Have you ever been in a prison? How would you feel? Who would you expect to meet and how do you think they will respond to you?
I’ve never been inside a women’s prison or any high security prisons. So when we recently received a request to speak to a group of women in a high security women’s prison about pelvic floor health; my first reaction was one of curiosity, excitement and a desire to help inform a group of isolated women about pelvic health. This was immediately followed by some trepidation, further increased by a warning that we would encounter some hardened and dangerous criminals, including members of international crime syndicates. I tried to lay this anxiety to rest – reminding myself that pelvic floor dysfunction is as relevant to a group of incarcerated women as it is to you and me. I should have nothing to fear as a health professional and my previous experiences of educating men in a low security prison had been very positive.
Part of the preparation for the visit included the need for an advance security check to ensure we were of suitable character. It seemed they needed to ensure that we were appropriate temporary visitors and not potential inmates. We also had to provide copies of any printed material we wished to distribute and a list of equipment we were bringing in. Certain equipment is strictly prohibited, including any electronic devices such as phones, cameras, laptop computers, any metal objects and most containers or bags. We were also asked to leave all personal items such as wallets, keys and cards behind.
On the day of the scheduled talk, I was fully prepared for the day. We had decided to take just a model of the pelvis, some printed brochures about pelvic floor exercise and a USB with the presentation. All of this was approved providing it was carried in a clear plastic bag and the USB contained no additional files other than the approved presentation.
Saying goodbye to my husband and daughter as I left home that morning, I casually mentioned what was on my schedule for the day. Their reaction was immediate – my husband was shocked and warned me that there were some dangerous international criminals in this prison. My daughter asked if they would provide a guard to keep me safe. My trepidation momentarily returned, but I reassured them (and myself) that there were processes in place and I was positive we would not be exposed to any dangerous situations.
Arriving at work that morning, I was greeted by the excellent news that the prison health officer had called to report an unprecedented interest in the topic and with more than 40 women signing up for the presentation. My delight at the response was immediately dampened by the instructions that followed. The prison authorities were so surprised by the level of interest that they suspected an ulterior motive at play. Could we please ensure we wore flat shoes in case we needed to move quickly and bring a warm jacket in case we were isolated for any length of time! To further ensure safety they had limited attendance to just 25 women.
I am not usually anxious, but for a moment I felt my chest tighten, then I put my logic to work:
- I always wear flat shoes and carry a warm jacket in winter, so no need to change any of my planning.
- My previous experience with community talks is that the organisers almost always underestimate the level of interest in the topic of pelvic health.
- 1:3 women experience incontinence, so I would expect up to a third of the women in the prison to already have a pelvic floor problem and many more to be interested in prevention.
- We had previously visited a low security men’s prison where almost a third of the prison population (100 men) attended our presentation and were engaged and interested in the topic.
- Some emerging research from a NSW physio suggests that there is a higher incidence of incontinence in prisons compared to the general public.
- The women had been promised refreshments, so any ulterior motive was more likely to be associated with a break from usual prison routine and food.
So my anxiety was allayed and curiosity and excitement took over again. We packed our brochures and the model pelvis and headed off for the prison. As always, it took longer than we thought to get to our destination, but we made it at the agreed time and at 1pm we were parked outside the prison walls staring at the bleak high walls surrounded by bare winter soil. No pretty plants or trees in this neighbourhood!
On our way in we passed a little girl happily skipping along next to her grandmother as they exited the prison. The image jarred with my preconceived ideas about prison life. Why hadn’t it occurred to me that there would be mothers inside receiving visits from their children?
Once through the solid exterior doors, we were met by the health officer and guided through the security process: All personal items in the locker. Security passes issued. Only pre-approved equipment and resources to be taken with us. Shoes and loose items scanned in an x-ray machine. Walk through a metal detector. Turn out pockets. Hand held scanner passed over our bodies to check for hidden items. Don’t touch your shoes or loose items until given the all clear by the security team.
It was a bit like airport security only the prison officers seemed friendlier and helped us feel at ease with the process.
