Menopause made my insides 'fall out' – women should be taught how to stop this happening

Caroline McShane, 49, from Gloucestershire, didn’t get the help she needed for a pelvic floor issue after the birth of her second daughter when she was 35. As a result, when she hit menopause, she ended up needing surgery. Here she shares her powerful story and her mission to raise awareness.

I’d finally summoned up the courage to go to my GP and explain I thought something was wrong with my pelvic floor but he basically said, "Well you’ve had two children, it’s to be expected."

It was so deflating. I felt embarrassed I’d even mentioned it. I was made to feel the fact I’d been in discomfort for months after giving birth was a silly, trifling thing and it was something everyone else was just putting up with. But now I know that advice was not just wrong, it was dangerously misleading.

Warning signs

Like most mothers in the UK, I’d last seen the GP at my six-week check after having my second daughter in 2010. She had been a big baby and was born in a dramatically short two-hour labour.

At first, I felt like I was recovering from birth normally. But after my baby turned six months old, I started to notice an uncomfortable bulging feeling in my vagina whenever I was physically active.

Being a mum to a baby and a two-year-old meant I was constantly on my feet and having to bend down and pick up my children – which was when the bulge felt worst.

It’s so hard as a parent to find time for yourself, even for something as important as your own health, so I put off seeing the GP for ages, hoping it would just go away.

But eventually, when my daughter was about nine months old, I did go to the doctors, only to be given the dispiriting advice that this was a common experience and something I would just have to learn to live with.

A damaged pelvic floor

The GP told me I had a mild prolapse. I later discovered this meant damage to my pelvic floor (the layer of muscles and ligaments inside the pelvis) in childbirth had caused my pelvic organs (the bladder, uterus or bowel) to shift out of place.

Prolapse is often caused by pregnancy and birth, because of the strain they put on the pelvic floor. Symptoms can include incontinence, pain, sexual dysfunction and an unpleasant heavy or bulging sensation in the vagina. At that point, I just had the bulging feeling.

The GP told me to do pelvic floor exercises (also known as Kegels) and said I should be fine, but I instinctively felt there was more to it and I pushed to be seen by a pelvic physio.

Unfortunately, the NHS physio I saw a few months later was very inexperienced and didn’t even examine me. She just told me to do pelvic floor exercises and that was that.

No one at any point assessed me properly or even really explained what prolapse was. I was told to 'do pelvic floor exercises' but I wasn’t shown how to do them – or checked I was doing them correctly.

But looking back, what I’m most frustrated about is that no one told me how important it was to keep up my pelvic floor exercises. I was made to feel like this was a very minor issue that lots of women 'just put up with' and there was no need to worry about it.

Alarming new symptoms

So I moved on with my life. I did pelvic floor exercises occasionally but I didn’t really worry about it. I was able to get back to all the active hobbies I loved, like swimming, cycling, paddle-boarding and horse riding, without the bulging bothering me too much.

But all that changed as I approached menopause in my late 40s. I noticed my periods becoming heavier and more irregular, but something else changed dramatically too.

Suddenly the slight bulge became a major bulge – I could feel my insides actually sticking out of my vagina into my knickers. It was horribly uncomfortable and embarrassing. I had to keep going to the bathroom to try to rearrange myself. I also suddenly noticed I was leaking urine – not lots but enough to make me feel dirty.

All of the active hobbies I loved doing became impossible – it was just too uncomfortable to move around for any length of time. Suddenly I felt like an old lady. I’m usually a happy and confident person but I felt broken.

I went back to the GP twice but both times I was just told I needed to do pelvic floor exercises. I’ve since discovered these can have little effect on severe prolapse – which is what my condition had developed into by then.

At that stage I should’ve been referred to a specialist gynaecologist. They help women experiencing more serious prolapse, usually by providing pessaries (rubber or silicon devices which can be inserted into the vagina to hold pelvic organs in place) or by carrying out repair surgery.

Eventually, I paid to see a private women’s health physiotherapist who was alarmed I hadn’t been seen by a specialist already. Luckily, I had private health insurance so she helped me get an urgent referral through that to see an NHS gynaecologist.

Major surgery

I was 48 when I had the appointment with the gynaecologist. Finally, I felt like I was being taken seriously for the first time since I had my daughter at 35.

He explained that the damage caused to my pelvic floor in childbirth hadn’t been properly treated or managed. If I had been told all those years ago how to do pelvic floor exercises correctly and how important it was to do them at least three times a week, I might have been able to prevent my condition getting so bad.

