It's time to break the taboo around pelvic floor health in Canada, say advocates

The months after her daughter's birth were difficult for Carrie Anna McGinn.

On top of the usual challenges of new motherhood, the Quebec City woman also faced urinary incontinence and pain during intercourse. Every time she would sneeze, cough, run, or lift something heavy, she says she would "leak." 

"I kept thinking maybe this is in my head. Maybe this is my way, my body's way of reacting to birth," she said.

"Or maybe I'm thinking too much about it or maybe it will get better, or maybe it won't."

It didn't. At least, not on its own. 

McGinn was suffering from pelvic floor issues brought on by pregnancy and childbirth ⁠— an extremely common medical issue that women's health advocates say doesn't get enough attention. 

She says she wrestled with the decision to speak openly about it, 

"There is still a taboo that exists about pelvic floor health, and talking about things like incontinence and pain during sex," McGinn said.

"These are such normal things for so many women after giving birth."

What is the pelvic floor?

The pelvic floor is the muscle group that fills the hole at the bottom of the pelvis. It contains the genitals, and acts as a hammock that holds up organs such as the bladder, uterus and rectum.

It's a part of the body many people don't think about, or maybe even know exists, until it starts not doing its job. 

When the muscles become too weak or stretched, patients can suffer from urinary or fecal incontinence or a condition known as organ prolapse, when the organs held up by the pelvic floor drop, sometimes to the point of bulging out of the vagina.

About a quarter of all women are affected by pelvic floor disorders, according to a 2008 study published in the Journal of the American Medical Association.

The main risk factor is pregnancy.

Put on the 'back burner'

For McGinn, it meant that every time she stood up after going to the bathroom, she felt a surge of urine discharge involuntarily.

After months of pushing the problem to the "back burner," she says she consulted a physiotherapist specializing in perineal and pelvic floor rehab. 

After about a handful of sessions, she says her problems disappeared.

It was a fairly easy fix. McGinn is frustrated that there isn't more support from the medical system to help people with their pelvic floor.

"It's normal. We should be talking about this more openly," she said.

Change the culture

Sarah Baribeau is trying to change that lack of support. 

Seven years ago, the kinesiologist opened Bougeotte et Placotine, a gym in Quebec City for pregnant people and new mothers.

Baribeau says the vast majority of clients who come to her gym say they had never heard about the pelvic floor before. No one talked to them about the need to rehabilitate it after the birth of a child, be it vaginal or Cesarian.

That, she says, is a major problem.

She frequently holds lunch-and-learn conferences with physicians and health-care providers, teaching them how to speak with their patients about staying active during their pregnancies. 

She provides strategies to help moms recover after birth and preventing damage to their pelvic floors.

She says she's continually surprised by how little first-line care providers know about pelvic floor health. 

"I cannot believe that they don't have more information about it during their studies," Baribeau said.

"They know a lot of things, but they don't know anything about pelvic floor and exercise, and they are in the first row with the new moms and pregnant women." 

Ninety per cent of cases of incontinence in aging women can be improved with exercise, and 70 per cent of cases can be treated with physiotherapy, according to a study by Chantal Dumoulin, a Canada research chair in urogynecological health and aging at the Université de Montréal. 

Dumoulin says clinical practice guidelines indicate first-line treatment is supposed to be pelvic floor rehabilitation immediately after delivery.

"However, this is not what we find in our health-care system right now," she said. "So this is really sad."

An expensive problem

Pelvic floor problems are expensive for the health-care system, Baribeau says, and for the patients as well.

Depending on where patients live and what kind of insurance they have, physiotherapy is often hard to find, and can cost over a hundred dollars per session. 

Persistent urinary incontinence or organ prolapse is often treated with surgery, which involves attaching a mesh sling to help support the urethra, keeping it closed to prevent leaking urine — even when under pressure.

It isn't a permanent fix though. It lasts for about seven years. And it's controversial. 

There have been world-wide reports of serious complications linked to the devices.

In Canada and the U.S., thousands of women reported that the plastic-covered mesh eroded inside them, causing intense pelvic pain and autoimmune symptoms.

In April, the U.S. Food and Drug Administration banned the sale and distribution of the surgical mesh.

In July, surgical mesh implants used to treat pelvic organ problems were removed from the Canadian market following a safety review by Health Canada.

Health Canada says the mesh can still be used, but only in specific patient groups, such as patients who have recurring pelvic organ prolapse or those unable to undergo other surgical treatments.

'It changed my life'

For some, though, physiotherapy isn't enough to solve their problems.

Following back-to-back pregnancies, Montreal's Nancy Benamor struggled with incontinence for nearly 16 months, despite sometimes weekly physiotherapist appointments and several kinds of treatment. 

"You live in fear," she said, describing having to always know exactly where the toilet is.

"You're choking to hold it in and then running to the bathroom to cough or sneeze on the can because you don't want to pee yourself."

She hit a breaking point, and despite the risks, she chose to have the surgery. 

"I feel that I have my old life back," she said "It's a freedom. It's liberating."

'There should be help for us'

McGinn, meanwhile, says she felt "ecstatic" when she finally started to heal.

"I remember … not having incontinence and not having pain and thinking, 'Oh my goodness,  I'm me again'," she said, sitting at her kitchen table in her condo littered with children's toys, the violet smears in a small ceramic bowl all that's left of a berry crumble.

She would like to see first-line care providers talk about pelvic floor health more openly, and have physiotherapy covered by the public health-care system.

"There should be help for us," McGinn said, "Women's health matters and pelvic floor is an essential part of women's health."

Written and produced by Marika Wheeler and Jeff Goodes. Produced with the assistance of The Doc Project Mentorship Program.