Once through security we were allocated an escort and passed through a series of “airlocks” where only one door could open at a time and finally we were inside. I scanned the large open courtyard. No trees and very little greenery, a small flowering aloe to the side. Gravel and concrete paths. Lots of women walking in small groups or on their own, heading off to allocated activities and appointments in one of the many featureless buildings. We passed the gym and I initially thought that this must be a popular activity because everyone seemed to be wearing fitness gear. Then it quickly dawned on me that everyone was dressed in identical tracksuits except for our small party.
I wondered about the past stories of the women I saw, the crimes that had put them there and their futures. I tried to guess who might be dangerous and who had just found themselves caught up with the wrong crowd, but the women all looked relaxed an un-menacing. In fact they looked much like groups of women you would see in any public space if you could ignore the obvious uniform.
The pelvic floor seminar had been well advertised and I spotted a poster on the Gym door as we walked past on our way to the activity centre. The room we had been allocated seated 25 women and a few of them were already gathered in the foyer of the building. At the allocated time they started to drift into our room, each clutching a personalised time table to prove they were entitled to be at this event. One woman told us how excited she was about this seminar because she was leaving that Friday and had been dealing with some urine leakage since she had her children.
As I had predicted, the high level of interest was simply a reflection of a high level of need. Only 3 women seemed to be intent on being disruptive with some crude jokes at the start, but their colleagues quickly shut them up and let them know that they considered this topic to be important. The women were mostly in their late 20s or early 30s, with only a few being in their mid-40s. They were they first audience I’ve encountered with the brutal honesty to agree with me that I was very old at 52. I was also surprised at the naivety of some of the women – one young woman genuinely did not know what incontinence was and I think she only attended because she assumed the talk was about sex.
Some of the women looked like they had had a rough life and others could have grown up in Toorak, but appearances rarely tell the full story. It’s amazing how different women can look when wearing identical tracksuits. Some were rather scruffy and others might have ironed their tracksuits before putting them on. A couple of women in the front row looked like they had been to the hairdresser that morning and their tracksuits might have hidden designer labels, but any veneer of a privileged life was quickly dispelled by the simple vocabulary and limited understanding of words I use commonly in other settings. Many had no idea what faeces or urine were, terms gleefully translated by their friends into poo and wee. Similar translations were quickly provided for other anatomical terms such as the anus, urethra and vagina – I leave the translations up to your imagination.
My designer lady in the front row later put any thoughts of a good life out of my mind when she asked whether it was normal to pee herself when her (ex)husband hit her across the face. Many in the audience seemed to identify with this extreme stress reaction to physical violence.
The women really enjoyed the anatomy lesson, in particular the practical surface anatomy to identify their core muscles, including the pelvic floor. They also loved the idea that pelvic floor exercise could be done in the gym, incorporated into their usual workout, and not just a static lift and hold while sitting or lying down.
Another area of great interest was the Bristol Stool chart and there was some discussion on the effects of opioid drugs on gut function. Constipation was a common theme for many of the women and some of them were happy to share their experience of the Methadone program and the types of laxatives available within the prison system. There were no Asian women present in the room, but when shown the correct defecation position, several women exclaimed that their Asian colleagues had it right, because they all prefer to squat.
The allocated time for the seminar seemed to go very quickly and the women asked many relevant and thought provoking questions. There was a clear intention from most of the group to include pelvic floor exercise and good bladder and bowel habits into their routine from now on. Any fears of ulterior motives were definitely unfounded and most of the women did not even stay for the refreshments provided after the talk.
Our exit from the prison was a lot quicker than our entry and soon we were back on the outside of the bleak walls.
We have been invited to return for further seminars at the prison and I hope that when we return, we will once again be able to engage with a group of interested and curious women who are keen to learn more about how their bodies work.
Therese (Terry) Wesselink is our registered physiotherapist with post graduate qualifications in Pelvic Floor Physiotherapy.
She is one of the continence clinicians here at VCRC and a sought-after speaker at community and professional events.
The Victorian Continence Resource Centre is the peak body for Bladder and Bowel Health in Victoria.