week, the one week when I knew that I'd be away. So I've had to postpone that. And then in the meantime, as I say, Tracey Matthews heard about all this and offered to see me. So I'm on the way to see her now. And you're coming with me. You're coming to a pessary fitting with me. Let's see what happens.

Tracey

<Helen! Hello, I'm Tracey. Nice to meet you.>

Helen

<Lovely to meet you too!...>

So this is how it started, at the White Hart Clinic in Barnes in southwest London last week, on a gorgeous sunny day. Tracey cleared her diary to help me find a pessary. I was there for a good couple of hours, I'd say. So obviously you're not going to hear all of that, but I am going to try to give you a sense of it, followed by a chat with Tracey herself, who's a former athlete...with a prolapse. First step, though, medical history.

Tracey

<Right, are you ready?>

Helen

<Yes>

Tracey

<So tell me. So what I need to know is kind of your history, children, birth, when you first felt your prolapse, when it started bothering you.>

Helen

<Yes. So I've got two children. My daughter....>

I don't know why I wasn't prepared for this. Obviously, it makes sense to know how it all started. So, in brief, for me, I mean, I think you know, but my daughter was born by elective section because she turned breech. She's nine now. And then I had my son a couple of years later. It was a vaginal birth. It didn't go especially well. I had an episiotomy, which ended up with a third degree tear. And a couple of weeks later I had a prolapse. And here we all are.

So the key thing being, if you're going to an appointment, do expect questions about birth or births. Also about symptoms, about toileting, what exercise you're doing, where you want to get to, whether you're drinking enough water and what your hopes are.

Tracey

<So you're here for a pessary. You've looked into pessary. What's your most bothersome symptom? What is it that affects you the most on a day to day basis?>

Helen

<So it comes and goes. But yeah, probably just feeling it sometimes. And I say sometimes because really not every day, you know like through my cycle, it comes and goes. But when it does, it makes it grumpy. It's like...I always compare it to, like, wearing knickers a couple of sizes too small. It's just that level of annoyance. It's not pain or anything like that.>

Tracey

<It's just irritating?>

Helen

<Yeah. Annoying. So there's that. And then my other reasoning, really, for wanting to get a pessary, is just because I do like to go running, even though I'm not running millions of miles. I just feel like it would be extra security to stop things getting worse.>

So we had a good long chat about everything. And then the pessaries came out. And if you thought they were all ring shaped - because that's often all you see - think again.

Tracey

<The ones that we really use...so we've got a cube there, and they vary in different sizes.>

Helen

<I was going to say that's very small. It's like a dice. Oh yeah...no there's another one!>

Tracey's cupboard is like a pessary sweet shop. All different shapes and sizes. Cups, cubes. Some you take out every day, some you leave in for three months. Some you can wear with intercourse, some you can't. Some are for stress incontinence. Some are for prolapse. Some are for both. You get the idea, and then the examination.

<Okay, I think I'm decent>

Tracey

<Ready?>

Helen

<Yeah. Go on, give it a go.>

Tracey

<Are you feeling okay? You're not too nervous?>

Helen

<I feel fine. I feel fine.>

So Tracey starts by looking externally for scar tissue, to see if the tissues are healthy.

Tracey

<It looks fine. There's no...it does look well, oestrogenised, to be honest. But we might consider getting some topical oestrogen and we'll discuss that afterwards. Okay. Do a pelvic floor squeeze and lift for me.>

Helen

She gets me to contract and then relax my pelvic floor. Then there's an internal examination. She's looking for scar tissue there. Is the pelvic floor moving symmetrically. If not, a pessary can tilt. She's measuring using fingers, checking everything's healthy. Would it be worth using some topical oestrogen? Probably, she thinks, in my case. And then she asks me to lie on my side for another examination. None of it is uncomfortable at all. Honestly, I actually find the whole thing really reassuring, just to be assessed so thoroughly and to get this understanding of what's going on.

Tracey

<So I'd say it's a grade two anterior wall. I can't see anything of the posterior wall at the moment.>

Helen

<Okay.>

Tracey

<And it's not coming to the entrance. It's just slightly inside the entrance, but there is some movement on that wall.>

Helen

So, I am a candidate for a size two cube.

Tracey

<I'm going to put it in. You're going to go for a walk, and then I'll show you how to manage it.>

Helen

And putting it in is much more straightforward than I imagined. Easier, in my opinion, than the ring I tried a few years ago. You use a water based lubricant on all the sides, and then you squash it between your finger and thumb, and then you insert it. And, a lot like a menstrual cup, which I used to use before kids, it sort of suctions to the wall of the vagina and then it's in. And certainly for me, it didn't hurt at all. I couldn't even feel it.

