After undergoing a traumatic forceps delivery for the birth of her first child, Heather Barnes was assured by medics that the backache, numbness and incontinence she experienced afterwards was ‘to be expected’ and would soon resolve.
‘But it didn’t,’ says Heather, from Tunbridge Wells.
‘Months passed and I still felt numb. Going to the loo was awful, I couldn’t walk properly and I also had back pain.’
It didn’t just take weeks or even months – it was decades before Heather would finally discover the full extent of the damage done during the delivery, and mercifully discover that there was a treatment that could help.
It would transpire that Heather had not only had a severe tear around her perineal area (between the vagina and the anus), she had also suffered pudendal nerve entrapment – which occurs when a major nerve in the pelvic region, responsible for sensation in the genital region and control of bladder and bowel function, is compressed and damaged.
The result is often agonising pelvic pain, and loss of normal control of both the bladder and bowel in some cases.
By the time Heather was diagnosed – 40 years after giving birth – her life had long been changed.
She had such poor control of her bowels that even going to the shops was difficult – and her back pain was so excruciating that she was never able to return to her job working in a bank, meaning her career came to a juddering halt.
Heather Barnes, now 74, was assured by medics that the backache, numbness and incontinence she was experiencing were all normal after giving birth
Heather had not only had a severe tear around her perineal area (between the vagina and the anus), she had also suffered pudendal nerve entrapment
What’s more, she never had another child. ‘I was too terrified and in too much pain,’ says Heather.
She’s understandably angry that she had to suffer for so long.
Such stories are all too common and becoming increasingly more so – as the number of birth injuries generally are on the rise.
Around 4.5 per cent of first-time mothers (7 per cent of those who require the use of instruments, such as forceps) are left with severe third-degree or fourth-degree tears, which damage the muscles that control the bowel.
This is known as an obstetric anal sphincter injury (OASI) and often leaves women in pain and incontinent.
That figure is a significant increase from the 1.8 per cent of first-time mums affected in 2000, according to a study in the BJOG, an International Journal of Obstetrics and Gynaecology in 2013.
‘That increase is partly due to better detection but also due to an increase in older mothers (over the age of 35), and due to women having bigger babies,’ says Professor Julie Cornish, a consultant colorectal surgeon with a specialist interest in pelvic floor surgery at the University Hospital of Wales in Cardiff.
‘As you get older your tissues become less stretchy and so [they] are more likely to tear – but also it is thought that as you get older the power of the pelvic floor [the hammock-like layer of muscle that supports the womb, bladder and bowel] to push reduces.
‘This makes not only tears more likely, but also nerve damage,’ she adds. ‘As well as age, risk factors include being a first-time mother or having a big baby.’
Pudendal nerve entrapment is less common than a tear, but many women will have both. The nerve typically becomes compressed after a long labour that involves the use of forceps to get the baby out.
‘Even without forceps if a baby’s head rotates the wrong way and they are face up, for example, that increases the risk too,’ says Professor Michael Keighley, a colorectal surgeon and founder of the MASIC foundation, a charity for women affected by birth injuries.
‘I usually find a woman in her first labour who has had forceps delivery – particularly if there has been a big pull, or the baby’s head is face up – will have a bigger chance of pudendal nerve injury.
‘The nerve injury may be transient, but if there’s been a lot of force or pressure on the nerve it can be permanent – so these poor women suffer almost permanent pain; their sex lives are dreadful; and they don’t have a decently functioning muscle – meaning they may be incontinent.’
Many women suffer in silence, says Professor Keighley, ‘until they reach the menopause because it is only then that the condition worsens – they may find they need to wear pads all day long, and with ageing joints cannot reach the bathroom in time.’
When her daughter became stuck in the birthing canal during the rapid labour, Heather’s medical team had to cut her to manoeuvre in the forceps around the baby’s head and pull her out – all with no anaesthetic.
