Wednesday 16 July 2014

"Ask Me Three" - A Simple Resource for Talking to Health Professionals

This great video shows how asking these three simple questions can cut through confusing medical language


Though I have previously featured a few good resources to help you get the most out of your visits to doctors or specialists, you may have found that they did not work for you. This may have been because they involved too many steps; too many things to remember; or just "weren't your style".
 
The National Patient Safety Foundation has worked with doctors to work out the main questions patients should ask: Ask Me Three.
 
1. What is my main problem?
 
2. What do I need to do?
 
3. Why is it important for me to do this?
 
These questions are short, easy to remember, and are in everyday language. This is a great place to start when making sure that you and your health professional both clearly understand the situation and the plan of action.
 
 

Tuesday 15 July 2014

Health Professionals: These Are the "Words to Watch"

 
 
The National Patient Safety Foundation in America has recognised that many problems arise when communication breaks down between patients and health professionals. They have made a list of types of language that health professionals use which may be confusing or offensive to patients; and which risks alienating them.
 
You can download a PDF about this research here: Words to Watch.
 
The Prolapse Information Project has previously highlighted the importance in language choice when discussing prolapse here: Prolapse After Childbirth: Common Not Normal.
 
If you have a busy practice it may seem like you don't have the time to police the language you use. You may also feel as if you shouldn't have to 'coddle' your adult patients. However, good communication is vital to an effective health practice; and taking into account the way your words will affect the person you are speaking to is a cornerstone of good communication.
 
A manageable approach may be to concentrate on one area of language at a time: medical words, concept words, category words, or value judgement words. Look at the list and see if you use some of the words on there, and try to use the suggested alternatives instead. You could even ask you patients for feedback about the clarity of your communication.
 
When talking specifically about prolapse, here are some terms to consider:
 
"Take it easy"/"Don't overdo it" - these are both very ambiguous. Consider using more specific language like "Don't lift anything that makes you strain to pick it up", or "Take a rest by lying down for 15 minutes if the feeling of pressure becomes too strong".
 
"Weakness" - women are often told that they have "vaginal weakness" or "pelvic floor weakness". While you mean this in a medical sense, remember that to your patients this is a negative value judgement. Consider instead explaining the condition in terms of an injury, or by saying that a stronger pelvic floor might help them manage their symptoms.
 
Reconsider using the phrase "nothing can be done" (usually when referring to a mild or moderate prolapse), when you actually mean "Unless you have bothersome symptoms, this degree of prolapse doesn't require treatment."
 
Using specific, emotionally sensitive language will help to foster better relationships with your patients and make them more involved in managing their health conditions, including prolapse.
 

Monday 14 July 2014

Learn About Managing Prolapse Through Lifestyle Changes on MD Conversation





 
MD Conversation provides online presentations that can be used instead of information pamphlets by doctors and specialists. While this is a subscription service, the introductory presentation on Pelvic Organ Prolapse (POP) is available free online here: An Introduction to Pelvic Organ Prolapse.
 
This presentation is very detailed, and includes moving diagrams that may help you to understand pelvic anatomy and POP.
 
The best feature of this presentation is that it clearly states what the goals of POP treatment are, and then compares the available treatments against this list of goals. It also goes into much more detail about lifestyle changes (such as quitting smoking) than most other resources.
 
The presentation can be paused, and you can review individual sections as many times as you want.
 
Please note that the Prolapse Information Project is not affiliated with MD Conversation, nor am I necessarily suggesting that you subscribe to this service. I am only directing you towards the free portion of this service.

Sunday 13 July 2014

A Resource to Help You Get Informed Post-Surgery and Have the Best Chance of Recovery





Prolapse Repair Surgery is a big step to take. It is major surgery, usually with a fairly long recovery period. Added to that is the relatively high rate of failure, which makes it all the more important for you and your surgeon to work as a team for the greatest possible chance of success.
 
However, it can be difficult to be a team if you do not have a clear method of communication. Often, information about how a procedure went, and what you need to do to look after yourself post-surgery, is given to you in the recovery room or in the days following the surgery while you may still be disoriented or overwhelmed.
 
