Prolapse recovery often involves ups and downs. I consider a setback to be any experience with my POP that might send me into a tailspin of worry about my POP getting worse, helplessness in my mission to manage my POP, and feeling like I am back at square one. Sound familiar, POP Warriors?

This tailspin might get set off by:

• A change in organ involvement or the grade of prolapse
• A symptomatic day or moment
• A return of or worsening of POP symptoms
• New POP symptoms
• A lapse in how we are coping with the impact of POP on our mental health
• A lapse in maintaining a habit or lifestyle change that has helped POP symptoms in the past (i.e. hydration, diet, movement practices, self-care)

My Story

I had my pessary fitted 4 years ago now. At that time, my uterine prolapse was being graded a 3 and my rectocele was being graded a 2. I was fitted with a pessary called a ‘ring with support’ whose purpose was primarily to support my uterus. It took some getting used to but overall, I have loved having her on board! A few weeks ago, my wonderful pelvic health therapist reminded me that I was past due for a pessary re-fit.

Re-fits are done for a couple of reasons:

1. Our bodies evolve and our vaginas change over time
2. Pessaries can break down over time, developing knicks and tears or losing some of their stiffness & therefore capacity to provide the support they are intended to give

At my pessary checkup…well….things had changed. My uterine prolapse was looking better but my rectocele had progressed and I know I had a mild bladder prolapse.

Cue spiral…

“It’s just going to keep getting worse.”

“I have put in so much work into managing this and it is still getting worse.”

“What’s the point of even trying anymore…I’m doomed!”

“My body is so broken.”

“We are already here?…What am I going to do in 10 years?”

“Should I really be supporting other women with POP if I can’t seem to manage my own?”

This wasn’t the best of days for me. I was trying to remind myself of all that I do know about POP to try and quiet those thoughts. But, in truth, I wasn’t quite ready to make sense of and process this new information about my body just yet. I was super cranky! I found myself snappy with my family and turning to my favourite ‘numbing’ strategies – ALL the food! ALL the wine! And ALL the Bridgerton!

Ultimately, by the evening of my check-up, I was ready to drop my guard and talk to a trusted loved one about my reactions, take stock of what this new information might mean for me, and step out of my tailspin. 5 years ago this tailspin may have lasted weeks, if not months. It takes practice to find ways to step out of what I like to call “The POP Hijack” which is based on Cognitive Behavioural Therapy.

Here are my TOP 7 Tips for Working Through POP Setbacks:

1. Know your Red Flags

 It can be incredibly helpful to take stock of:

• The scenarios that for you, tend to prompt the tailspin
• Your automatic reactions when the tailspin strikes
• Your signs and patterns when you are not coping well with your prolapse. Perhaps you find yourself thinking about worrying about POP often, frequently checking your POP, getting irritable, or isolating yourself from loved ones
• Your POP stories – the things that your brain likes to throw at you when you are caught in a POP Hijack

Noticing the POP Hijack and developing a greater awareness of what happens for you when you are in one is the first step towards being able to step out of it!

2. Come back to the Facts

In the middle of big emotions, our thinking is going to be a bit more rigid and negative. Take stock of what your brain likes to tell you in these challenging moments and, as emotions settle, it can be useful to take stock of ALL the facts. This allows your brain to zoom back out to the big picture and think more flexibly about what it all means.

For me, it was helpful to remember my rectum and bladder were sitting lower in this assessment AND. . .

• Our organs are designed to shift & move
• A grade assessment is a snapshot in time and can be impacted by the time of day, my cycle, my position, the fullness/heaviness of my organs, changes in how my practitioner might be grading over time or how different practitioners might grade, how hard I was bearing down and subtle differences in the instructions that I am getting
• When things move & evolve, other things will move too. My uterine prolapse is actually sitting higher, which means that my pessary had been doing her thing and doing it well!
• The uterus often supports the bladder & rectum. My uterus shifting upwards thanks to mine and my pessary’s hard work may have created the space for my bladder and rectum to settle into these new positions

3. Remember that it’s impossible to go back to Square One

 When in the midst of a setback, it is oh so common to think that all of the work you have put in to manage your POP and the emotions that have surrounded it have all been for nought. When this happens, it’s helpful to remember. . .

• It’s impossible to undo all of the work that you have already done or unlearn all of the things you have learned about POP and about your body
• The work that you are doing may not guarantee that setbacks won’t happen but it sure as heck means you get to encounter them with more wisdom, knowledge and tools than you had when you first encountered a POP diagnosis

4. Be Kind to Yourself

In the midst of a setback, we can also get sucked into self-blame. . .

“I should have been doing more.”

“I should have been doing less.”

“This is my fault.”

“I should have known better.”

The reality is that navigating the uncertainty that comes with the ups and downs of the POP experience is EXTREMELY hard! You have been doing the best you can with what you know and have been learning along the way.

We can do the best we can AND there will still be some factors outside of our control. Be kind to yourself in this moment.

5. Baby Steps

When we get hooked into all of the “shoulds”, it can also be very easy to become frozen in overwhelm and helplessness. You might even find yourself tempted to throw all of the things you’ve been doing to manage your POP out the window.

It can be helpful to pick one accessible baby step that shows your body some love and that you know has been supportive of your recovery to date. See if you can find your way back to consistency with just one thing (i.e. a movement practice, hydration habits, a dietary change, a regular mindfulness practice, taking breaks from thinking about POP and reconnecting with fun or pleasure).

6. Treating Setbacks as an Opportunity to Tune In

 Unpopular opinion alert…Set \backs are an inevitable part of the recovery process. Yup. . .our bodies evolve and change. This doesn’t necessarily mean that things are doomed to get worse over time. But it does mean that our bodies are going to talk to us as things change. Discomforts and other frustrating signs and symptoms are our bodies’ method of telling us that it might be helpful to pay attention and change something up about how we are caring for ourselves. When we encounter setbacks from a compassionate and curious stance, we can ask the question:

“What might this be trying to tell me?”

In my case, yup, my organs had shifted. My rectocele has been a bit more noisy and this gave my practitioner and I more information about what my body might find most supportive at this point in time.

7. Celebrate ALL the Wins!

When our brains want to focus on everything that seems to be going wrong, it is so important to intentionally take stock of and celebrate the things that are going right even if they seem teeny tiny. This might be those baby steps we are taking to care for our bodies, the new information we have gained about our bodies, breaking out of old habits that are no longer helpful (i .e. checking POP multiple times a day), or it might even be things outside of your POP experience that you are grateful for.

Here is your friendly reminder that you are NOT your POP and it doesn’t have to define you.

Lara Desrosiers is an Occupational Therapist that supports individuals struggling with pain and pelvic health challenges to get back to living life. She works with individuals from across Ontario, Canada. To learn more about Lara and her work, visit Pelvic Resilience.