Tracey

<Do a few squats. Do a few lunges.>

Helen

<Do you know, I do feel the difference with that.>

Tracey

<Do you feel it at all?>

Helen

<I don't feel the pessary, I don't think so.>

So Tracy sent me off for a walk, up the road and up over the railway bridge, and I feel absolutely fine. I feel brilliant. I feel lighter. I'm walking at pace. That's why I'm a bit out of breath. I can't feel the pessary. I do feel just a bit less bulgy, and I didn't particularly think I was feeling bulgy today. But I can notice the difference. And I just feel really happy, like, optimistic that this could just be the thing that I need. So far, so good.

The biggest learning point for me through this is that if you don't have the pelvic floor strength, a pessary is not going to work. You have to have that to hold it in place, otherwise it will just fall out. And it turns out I need to do better. I have been told.

Tracey

<So pelvic floor strength. You've got a good squeeze. But we need you to really concentrate on the lift. So with you, it's a lot about posture as well. You're very stiff in your thoracic, so you sit like this...and you stand like this.>

Helen

<Oh no!>

Tracey

<So that really kind of makes a massive difference on how your pelvic floor elevates and lifts.>

Helen

<And the thoracics is?>

Tracey

<Is your upper back. Yeah. So, like, where your bra strap is, that kind of area. You just...posture wise you're very forwards like this. So we need to kind of think about getting you stacked. So your ribs stacking over your pelvis.

I'm not saying you walk around like this all day, I want you to move. But general position wise, when you're doing...all your pelvic floor now should be done in standing. You're good enough to do them in standing, but I want you to exhale, squeeze and lift, and really thinking about a wrap as well. So you're not tightening your tummy muscles in, you're lifting your pelvic floor up. And you're also wrapping around to lift those lower abdominals as well. So you're getting that nice lift. And then you're going to hold for 10 seconds and you're going to repeat it ten times, twice a day. I know, it's all boring. I know.>

Helen

<No. No. I'm in.>

Tracey

<And then you're going to do fast ones. So your fast ones again, you were just squeezing the entrance...>

Helen

That's the work for me. Obviously, it's going to be different for everyone. So, as ever, please don't take this today as a medical advice.

With cubes, you have to take them out every day. There's no magic cleaning solution. You just use warm water and let them air dry. You sterilize them in boiling water from time to time. Tracey told me that pessaries, you know, they're not for everyone. If you have a hypertonic pelvic floor, for example, they can make your symptoms worse. If you have atrophy, that can be a problem. But for some people, they're life changing. And Tracey is speaking from experience, because she wears one too.

Tracey

So I was an athlete. I used to row for Great Britain, two times, did Commonwealth medals twice. Did some World Championships. Then I went into Strong Woman. So I did some Strong Woman training, like, yeah, like the Atlas stones and the lifting and the yolks. I loved it. And then CrossFit. So just the functional fitness and just loved it, really. That's my background.

And then I had my son, and that was probably most similar to most women's experience that I have through the door. He was back to back. I was induced. I was two weeks over and he just didn't want to come out, basically, he liked it so much. So I was taken to theatre and they're like, we're going to do a C-section, but he's too far down. So they ended up kind of pulling him out and I had an episiotomy.

And then, like, three months later...I mean I was so kind of quite sore from the episiotomy and from that anyway, that I didn't really notice that I had a prolapse. But then I had a shower and I was just like, oh, I've got a lump. And knowing what I know is probably...sometimes being a women's health physio, you're like, knowledge isn't power!

Helen

And were you a women's health physio before that happened?

Tracey

Yeah I was doing some, but not as in depth as I'm doing now. But I was doing some, mainly pregnancy. So I was just like, oh, I know what this is. So then I went to my friend and she confirmed it. She's like, you got a grade two, but your pelvic floor is kind of...one side is working really well, and one side is not working really well. So there's things to work on, but it is a roller coaster. And I went through a roller coaster.

And I look back now and I think there is like, a pattern. And I notice in my patients there's a pattern. You find out about it and you're like, this is devastating because everything on Google is like, it's devastating. And then you kind of go through you get really angry, and then you kind of go through...right a bit of acceptance, okay, I've got to own this. I've got to do something about it. And then it's kind of a gradual management from there on, and you have good days and bad days.

And then second time around I had Maisie, and I had a C-section, but not because of anything like prolapse symptoms. I actually had high blood pressure, so then I had to...they said, we recommend with your age and everything, that you have a C-section. But I actually was asymptomatic with all of my prolapse symptoms going into my second pregnancy, and it wasn't until the third trimester that I felt a bit heavy that I had symptoms. But before that, that's how I kind of then thought on my journey with my prolapse, I was like, there's got to be something that women can do. There's women out there. We need to be active as we hit menopause. We've got to keep doing weights, we've got to do resistance stuff. And everything on the Internet was like, no, you can't do this. No, you can't do that. So that's how I kind of really went head on into it. And then it's like, right, I'm just specialising in women's health now, and I'm going to do pessaries.