The National Patient Safety Foundation in America has recognised this, and has created a tool to help you and your surgeon clearly record your discharge information. It is a PDF, and can be downloaded here: Post-Discharge Tool.
 
This excellent resource includes spaces for you and your surgeon to record:
  • Follow up appointments, including a plan for what you need to bring and ask at each appointment
  • A clear diagnosis
  • A checklist of important steps during your recovery
  • A medication list, including detailed information about doses, and the reason you need to take each medication
If your medical practice includes post-surgical care, distributing this resource to your patients may improve your surgical outcomes, and field fewer phone calls asking for clarification of your instructions.
 
Everyone involved in managing prolapse, both patients and health professionals, benefits from improved communication.  
 
 

Friday 11 July 2014

"Healthy Women's" Tips for Talking to Your Doctor



 
Healthy Women is a non-for-profit organisation that aims to provide accurate health information for all women.

They recognise that sometimes it can be difficult to talk to your doctor about women's health issues, such as prolapse. To help you approach your doctor, and get the most from your consultation, they have created the following webpage: Tips for Talking to Your Healthcare Provider.

The tips are very practical, and include:
  • Specific questions to ask at each appointment
  • A few sentences you can use if you feel uncomfortable asking your doctor to clarify what they have said
  • Letting your doctor know if you have trouble reading, so they can give you information in another way
  • When to change doctors
The second page of the article discusses some ways in which you can use email to stay in touch with health care providers, and save you unnecessary appointments.
 
Speaking up, even when you are in an intimidating situation, is a great way to improve your level of medical care.
 
 

Thursday 10 July 2014

Australian Women: You May be Eligible to Receive Some of Your Prolapse Treatment through Medicare



 
Medicare is the Australian system of free healthcare for all citizens. This system has many good features. However, it can still be difficult and expensive to manage a long-term health condition such as prolapse if you need the support of a health professional such as a Women's Health Physiotherapist.
 
There is a little known Medicare entitlement called the Chronic Disease Management Plan. Despite the name, it can be applied to any health condition, including prolapse, that has been going for more than six months.
 
Once a GP has written a Chronic Disease Management Plan and Team Care Arrangement that involves at least two other specialists (such as a Women's Health Physiotherapist, a Continence Nurse or a Urogynaecologist), you may then be eligible to claim a rebate for these services from Medicare. This plan also helps to coordinate your care between your specialists.
 
If you are an Australian citizen and do not have private health insurance, a Chronic Disease Management Plan may enable you to access all the services you need to manage your prolapse effectively.
 
For more information, go to the following website: Chronic Disease Management Plan.

What the National Guideline Clearninghouse Says About POP May Surprise You




Ever wondered just what your doctor or specialist was thinking when they recommended a particular treatment for Pelvic Organ Prolapse (POP)? The US National Guidelines on POP may help shed some light on their thought process.
 
The National Guideline Clearinghouse is part of the US Department of Health and Human Services. Their recommendations about Pelvic Organ Prolapse summarise all of the research on the topic until 2011 in a single page of dot points. You can read these guidelines here: Pelvic Organ Prolapse: Recommendations.
 
The most interesting part of these guidelines is the difference between the guidelines from good-quality research (Level A evidence) and the guidelines based on 'professional knowledge' from health care providers who treat POP (Level C evidence).
 
The agreement between healthcare providers is that women with POP who were asymptomatic (had no symptoms) or who had mild symptoms required no treatment. Many women with 'mild' POP, who perhaps experience discomfort or mild pain and incontinence, may be familiar with this view; having been told by health professionals that they do not require treatment.
 
However, there is no evidence from good-quality research that mild POP should go untreated. In fact, the National Guidelines state that a pessary would be appropriate for most women regardless of the degree of their prolapse.
 
We often assume that health professionals are acting based on the most up-to-date scientific evidence, but it is worth remembering that they are also using information that they received during their training, or impressions they have formed during their career.
 
If you have mild prolapse, have seen a health professional who believes you do not require treatment, and can not change health professionals, then it may be worth printing out this section of the guideline while trying to demonstrate to them that you need treatment.
 
