Alison Hainsworth
Colorectal, Pelvic Floor and EGS surgeon, Guys’ and St Thomas’ Hospital
Injuries to the pelvic floor — often following childbirth — are seen as a ‘neglected health issue.’ With symptoms including urinary or bowel leakage, patients can be reluctant to seek help.
Childbirth-related pelvic floor injuries are common: in the first year after birth, 1 in 3 women will experience urinary leakage; 1 in 10 will suffer from accidental bowel leakage; and 1 in 12 will feel a prolapse or lump. Treatments, however, are often straightforward with physiotherapy or lifestyle changes.
Seeking help for pelvic floor injury
Alison Hainsworth, Colorectal Surgeon and Pelvic Floor Unit lead at Guys’ and St Thomas’ Hospital in London, explains that possible side effects of giving birth were rarely discussed in the past.
“Hopefully, that is less so now; but after delivery, there is still a lack of understanding of what a normal recovery will be like,” she says. “People are embarrassed about symptoms, such as having leakage of faeces or urine, and a fear of talking about those issues means people do not seek help.”
People are embarrassed about symptoms, such as having leakage of faeces or urine, and a fear of talking about those issues means people do not seek help.
She stresses discussing symptoms with GPs and points to other health professionals that can help, including pelvic health physiotherapists and specialist continence nurses. “We want to identify women as early as possible because we know that can make a difference,” she says. “However, if women just try to manage their symptoms, they are missing out on help; and symptoms may either not get better or get worse.”
Pelvic floor disorders can also affect men as well as women who have not had children. “We want to empower people to seek help as there is a lot that can be done.”
Ultrasound to determine treatment
While damage can be noted during birth, a woman can undergo an endo-anal ultrasound scan 12 weeks after delivery if symptoms persist to assess potential damage to the anal sphincter muscles.
Endo-anal ultrasound, which involves placing an ultrasound probe into the anal canal, enables clinicians to decide on the best course of treatment in the event of an anal sphincter muscle injury. This usually involves pelvic floor exercises, dietary considerations, or medication.
“It’s very rare for our patients to need surgery — majority can be helped with conservative, non-surgical treatments,” emphasises Hainsworth. Ultrasound findings can also help healthcare professionals work with patients to make informed choices about future pregnancies and subsequent deliveries.
Perinatal network
Hainsworth also highlights the new perinatal pelvic health clinics, which will be established nationally from next March after being piloted at 14 sites. These are for women who are pregnant or experiencing pelvic dysfunction in the first year after pregnancy and aim to make care safer, more personalised and more equitable.