And so I sourced out the only lady in the world who does a pessary course, and she's based in Australia. And so got on her course. I think there's actually three of us now in London that do it. I'm sure there's others in the UK, but there's three of us I know in London. And it was great and it was eye opening. There's a lot of research. And it's just another tool to help women to manage everything prolapse wise, basically.

So I wear a pessary for sport, for lifting, and I run as well. But it's not an easy road back. It's a long road. It's a lot of rehab, and you have to think about it. You don't want to think about all the time, but you have to kind of think, right, I need to do my pelvic floor, I need to do my strengthening. I need to do my whole body strengthening. And that's what I try and instill in the women that I see, is that it doesn't have to be this devastating thing that you see on the internet...you know you can manage it. We don't have to accept it, we don't have to put up with it. The same with leaking - you don't have to put up with it and accept it...there is something you can do about it. Which is why I think pessaries...just, if they help take away that nagging symptom of day to day, 'Oh God, I'm just feeling it today,' then why wouldn't we use them? It's like everything with women's health, the research is just is not fully out there. But it is coming, it's coming slowly. And like I said, we're the generation that have to be...we've got Instagram now. Good thing or bad thing. Facebook...we've got to shout about it, we've got to make it that it's not a taboo. And pessaries aren't a taboo. I fit more pessaries in postnatal women and younger women than I do in anybody older, you know over the age of 60.

Helen

It's really pervasive that thought though, isn't it? Because I do hear that from women who get in touch and say, the GP said I'm not old enough to have one, and that sort of mentality. It's still so out there, even amongst medical professionals.

Tracey

I know. It's changing. It is changing. We are fighting a battle and the physios should be doing this. I mean, the guidelines came out last year, which is brilliant, and the guidelines have just come out in America as well. So USA physios can start fitting pessaries...and it's just what we should do. It should be part of our practice because, you can you see how in depth it's been, I couldn't just fit you a pessary and say off you go, out the door. For me, it's got to be that in depth, because I need to know that it's working for you and that you're comfortable. So it will be a momentum, it will start building, and physios are just the perfect people to do it.

Helen

And as we go forward, you said hopefully pessaries are going to become better known and more people are going to use them. Are you seeing new ones coming out all the time?

Tracey

Not so much. Although in I think it's Canada, which I think this is really high tech, they are doing...it's like basically a 4D vaginal ultrasound in women that have mainly have a levator tear, so a tear in one of the muscles near the entrance, which makes your vagina opening wider, which can happen with forceps and with birth. And what they're doing is they are doing like a 4D ultrasound of this woman and then they are building a specific pessary with one of those...you know those laser machines...

Helen

A 3D printer?

Tracey

Yeah, with a 3D printer. So they're building a specific silicone pessary for that person.

Helen

Yeah I mean that makes so much sense because we're all different. And you could have a bespoke one that will definitely fit.

Tracey

I don't know how much it costs. I hate to think how much it might cost. That's in Canada. I read about that. I thought God that's really specific.

Helen

That's genius.

Tracey

It is genius.

Helen

Okay, maybe this is where we need to...you can just get those 3D printers...we could do that!

Tracey

I'm not sure that would be medically ok...

Helen

Imagine that. A bespoke pessary for everyone who wants us. I will link to that project and all the other things we touched on in the show notes. Huge thanks to Tracey Matthews, who see me last week. She is @prolapsestrength on Instagram...and for openness, I didn't pay for the assessment. I did pay for the pessary.

And the big question - you're probably wondering how it's going? I can't give you a proper update just yet because...this is so typical. I started my period within a couple of hours of leaving Tracey and the cube came out of place. So I checked with Tracey and we agreed to wait a few days to give it a proper try. But she's been really clear on this. I do have to really focus on the pelvic floor function to build the strength that I'm going to need to make it work. So that's where I am, and there is work to be done. It's not a quick fix. I'm genuinely still really optimistic, though. I do think this could be the answer for me. I'm going to keep you posted and I hope this has been helpful. Thank you for coming with me to my pessary fitting. What a weird world we have created!

For more pessary chat, listen to last season's episode Vaginal Pessaries: A Deep Dive. And you can support the podcast at buymeacoffee.com/whymumsdontjump and it can be completely anonymous if you prefer. You can find me on socials @whymumsdontjump - we've had a lot of chat about pessaries on there this week. Come and join us - or online at whymumsdontjump.com.