The Toll of Emotional Abuse on Health Recovery: When Pelvic Organ Prolapse Healing Resists Traditional Standards of Care

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We are all to some degree products of how we were raised, at times a good thing, at others not so much. The most difficult aspect of navigating emotional abuse, is never knowing when an abuser is going to spew their venom, often leaving behind a life-long reflex that continues to impact daily navigation. The stuff that goes bump in the night. The whispers that occur inside our heads when life events raise ripples. It’s what we choose to do with life’s garbage that separates us into those who are successful sifting the issues that come with life, and those who can’t seem to capture ballast no matter how hard they try.

Throughout most days, I ritualistically reflect on how aspects of my traditional routine impact the ways I interact with the women APOPS supports. An incident that occurred recently has had my fingers poised at the keyboard, in an effort to purge the deeply rooted anger that will no doubt continue until I share it in some productive way.

For those embedded in an emotionally abusive relationship with a spouse or live-in love, the abuse ends when the relationship ends. While it often takes time to put the pieces back together, there is hope to recapture self-esteem. But for those who navigate emotional abuse at the hands of a parent, the dance often continues for a lifetime. Parental love can cause considerable confusion when coupled with emotional abuse. Loving our parents is understood, assumed, expected. But for anyone who has been emotionally abused by a parent, the love/hate confusion that courses through the substructure of the psyche may disable the capacity to move forward with health treatment, because those who have been abused seldom believe they deserve to feel better. And while most women express significant emotional distress when experiencing pelvic organ prolapse, a small percentage of them have an incredibly magnified difficulty.

 Emotional abuse can be subtle and insidious. Those who have experienced parental emotional abuse know what I’m talking about. Understated tone and bullying voice inflection. Cryptic terminology. Disapproving or derogatory words spoken in whispered, low volume so only you hear them. Negative “humor” that pokes fun at physical flaws or weaknesses to disempower, such as comments about your appearance, background, or accomplishments. Marginalizing, ridiculing, or dismissing in front of others. The silent treatment. It is in the interest of helping women who have a particularly difficult time with the emotional side of POP that I’d like to share a very personal story.

I travel to my parent’s farm every other weekend to address the quality of life issues that occur for an 89-year-old loving father with significant dementia, and an 85-year-old passive-aggressive mother with Alzheimer’s. I’d like to clarify up front, I love both my parents. But my relationship with my mother has been strained my entire life because of significant emotional abuse that has occurred and continues to this day. On my most recent visit, while standing at the bathroom sink applying eye makeup prior to going out for breakfast at my dad’s request, my mother stood in the doorway, ready to head to the restaurant. As I continued to apply mascara, she made her traditional snarky “woohoo” comment (insert sarcastic voice inflection, this sound effect is not a compliment). This has been a warning sign to me for my entire adult life, mom’s battle cry so to speak. Since the last time she threw that comment my way we got into a rather heated discussion, I chose to ignore rather than acknowledge her sarcasm. At which point she smacked me in the tummy with the back of her hand, and said “that’s quite a belly you’ve got there, when are you due?” While seething inside, I managed to spit out “nice mom skills” rather than go down the rabbit hole. But there was no doubt she succeeded in accomplishing her mission, I felt fat, ugly, and insecure. Those who know me know I’m none of those things, but what was significant about this exchange is what I felt like on the inside. I’m well past successful POP treatment, but I can’t begin to imagine how devastating this could be to a woman who has experienced the emotional struggles that often accompany pelvic organ prolapse.

So how does this relate to women who are struggling with treatment for pelvic organ prolapse? Women are seldom evaluated in depth for the emotional distress POP causes, and they are frequently told their emotional concerns are over-blown in their heads. Those who have experienced emotional abuse have an extremely difficult time coming to terms with the symptoms of pelvic organ prolapse. They struggle more than any other women in our fold. And they deserve acknowledgment and support.

When a person does not feel worthy of healing, while physical repairs may result in anatomic repair, the inability to heal emotionally when you don’t feel “worthy” of healing, may road-block the success of any treatment, whether surgical or non-surgical.  As indicated in the Jean-Philippe Gouina and Janice K. Kiecolt-Glasera academic paper “The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms”, physiological stress responses can directly influence wound healing processes. This analysis further indicates clinical studies validate that behavioral stress management interventions prior to surgery have been associated with improved post-operative outcomes, including fewer medical complications.

Within our space, we see how low self-esteem of women who have been emotionally abused can result in denial of a pelvic organ prolapse severity, feelings of guilt about having the condition, aggressive vocalization toward other women experiencing POP, and most commonly, low self-esteem, which characteristically ripples through our community of women whether emotional abuse has occurred or not.

While a clinician’s job is to heal the body, it is imperative women in need of emotional support during their POP journey have access to a support system, whether provided within a clinician practice or forwarded into APOPS support structure while they navigate treatment for pelvic organ prolapse.