When she was told she could no longer exercise, go for a run or even hold her young son, Pilates instructor Holly Puddephatt thought life as she knew it was over.
The fit, active woman from Leeds, 37, was diagnosed with bladder and uterus prolapse 18 months after giving birth to her daughter Thea, now three, and told she had to ‘live with it’ .
“My GP said goodbye to me and told me to go home,” he says. “I couldn’t believe they were treating me so badly.”
A prolapsed uterus (medically known as uterine prolapse) is where the muscles and tissues that support the uterus weaken, causing it to slide into the vagina.
“In severe cases, the uterus may even protrude outside the vagina,” says Dr. Shazia Malik, an obstetrician and gynecologist and UK medical director of virtual women’s health clinic Daye.
The condition belongs to a group of pelvic floor disorders known collectively as pelvic organ prolapse, in which the supporting tissues have weakened so that the organs in the pelvis, including the bladder and rectum, fall from their normal positions. to the vagina.
Pelvic organ prolapse affects one in ten women over the age of 50, according to the Royal College of Obstetricians and Gynaecologists.
It can be due to several factors: aging (as muscles lose elasticity); diseases that weaken connective tissues (including genetic disorders); pelvic floor injuries; and having had a hysterectomy.
Pilates instructor Holly Puddephatt thought life as she knew it was over when she was diagnosed with a prolapse.
But less known is the important role that childbirth (specifically a natural vaginal birth) plays in otherwise fit and healthy women like Holly.
An American study, published in the International Urogynecology Journal in 2013, suggested that a vaginal birth significantly increases a woman’s chances of prolapse. Up to 50 per cent of women may have some degree of prolapse afterwards, says Jo Dafforn, women’s intimate health physiotherapist and pelvic health clinic leader at Nuffield Health.
Many of those affected may not even realize it and “could be walking around without symptoms,” he adds.
But one in 12 women with pelvic organ prolapse will report symptoms, such as vaginal “heaviness” or dragging sensation, a lump inside the vagina, lower back pain, and problems controlling and/or emptying the bladder or bowels, says Ms. .
And too often women are not told that help is available, adds Dr. Malik. A preprint (meaning it hasn’t been peer-reviewed) study published last year found that pelvic floor muscle training combined with lifestyle advice significantly improved symptoms and quality of life in women with prolapse of pelvic organs from mild to moderate.
But women often feel too ashamed to seek help. “It is very important not to feel ashamed or reluctant to seek specialist advice and evaluation,” adds Dr. Malik. “It’s common and there are many ways to help and no one should suffer in silence.”
Holly’s problems began after Thea’s birth, which ended up being a long one. She had an epidural, which meant she couldn’t feel anything when the midwife told her to push. Her baby was finally born with forceps.
However, Thea was healthy. Holly was simply relieved it was all over and determined to get on with her life as a new mother when they were both released from hospital a few days later.

Holly’s problems began after the birth of her daughter Thea, which ended up being a long one. She had an epidural, which meant she couldn’t feel anything when the midwife told her to push.
He experienced a “heaviness below” in the following weeks, which he now realizes was a symptom of prolapse. But, at the time, she attributed it to getting stitches (for an episiotomy during a forceps delivery).
But things did not improve. In fact, Holly even had difficulty walking properly. She mentioned the heaviness at her eight-week checkup, but her doctor simply advised her to do some pelvic floor exercises.
As her stitches healed, Holly started to feel a little better. “I thought I’d get over it,” he remembers. She and her partner, Curtis, 33, a gym manager, threw themselves into parenthood and life went on.
Then, when Thea was 18 months old, Holly began to feel strange once again. “It was hard to explain,” she says, “but I felt like I had a tampon trapped inside me, even though I didn’t have one.”
He even asked Curtis to check it out. “There was nothing there, but it felt like something was stuck or hanging on me.”
Worried, she saw her family doctor and tearfully explained the problem. She recalls: ‘I saw a doctor and I thought she would be understanding. But she asked sharply: ‘Why are you crying?’
The family doctor performed an internal examination and soon after diagnosed a prolapse. Holly was then told that nothing could be done, that she would simply have to adapt, and that there was “no point” in referring her to a specialist. “I left crying,” he remembers.
The problem got worse: ‘At certain times in my monthly cycle it would get worse and it was really painful. When I walked I felt like my insides were going to fall out. Sometimes if I just moved I would leak urine.’

Holly has benefited from pelvic floor exercises and continues to do them a year later.
Symptoms can come and go like this, says Jenny Pullen, pelvic floor physiotherapist at Nuffield Health Haywards Heath Hospital. And he adds: ‘Many women say they feel that it gets worse towards the afternoon and evening, if they have been standing or carrying their baby a lot that day. You may also feel worse when estrogen levels are low and at different times in the cycle.
This is because estrogen is vital for tissue strength and flexibility.
Low levels (during breastfeeding or at certain times of the month, for example) can cause them to weaken and also make the vagina feel drier, making the “heavy” sensation of prolapse seem more pronounced.
Additionally, changes in hormone levels during pregnancy, as well as the weight of the growing baby, can put pressure on the pelvic floor, explains Dr. Malik.
The onset of labor, and particularly vaginal birth, further stretches these support structures. As the baby passes through the birth canal, the surrounding muscles and tissues are stretched beyond their normal capacity.
Although the body has an amazing ability to recover, some women’s pelvic floor never fully regains its original strength, says Dr. Malik. However, later births generally have a marginal effect.
He reiterates that while half of women who have had a vaginal birth may experience some degree of prolapse, ‘it is important to note that not all cases are symptomatic or serious.’
And while some women, like Holly, notice symptoms immediately after giving birth, for others there may be a delay “of many years” between having a baby and noticing the first symptoms of prolapse, says Dr. Malik, while other factors, including decreased hormones in menopause, being overweight, having a chronic cough, or lifting heavy weights regularly can have a cumulative effect over time.
Holly eventually went to see a private gynecologist who confirmed that, in addition to uterine prolapse, her bladder had also partially prolapsed into her vagina.
A women’s health physiotherapist gave Holly exercises to strengthen her pelvic floor, which can be very effective in reducing prolapse symptoms.
But it is important to have the help of a specialist, adds Dr. Malik, especially to check that the exercises are performed correctly.
The National Institute for Health and Care Excellence guidelines recommend four months of pelvic floor training for women with pelvic organ prolapse; “However, some women will start to see an improvement in their symptoms after a few weeks,” says Jo Dafforn.
In severe cases, surgery (to suture supporting tissues to strong bones or ligaments in the pelvis) may be suggested. Although this can be effective, as with all operations, there are some risks.
And there is a chance that the prolapse will occur again, says Dr. Malik. She adds that it can help to take probiotics, which maintain a healthy balance of bacteria in the vagina and urinary tract that can reduce the risk of infections (such as urinary tract infections (UTIs), which can exacerbate prolapse symptoms.
Good digestive health helps reduce the risk of constipation, which can also contribute to symptoms.
Holly has benefited from pelvic floor exercises. She continues practicing them a year later. She also uses an internal vaginal pessary (a removable device typically made of silicone) to support her pelvic organs and has been able to return to exercising, lifting weights, and lifting Thea.
Now she has opened her own Pilates studio to help other women improve their pelvic floor. “I wish they had given me more support and encouraged me to seek help sooner,” she says. “I would like other women to understand that they are not alone and that no one should tell them to put up with a prolapse.”
You can find Holly’s story on Instagram @hollyandthea.