Margaret's Story*
Step 1
Margaret discovered what mattered
Margaret (she/her) is a 75-year-old retired nurse who was finding her increasing bladder frequency both day and night becoming very bothersome. More recently, she had started to experience urine leakage and was noticing a heaviness and dragging sensation in her vagina. Margaret had stopped going to the gym and the movies and was hesitating when her son asked her to babysit. Her GP referred her to see a urogynaecologist who suggested she should try physiotherapy before considering surgery.
Margaret completed a bladder and fluid intake diary and through pelvic floor and perineal examination and assessment of pelvic organ support, we discovered that she had a bladder prolapse, reduced capacity of her bladder and weak pelvic floor muscles. Margaret tracked her progress through an accident diary and repeated the bladder diary. She came to understand that childbirth, a career that involved prolonged standing and menopause had created a “perfect storm”, and all contributed to her symptoms. Margaret felt more hopeful that there were treatments available and that she did not have to live worrying about leaving the house.
Margaret's Pelvic Health Goals:
- I want a plan to get this under control so I don't stress there is something else going on.
- To not go to the toilet as often at night so I can sleep better.
- I don't want my vagina poking out in the shower – it makes me scared it’s going to fall right out.
- To go to the movies without going to the toilet halfway through.
- To go on my walks without leaking as that is so humiliating - I want to enjoy my walks
- To not wear any pads - they are irritating and expensive
Step 2
Margaret restored what mattered
Margaret embraced pelvic floor muscle training with determination. We used biofeedback so she could see her muscles working and this motivated her to practice daily. Bladder retraining reduced her frequency and urgency, which improved her sleep and confidence to leave the house. Education about how to integrate pelvic floor muscle contractions into her daily activities - during her gym program, when walking, and with urgency - became second nature. We discussed pessary options for her prolapse, and Margaret felt empowered to make informed decisions about her care.
Step 3
Margaret enjoyed what mattered
After 5 months, Margaret proudly achieved 3 of her pelvic health goals, sleeping better, understanding her condition, and feeling more confident with her prolapse management. Two months later, the remainder of her goals were achieved when she returned to the gym, the movies, and walks again - laughing with friends without worry. She was babysitting her grandchildren regularly and had stopped wearing pads entirely. Margaret felt like herself again.