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  • 1.
    Mirskaya, Maria
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd.
    Lindgren, Eva-Carin
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Carlsson, Ing-Marie
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Online reported women’s experiences of symptomatic pelvic organ prolapse after vaginal birth2019Inngår i: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 19, artikkel-id 129Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Pelvic organ prolapse (POP) is a major public health problem with a relative high lifetime risk of surgery. The main risk factor for developing POP is vaginal birth. Many women become symptomatic later in life and most of the existing research on symptomatic pelvic organ prolapse (sPOP) predominantly concentrates on the effects of the condition on postmenopausal women. However bothersome symptoms of POP can be reported as early as in women’s 20s and may occur shortly after vaginal birth. Limited studies provide an insight into daily life of fertile women with sPOP. Thus, we aimed to explore fertile women’s experiences of symptomatic pelvic organ (sPOP) after vaginal birth.

    Methods: An inductive, text-driven approach was taken by selecting thread posts from an internet forum written by 33 Swedish fertile women who had experienced sPOP after vaginal birth.

    Results: The overarching theme “being irreparably damaged” was identified as representing an experience of being disabled by sPOP after vaginal birth. The fertile women experienced that their lives were ruined because of physical and psychological limitations caused by this unexpected, unfamiliar and unexplained condition. Living with sPOP impinged on sexual health, restricted daily and sports activities and affected the women’s ability to fulfill everyday parental duties. This in turn compromised women’s psychological health. In addition, the negligence of healthcare professionals who tended to trivialize and normalize the symptoms led to the belief that there were no sustainable treatments and that women would have to live with bothersome symptoms of POP for rest of their lives.

    Conclusions: This study found that sPOP had a significant negative impact on fertile women’s lives. The women indicated that they had not had the opportunity to voice their concerns and had not been taken seriously by healthcare professionals. It is of the utmost importance to acknowledge this problem and develop guidelines for prevention and management of sPOP to improve the quality of life for women. © Mirskaya, Lindgren & Carlsson. 2019

  • 2.
    Mirskaya, Maria
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Lindgren, Eva-Carin
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Carlsson, Ing-Marie
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Ruined active life: Experiences of fertile women with symptomatic pelvic organ prolapse in daily physical active life2019Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Pelvic organ prolapse (POP) is a major public health problem. Symptomatic POP (sPOP) affects quality of life and implies an increased risk for surgery. Many women become symptomatic later in life. Existing research on sPOP predominantly concentrates on the effects of the condition on postmenopausal women. However, bothersome symptoms of POP may occur shortly after delivery. This paper provides insight into fertile women's daily physical active lives in order to better understand their situation and improve care for this group.

    Aim: To explore how fertile women with symptomatic POP after vaginal delivery experience their daily physical active life.

    Methods: An inductive, text-driven approach was taken, selecting thread posts from an internet forum written by 33 women. The data presented in this article stem from a larger empirical data that explored fertile women's experiences of symptomatic POP after vaginal delivery (VD). Data were processed using qualitative content analysis. The data consisted of chains of questions and answers or comments on the topic of sPOP, posted on an online forum by fertile women who had experienced sPOP after VD.          

    Results: The theme “Ruined active life” showed that many of the fertile women experienced that their lives were ruined because of unexpected physical limitations caused by sPOP. They found themselves balancing being a parent and being disabled because of sPOP. Bothersome symptoms like vaginal heaviness, fullness, soreness and pain were aggravated by many basic daily activities, generating fear that any action involving physical activity might worsen the situation. The women were extremely scared that doing daily household chores and parenting, e.g. lifting and carrying the baby or using a carrycot, might aggravate the symptoms. Moreover, this fear restricted women from playing active games with their older children, such as helping them onto a swing, teaching them to ride a bike, and jumping on a trampoline. All these restrictions led to feelings of being inadequate mothers, resulting in frustration, sadness, anger, uncertainty and a growing sense of hopelessness.Another substantial result of this study addresses sport activities. For many fertile women, sports activities had played an important role before delivery, and now sPOP restricted them from it. The realisation that they could not continue engaging in sports at the same level of athletic performance as before delivery led to intense grief, anxiety and frustration. For instance, women had to give up running and high-intensity training. Some of them did not dare to participate in any activities at the gym. One of them had to quit her job as a training instructor. Giving up favourite activities that were a part of the women’s identity caused an identity crisis, leading to depression. They often expressed that they “just wanted their life back”, demonstrating an inability to accept the new situation. Discussions concerning exercise and safe workouts were very common in the thread. Women were desperate to find information and sought advice from healthcare providers regarding lifestyle changes and how to adjust physical activity in relation to sPOP. However, it was found to be difficult to access satisfactory, unambiguous information. Instead, information was inconsistent, unclear and difficult to understand. Although some healthcare providers were considered helpful and kind, unfortunately they lacked knowledge, which led to useless advice being given which often was not in line with the information that the women had found out by themselves from independent sources. For instance, one woman was encouraged to continue with life as usual and with exercises such as doing sit-ups in spite of her complaints about aggravating her symptoms by physical activity. The woman was told that “nothing would fall out” and in any case if it did happen she was in no danger. Moreover, the fertile women who sought professional help expressed that normalisation of sPOP as a condition was common among healthcare providers. On the contrary, women did not perceive the symptoms of POP as normal or natural, and the attitude of healthcare professionals was experienced as humiliating and discouraging and caused feelings of not being taken seriously. This led to mistrust, disappointment, frustration and criticism of healthcare professionals and the system.

    Discussion: The fertile women in this study experienced failure to carry out their parental responsibilities, both physically and emotionally. Fear that activities such as lifting children or playing active games with them might worsen the symptoms led to emotional imbalance. This worry has reasonable grounds, owing to an assumption that increased load to the pelvic floor in the form of elevated intra-abdominal pressure (IAP) contributes to development of POP. It has also been shown that IAP increases during brisk walking and as a result of carrying things in a front carry position, which is used by postpartum women to carry their babies in car seats (1).

    One of the main findings of this study was psychological suffering due to an inability to participate in high-intensity exercise, since for some women, exercise was a part of self-esteem and a natural part of life. It is well established that physical activity has positive effects on health. Moreover, moderate or vigorous physical activity such as brisk walking, cycling, tennis, swimming and running has been shown to reduce depressive symptoms postpartum (2). Some of the fertile women in this study suffered from anxiety and depression and would probably have benefited from participating in physical activity. However, they felt unsure about what kind of physical activities they could resume without worsening their symptoms and became disappointed when they faced a lack of understanding and competence among healthcare professionals in terms of advising suitable exercises. Likely recommendations regarding leisure-time physical activity for postpartum women with depression without sPOP must differ from those with sPOP. One such physical activity that has been found to be suitable for women with sPOP is basic Pilates exercises, which does not raise IAP and, for instance, is safe to recommend for women after POP surgery (3).

    Conclusion and clinical implications: This study demonstrates that sPOP has a significant impact on fertile women’s active life. sPOP restricts daily and sports activities and affects the ability to fulfil everyday parental duties. In addition, the lack of information from healthcare providers regarding suitable physical activities adds more emotional stress and worsens the situation. It is of the utmost importance to acknowledge this problem. There is a need to develop guidelines for management of sPOP after VD, including information regarding safe lifting techniques and suitable exercises. Copyright © ICS 2019.

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