Remember that at the Prolapse Information Network I recommend that you continue to seek medical help until you receive it. You are entitled to receive evidence-based, appropriate treatment for your prolapse.

Wednesday 9 July 2014

Pelvic Organ Prolapse on Medscape




Medscape is an online resource for health professionals.
 
Their page on Pelvic Organ Prolapse (POP) can be found here: Pelvic Organ Prolapse.
 
As with all of their pages on health conditions, it includes an overview, workup and treatment guide. All of these are very detailed, and based on up-to-date information.
 
If you are a GP, you may not have traditionally made screening for and treating POP part of your practice. It may not have been a large focus of, or even a part of, your training. However, as awareness of POP grows, you may find an increasing number of women seeking treatment for the condition - after all, it effects up to half of your female patients who have given birth.
 
This resource is a great place to start your professional reading about prolapse.

Tuesday 8 July 2014

Get Informed about Pelvic Organ Prolapse at "Healthy Women"




 
Healthy Women is a not-for-profit organisation that aims to empower women by giving them accurate information about their health conditions.
 
The section of their website about Pelvic Organ Prolapse (POP) is much more detailed than the average information sheet. You can find it here: Pelvic Organ Prolapse.
 
It has separate pages on the following topics:
  • Diagnosis
  • Treatment
  • Prevention (particularly useful for pregnant women)
  • Questions to ask your health professional
  • Answers to common questions (including some questions I haven't really seen addressed on other websites, such as "My doctor says I have some bladder prolapse, but I don't have any symptoms. How is that possible?")
  • Organisations that can offer help and support (mainly in the US)
This is a great place to start your in-depth reading about POP, once you have taken a look at a few information sheets.

Sunday 6 July 2014

Free Multilingual Patient Information Leaflets about Prolapse and Many Other Bowel and Bladder Issues



 
As a GP, it can be difficult to find accurate, easy-to-understand information for your patients about prolapse and continence. You may also feel that you do not have the time or resources to find and print off a pamphlet for each female patient who has bladder, bowel or prolapse symptoms.

The International Urogynecological Association has created an extensive library of patient information leaflets that can be found here: Patient Leaflets.

There are leaflets on many conditions and treatment options, including:
  • Pelvic Organ Prolapse (POP)
  • Types of POP repair surgery
  • Constipation
  • Urinary Tract Infection
  • Pelvic Floor Exercises
These leaflets are available in a number of languages, including English, Mandarin, Italian, Spanish and Arabic. They are in question and answer format, and include clear detailed diagrams. These leaflets download as PDFs, so you could save them to your hard drive if you do not have consistent internet access in your clinic.  

It is well worth your time to print off the relevant resource for your patients who are suffering from any of these conditions. When your patients are more informed about their health problems:
  • They are less likely to suffer undue anxiety due to misunderstanding their condition and treatment
  • They are less likely to get unscientific information from non-reputable sources, such as websites with commercial interests in the condition; and therefore less likely to undertake unproven treatments that could make their condition worse
  • They are more likely to follow your instructions for care if they truly understand them and understand how they will help
  • It will build better communication and more trust between your and your patients
  • This will in turn make your patients more likely to return to you for help, rather than turning to unproven alternative therapies
If you are a woman with a prolapse, you can also access these resources directly by using the link above.

Saturday 5 July 2014

University of Chicago Information Sheet

This series covers information sheets about POP from professional health organisations. These pages, though they don't necessarily go into a great deal of detail, are a good place to start. They help you gain a clear understanding of POP.

The University Of Chicago Medical Center


The University of Chicago Medical Centre has created an information sheet on prolapse which can be found here: Female Pelvic Organ Prolapse.
 
The strengths of this information sheet include:
  • A methodical approach that clearly outlines the types and causes of POP
  • Information with a good scientific basis
  • Detail on a variety of management options, including biofeedback (which is not often featured on information sheets)
One weakness of this information sheet is that it refers to diagrams that are not included. However, it is well worth reading, particularly for women who want an introduction to what is involved in biofeedback, and how it might help them.