Professor Julie Cornish, a consultant colorectal surgeon with a specialist interest in pelvic floor surgery at the University Hospital of Wales in Cardiff
‘I don’t recall much, just a lot of pain and blood,’ says Heather, who was then 31.
‘They joked it would take longer to sew me up than my whole labour took because I tore.’
Almost instantly, Heather noticed it felt ‘different down below’.
She said: ‘I felt numb on one side and couldn’t walk properly – but the nurses simply told me it was normal after childbirth, so I assumed it was something I had to put up with.’
But as the weeks passed, there was no improvement and when Heather opened her bowels she felt ‘everything was coming out sideways’.
At her six-week check with her GP, she mentioned this – but her doctor said it would pass.
‘But it didn’t,’ she recalls.
Over the early years of her daughter’s life Heather was back and forth to her GP and was repeatedly told her symptoms were normal after childbirth – and on one occasion that she was a ‘silly and neurotic woman’ – all the while suffering from pain and embarrassing incontinence.
After being called ‘silly’, she changed her GP in 1989 and was referred to a pain clinic, where she was prescribed strong painkillers – but while they helped the pain, they did nothing for the incontinence.
‘It was then something in me snapped,’ she says. ‘I couldn’t go on like this.’
It was in 2000 that she was finally referred to a different specialist who did a scan that revealed she had pudendal nerve entrapment – but at that time the surgery to release it was only available privately.
Heather managed to get the £3,500 together for the operation – and in 2008, she underwent surgery to free the nerve from the surrounding tissue.
‘It was amazing. I had it done before my daughter’s wedding and I noticed immediately the pain was gone and it worked on my incontinence, I’d say 60 per cent.’
But within a couple of years the effect had worn off and her incontinence was worse.
Heather, now 74, recalls: ‘I soiled myself in the shop, in my car, even next to my husband, Alan, in bed.
It was in 2000 Heather was finally referred to a different specialist who did a scan that revealed she had pudendal nerve entrapment
‘He was always so lovely about it, never said a bad word and always supported me. But no one should have to live like that.’
Sadly, Alan died of cancer six years ago.
Heather struggled on. ‘I was nervous going out alone in case it happened,’ she says.
Professor Cornish says: ‘I see older women who have struggled for many, many years – and the reason they come is they’ve reached a tipping point, where they can’t leave the house or they’ve had a bowel accident in the shops or someone in their family has figured out what’s going on.
‘You see all these adverts for incontinence products and it’s normalised. But it isn’t normal.’
Then three years ago Heather saw a Daily Mail article about sacral nerve stimulation (SNS) for pudendal nerve entrapment.
‘I read it in the newspaper – yet no doctor had ever told me about it,’ says Heather.
‘I saw the specialist who ran tests and confirmed my pudendal nerve was still badly compressed and I was a candidate for SNS.’
Heather finally had the SNS procedure in June 2025, which involved inserting a device under the skin which emits electrical pulses (powered by a battery worn on a belt), to keep the anal sphincter closed.
Professor Cornish likens it to a pacemaker for the bowel.
SNS is available on the NHS for bladder and bowel incontinence, ‘but it is not available at every hospital and it is not routinely used for pudendal nerve injury’, says Professor Cornish.
Given that it has a success rate ‘of around 75 per cent for bowl incontinence,’ she says, ‘it should definitely be available more widely – and it is very frustrating when patients think that the only surgical option for them involves a bag [i.e. a stoma]’.
There are other options too, she says: ‘We can get 70 per cent of people with faecal incontinence to a good quality of life with non-surgical management.
‘That can involve diet and lifestyle modifications, medication, physiotherapy – and then also rectal irrigation, which is washing out the bowel.’
For Heather, SNS has been the answer she has been looking for.
She says: ‘Immediately it worked. I can say I have had one accident since the procedure four months ago.’
Heather adds: ‘Life is so good now. I can go for lunch with friends, go shopping, not worrying about where the loo is or if I will embarrass myself.
‘I just wish Alan was here to see it. I finally have my life back.’