But I hadn’t taken proper care of my pelvic floor – and then menopausal hormonal changes had worsened my condition, causing the ligaments holding up my internal organs to collapse and fall out of place so they were protruding out of my body. This is because a loss of oestrogen can weaken tendons and muscles and reduce their elasticity.

I was shocked to discover I would need major surgery, including a full hysterectomy to remove my womb and ovaries. My internal organs also needed stitching into position in three different places. It’s impossible to know for sure, but if I had been given better advice about caring for my prolapse when I was younger, there’s a good chance I would never have needed the operation.

The surgery, in March this year, was intense and it was very difficult for the first couple of weeks afterwards. I was in a lot of pain but I was also terrified of damaging my stitches. I had to limit movement and be very careful about what I ate, as if I strained on the toilet, it could break the repairs that had been made inside me.

A new life post-surgery

It took just over six months for me to feel fully back to normal, where I could be physically active and restart my sex life with my husband.

Now, I feel like a new woman. My quality of life is a million times better – it’s incomparable. I do still have to be careful when I lift heavy things and I need to keep doing my pelvic floor exercises every day. If I don’t, I notice things start to feel uncomfortable again. But I’m back cycling and taking long walks with my family, which I could never have done before the surgery.

Helping other women

I'm still angry at the way I was repeatedly dismissed when I tried to raise my concerns about my symptoms. My daughters are now aged 16 and 13, so I’d been living with these problems for years. I feel if I had been properly assessed and given clearer advice about how to care for my pelvic floor in the year after my youngest was born, it could have stopped more damage being done.

When I look back, I just wish someone had explained clearly at the time how important it was that someone like me, with mild damage after birth, looks after their pelvic floor on an ongoing basis – and that this is what could happen if you don’t.

We don’t talk openly about these issues enough, which is why I’m now trying to spread the word with my Instagram account @mycapaciousvagina. The name is inspired by the description the gynaecologist gave of me after my surgery was complete. It’s a medical term but it made me laugh. It sounds so insulting – but I’ve taken it as a badge of honour.

Every woman I’ve spoken to with similar pelvic floor issues (and there are thousands of us) tells me: 'If only I had known' or 'I thought it was just one of those things women just have to put up with.' It makes me furious.

It’s not normal if you can’t lift things or bounce on a trampoline without having bulges or leaks – and there are things that can help. It’s so important to exercise your pelvic floor muscles regularly, just like any other muscle in your body. And if you find the exercises aren’t helping, speak to a pelvic physio who can check that you’re doing them properly or advise you how to get other treatments, like a vaginal pessary.

If we all had better education about our pelvic health, we wouldn’t have to live with these debilitating symptoms or end up needing major surgery.

How to do pelvic floor exercises

"Kegel exercises can help at every stage of life and are a great way of preventing things like incontinence, both urinary and faecal, while also supporting your pelvic floor during pregnancy," says Dr Hana Patel in partnership with Superdrug Online Doctor.

Patel's top tips for Kegel exercises are:

• Focusing on your technique, contract your pelvic floor muscles by squeezing and lifting them, then hold for a few seconds (start with 3-5 seconds) before relaxing.

• These can be done whenever you find time each day, for instance, whilst brushing your teeth or waiting in a queue.

• You can identify the pelvic floor muscles by stopping the flow of urine during urination – these are the muscles you'll be exercising.

• Release and relax the muscles for an equal duration.

• Perform a set of repetitions, gradually increasing the duration of the holds and the number of repetitions over time.

What to do if you experience a prolapse

"The first step is to consult your GP who may then refer you to an obstetrician, gynaecologist or a pelvic health specialist,” says Dr Patel. “They can properly diagnose the extent of the prolapse and provide personalised guidance. Avoid heavy lifting and strenuous activities that can strain the pelvic floor muscles. If lifting is necessary, use proper lifting techniques and engage your pelvic floor muscles."

"Remember, every individual's situation is unique, and it's crucial to follow the guidance and recommendations of your healthcare provider or a pelvic health specialist. They can provide a personalised plan to address your specific needs and monitor your progress over time."

If you only have mild prolapse or aren't experiencing significant discomfort or pain, Patel recommends pelvic floor exercises as a conservative and non-surgical approach to manage the condition. “This is particularly useful in cases of mild to moderate prolapse; for those who wish to have more children; if you're unwilling to undergo surgery or awaiting surgery,” explains Patel.

“However, if pelvic floor exercises are not effective in alleviating symptoms or if the prolapse is more severe, further treatment options, including surgery, may be considered straight away," she adds.

Additional research by Hannah Millington

Watch: The menopause and bladder leakage – a revealing new survey