Friday 4 July 2014

Tips for Talking to Your Doctor About Prolapse




Speaking to a health professional about the symptoms of your prolapse can be difficult. We are taught not to discuss bodily functions, sex, or our genitals, and it can be hard to overcome this even with a doctor. It can be particularly difficult have that first conversation where you disclose your symptoms.
 
The American Association of Urogynaecologists has created a really useful document to guide you through that first conversation: Tips for Talking with Your Doctor.
 
It has two parts.
 
On the first page, there is a questionnaire for you to fill in and take to your doctor's appointment. It covers most of the questions your doctor is likely to ask if you tell them you are experiencing symptoms that could be caused by a prolapse.
 
On the second page, there is a list of questions that you might like to ask your doctor in an initial meeting, to help you get a clear diagnosis, and a pathway towards further medical care.
 
It is really important to go into medical appointments as prepared as you can be, to make sure that your concerns are heard. If you are getting a friend or family member to act as an advocate, they might be able to help you fill in the questionnaire, or ask questions during the appointment.
 
Doctors, you may like to get your female patients to fill in the questionnaire on the first page in order to help you screen for women who are experiencing prolapse or other pelvic floor dysfunction. This is a great way to begin a conversation with your patients about a topic they might be desperate to discuss, but that they feel unable to talk about with you.

Thursday 3 July 2014

"Any Old Prolapse": Support on Mumsnet

Please note that the Prolapse Information Project does not necessarily endorse the views expressed by members of the support communities I link to. As always, I encourage you to do your own research and use evidence-based treatments.  


Often being diagnosed with a prolapse can be a very isolating experience. Many women don't have anyone to talk to about prolapse in their day-to-day life, or they may feel uncomfortable even bringing the topic up.
 
This is what makes online support communities so valuable.
 
Many online parenting communities have a lot of threads about prolapse, but often these threads are calls for help from people who have just been diagnosed, and usually they receive few replies. These threads often lack a 'voice of experience', who can answer questions based on having gone through the same thing.
 
The "Any Old Prolapse" thread on Mumsnet is unique. It has been running since 2009, and is very active. There are new posts almost every day, and often more than one, so if you post there you can expect a reply fairly soon. There are also many members who have been there a long time, and have a lot of experience to share about managing prolapse. You may also be able to share your experience. This community is very welcoming.
 
You can find the latest part of this thread here: Part 8.
 

PubMed: A Place to Get Medical Information, Not a Drink




 
PubMed is a free online database of medical studies, that includes the research published in almost all of the reputable medical journals. When you see information on PubMed, you can be relatively confident that it has been carefully reviewed by medical experts.
 
You can access PubMed here: PubMed database.
 
Accessing PubMed may seem a bit intimidating, particularly if you are not used to this style of writing. There is a good introduction to how to use this database here: An Introduction to PubMed.
 
Here are some terms that you might come across while using PubMed:
 
Research - an experiment or study of a topic, that follows very specific scientific rules to make sure that the results are as accurate as possible
 
Paper - a report about a piece of research
 
Journal - a specialist magazine where scientists publish the results of their research
 
Abstract - a short summary of a research project, that states the method the researchers used and the results of their research
 
You can search PubMed using keywords like "pelvic organ prolapse". Papers are listed in chronological order, which means the most recent are first.
 
PubMed is a great research tool for women with prolapse, their supporters, and health professionals. It is the main source of information about medical research that you read about here on the Prolapse Information Network.
 
As always, I encourage you to be informed about your prolapse, and about any treatments that are suggested to you. PubMed is a great way to access the latest scientific evidence to help you manage your prolapse.

Managing Your Pessary

Two common types of pessary
 

Inserting a pessary is a common way to manage prolapse symptoms. It is a device, usually made from silicone, that is inserted into the vagina. It helps to support the pelvic organs, and for many women can help to relieve prolapse symptoms including discomfort and incontinence.
 
