Record NHS waiting lists are exacerbating a hidden women’s health crisis, forcing distressed patients suffering from incontinence and vaginal prolapse – many of them new mothers – to pay for medical care.
Millions of women experience urinary incontinence and vaginal prolapse every year, with those who have recently given birth particularly at risk, but access to care, which was already patchy before 2020, has fallen off a cliff since the onset of the Covid-19 pandemic, i has learned.
Draft Nice guidelines published this year state that women with pelvic floor dysfunction who have experienced risk factors during birth such as forceps should be offered a three-month programme of pelvic muscle training. Ideally this treatment should be delivered by a specialist pelvic physiotherapist.
Vaginal prolapse: Vaginal prolapse, or pelvic organ prolapse, happens when the muscles and tissues supporting the pelvic organs – the bowel bladder or top of the vagina – become weak or loose, causing the organs to slip down from their normal position into the vagina. Studies have found prolapse can significantly affect women’s mental health and emotional wellbeing.
Urinary incontinence: Urinary incontinence is very common following childbirth, with around one in three new mothers said to experience it to some degree. Giving birth can weaken or damage the pelvic floor muscles, with the pressure of the bladder becoming greater than the strength of the urethra to stay closed. Incontinence can affect relationships and careers, and can lead sufferers to avoid exercise and sex.
Vaginal atrophy: Vaginal atrophy is the thinning of the walls of the vagina caused by decreased oestrogen levels. Women who experience this condition have a greater chance of chronic vaginal infections and urinary problems. It can also make sex painful. One woman who spoke to i said of the condition: “People don’t speak about it. I can’t even imagine what it would be like if I was a single woman trying to meet a new partner. It is really depressing.”
But waiting times are so great that some women are becoming prisoners in their own homes, while others who can afford to go private are paying for treatment out of their own pockets.
i has spoken to patients and physiotherapists across England, Scotland and Wales who have reported waiting times of six months or longer just to access a telephone appointment, which does not allow for a physical examination.
While men can also suffer from incontinence, experts agree the problem is far more widespread among women.
In addition to the discomfort, embarrassment and loss of confidence that incontinence and vaginal prolapse can cause, these conditions can also contribute to serious mental health problems – women with urinary incontinence after giving birth are almost twice as likely to experience post-natal depression, according to a 2011 study published in the British Journal of Obstetrics and Gynaecology.
Sarah (not her real name), 32, experienced vaginal prolapse in March after giving birth last December and sought private care when she was unable to access treatment via the NHS.
“No one had ever told me what a prolapse was – I was in complete discomfort. It’s torturous,” said Sarah, who lives in Haringey, north London.
“I felt my vaginal wall cave in and had no idea if that was something normal…It was one of the most traumatising periods of my life.
“I was a forceps-delivery birth, I had total incontinence for the first initial week or two and it is so obvious to me now I was going to prolapse,” she said.
Sarah was able to book an appointment with her GP and asked if she should see a pelvic physiotherapist but was told no, and to perform pelvic floor exercises – though no one had shown her how to do this.
She was eventually offered a telephone appointment with a physiotherapist but not an in-person examination so decided to go private instead as her husband’s health insurance would help cover the cost, which is £80 per session.
“My physio is on top of her game [but] it’s expensive,” Sarah said.
“There are women [waiting for NHS appointments] who will probably be told half of what they need to know and if they’re lucky they will be referred to a physio who won’t be able to see them for months.”
“To my knowledge, the pelvic physio service here was temporarily suspended last year and it has not been restarted,” said GP Natalie Dawson, who practices in Altrincham, in Trafford, Greater Manchester.
“Women often do pelvic floor exercises wrong so we can’t just print them off a leaflet with the information. As GPs we aren’t trained in telling people how to do the exercises. At best it will be ineffective, but it could make things worse.”
The backlog of patients caused by Covid delays is so great that the only way to get people seen quickly is to refer them on a two-week suspected cancer pathway, Dr Dawson added.
Patients with other conditions and symptoms are similarly affected but, Dr Dawson said: “Women bear the brunt. It’s got so much worse.”
Elaine Miller is a pelvic physiotherapist based in Edinburgh and a Fellow of the Chartered Society of Physiotherapy (CSP).
She said it was “ludicrous from a public health perspective” that women are facing so many obstacles in accessing treatment and warned that the problem could get worse because some areas are losing specialists as NHS physiotherapists suffer burn out and leave their roles.
“We only have about 900 registered specialists in the UK. In Wales they are really struggling to provide the service because they just can’t recruit,” Ms Miller said.
One woman who spoke to i said she recently began paying £55 per month to see a pelvic physiotherapist privately after she was unable to get an in-person GP appointment for a referral.
Aged 36, the woman, who is based in Wales and did not want to be named, said: “It’s money well spent but it’s not really money I have spare.”
The situation is equally dire elsewhere, said Lauren Connors, a spokeswoman for the CSP.
“In Scotland and England [there are] people who got referred in 2019 are only seeing pelvic physios now,” she said.
“As waiting lists are getting longer than ever its affecting people’s quality of life. Naturally you go private if you can.”
Ms Connors added: “Pelvic health issues only get worse so it isn’t sufficient to be waiting weeks, never mind months, for a referral. Everybody should have equality of access on the NHS.”
The Department for Health, NHS England and Scot Gov did not respond to requests for comment.