Becoming a mum left me incontinent - we need to talk about birth injuries

Seventeen years after the birth of her daughter, Geeta Nayar is still living with bowel incontinence.

She suffered a third-degree tear during a forceps delivery and her first episode of incontinence soon afterwards - but was discharged home without support.

Geeta said she stopped leaving the house, lost her career and lived with "shame".

Rhi, 49, who has the same symptoms, has kept them a secret from her children, fearing her son might feel responsible for the injury she sustained during his birth.

Bowel or anal incontinence - when you cannot control when you poo - affects 20% of women and is most commonly caused by a birth injury, according to the British Journal of General Practice.

Both Geeta and Rhi have welcomed new research in Wales working with marginalised communities to raise the profile of the birth injuries, as well as to identify the barriers to seeking help.

Geeta knew having her first child would be life-changing, but the 47-year-old told a recent women's health event in Cardiff that the severity of her injuries meant she was "in complete shock - physically and psychologically", after giving birth.

At that stage, she said she had no idea that her heritage and even her height put her at greater risk of an obstetric anal sphincter injury (OASI).

"I suffered my first episode of total bowel incontinence the very next day, but I was discharged without any follow-up or support," said Geeta, from London.

"From then 'til now I live with pain and incontinence and that's something that's really not talked about widely - with women generally, and certainly within certain communities."

Geeta said in the years following her injury she was "quite housebound to avoid the fear and the shame that comes with bowel incontinence".

"I stopped going out, didn't see my friends and really the saddest part was at that point I lost my career that I'd worked for nearly a decade to achieve - and that's despite having a really supportive family around me."

'I had 30 seconds hold time'

Rhi, from Cardiff, who blogs anonymously about her experiences, said the difficult birth of her son 17 years ago left her incontinent, due to an anal sphincter injury, and with post traumatic stress disorder (PTSD).

"I still see that moment most days," said Rhi.

"I don't have the same emotional reaction to it any more, but I will never have a nice memory of his birth, and that's a horrible thing to say - and partly why I don't want to tell him the whole story."

Rhi said within 24 hours of having her son she was experiencing bowel incontinence, but her mental health also spiralled and she was put under the care of the community mental health team.

When she was referred to a gynaecologist, she was told there was nothing physically wrong and that her symptoms were due to her mental illness.

"And so I walked away thinking: this is my new normal," she said.

Rhi said the social media images of perfect family days out were a far cry from what became her reality, where each trip was planned around the availability of toilets.

"Probably 75% of them would end up in me having to get changed somewhere.

"At most I had 30 seconds 'hold time' before a poo. When you're in town with your family and you need the toilet - time those 30 seconds and see where you get.

"That's the reality that a lot of women with anal sphincter tears are living with."

It was only after the birth of her second child, three years later, that she was referred to a colorectal surgeon who discovered an anal sphincter tear.

Five years ago, Rhi had a procedure to put a sacral nerve stimulation system in place - where the nerves controlling the bowel can be stimulated with a device implanted under the skin.

"I went from having accidents pretty much every day, through urgency, to only once a month. It's not a miracle cure, but it's very good management."

The change in her life was poignantly noticed by her young son, who told her: "Your eyes smile now and they didn't smile before."

Rhi, who shares her experiences in a blog called "A Mum from the 'Diff" and voluntarily runs the Masic Foundation support group in south Wales, said there was "embarrassment" talking about such an intimate area.

"If it was a barrier for me, I can't imagine what kind of barrier it is to other women who may have a very different cultural background or don't speak English as a first language," she said.

A number of maternity units across Wales and England have now introduced OASI care bundles, which include discussions with pregnant women about how to reduce their injury risk, as well as better examinations after vaginal birth.

Meena Ali, consultant urogynaecologist at Cardiff and Vale health board, said staff were more aware and better trained to identify issues.

"After repair we refer them to physiotherapy colleagues, who help them from the beginning - to do the exercises, teach them to avoid certain things like constipation and how to use their pelvic muscles."

Research has now been funded by Health and Care Research Wales to work with marginalised communities in Wales to improve access to support, in a project called Pelvic Power Partnership.

Nicky Edwards, clinical nurse specialist in pelvic health and the functional bowel service at Cardiff and Vale health board, said the service saw predominantly white women, meaning others could be suffering in silence.

"It's about giving different communities a voice," she said. "We always adapt services to make it better for patients, but we only measure what we see in the service.

"So if there's a certain demographic that aren't coming to the service, we can't make it better for them - it's only driving inequality.

"We want to know why these women don't engage with the service and how can we overcome these barriers."

Eight years after her daughter was born, Geeta began sharing her experiences with others as an ambassador for the Masic Foundation.

"It was very difficult because there's taboo and stigma around bowel incontinence, but it was also empowering knowing I was contributing to making a difference for other women," she said.

"Peer support was so important - it was the first time I'd met other women with these injuries."

Geeta returned to her work in patient advocacy at a law firm a few years ago and is now arranging the second South Asian Maternal Health Conference.

"My injuries were 17 years ago and I think we have slowly started to break down that taboo and stigma, but we do need to do a lot more.

"We need to be educating the next generation about their pelvic health.

"And to anybody experiencing any kind of incontinence, you do not need to suffer in silence - please go and see your GP and try and get a referral to a pelvic health specialist physiotherapist."

You can listen to Women's Health Explained, BBC Wales' panel discussions on women's health, which was recorded earlier this year, on BBC Sounds.