Many women are unsure about using a pessary, as they are concerned about how it will feel, or if it will fit. Pessaries come in many different sizes and shapes, and most women can be fitted for one that they will find comfortable by a qualified health practitioner. Once a pessary has been correctly fitted, many women can manage it themselves, including removing, cleaning and reinserting it.
 
Cambridge University Hospital System has created an information page to inform women about pessary as an option, and to help them learn how to manage their pessary.
 
In includes a very informative video, which can be found here: Managing Your Pessary.
 
This video includes:
  • A quick explanation of prolapse
  • An explanation of some of the benefits of using a pessary
  • Demonstrations of how to insert two types of pessary, including the ring pessary (one of the most commonly prescribed)
  • Information on cleaning and replacing pessaries
One of the greatest features of this video is real women speaking about their experiences of using a pessary. As always, it is very useful to see the perspectives of women with a prolapse, alongside the scientific information.
 
This webpage, as they state in their video, is not intended to replace visiting a health professional. It is very important that a qualified practitioner fits you for a Pessary, and monitors your use of it at the beginning.
 

Wednesday 2 July 2014

The Best Evidence for Prolapse Repair Surgery





In previous posts, I explained how you can use Cochrane Reviews (a summary of recent medical research) to get the latest scientific evidence about each treatment option for prolapse. You can read the reviews here: pessary, oestrogen and conservative management.
 
The Cochrane Review for prolapse repair surgery can be found here: Surgical management of pelvic organ prolapse in women.
 
Because of the vast number of surgeries available, and the controversy surrounding many methods, this review cannot be quickly summarised, and needs to be read in its entirety.
 
I strongly recommend that you at least look at the section about the type of surgery that you are considering, or that your surgeon has recommended. This is not necessarily because you should not go through with the surgery, but it will help you to be informed about the risks and ask the right questions at your specialist appointment.

Tuesday 1 July 2014

Pelvic Floor Disorders Network: Working Together to Research Prolapse


 

 
The Pelvic Floor Disorders Network (PFDN) is an American group trying to improve the quality and speed of research about conditions such as prolapse.
 
It is made up of eight American research hospitals working together. This enables the PFDN to research more quickly, and to include more participants in their studies. This is very important, as the more people there are in a study, the more likely it is to produce results that will apply to a wide variety of women.
 
Currently, their research projects relating to prolapse include:
  • A comparative study of uterine prolapse procedures
  • Examining the durability of prolapse repair surgery
  • The position of the bladder, bowel and vagina in the years following prolapse repair surgery
 
You can read more about these research projects on their website: Pelvic Floor Disorders Network.
 
Much of the research about prolapse in the last 10 years has been produced by the PFDN - to date their members have published 79 papers. They should be acknowledged for their contribution to our understanding of prolapse, and improvements in treatment.

Monday 30 June 2014

Prolapse: (Not) In the News





The following statistics show how many news articles turn up in a Google News search for each of these major women's health issues:
 
Polycystic Ovarian Syndrome: 3,700
Osteoporosis: 25,200
Breast cancer: 903,000
 
How many articles are there on prolapse?

525
 
I am of course not suggesting that prolapse is equivalent to cancer. I merely want to point out that, as far as women's health issues are concerned, prolapse receives very little media attention, particularly considering that it effects a greater percentage of women than any of the other conditions listed above.

Perhaps, however, this doesn't surprise you at all. After all, many women have never heard about prolapse before they are diagnosed with it.

You can help us raise awareness about prolapse by:
  • Talking to your family and friends about it, the way you would any other health condition
  • Sharing our prolapse infographic on social media
  • Seeking treatment, and being frank with your GP about your symptoms and the effect they have on your life (we need to raise awareness among health professionals too)
If you would like to do something about the lack of media representation of prolapse, contact newspapers and TV news programs in your area and tell them that there is a story that needs to be run about an issue that affects many of their viewers.
 
It is only through increased awareness that we will get better treatment and less stigma.

Sunday 29 June 2014

The Benefits of Pelvic Floor Training



 
 
Pelvic Flor Training (PFT) is a good treatment option to help many women manage their prolapse.
 
Increasingly, there is evidence showing that PFT can improve the symptoms of prolapse in women who do not have too much damage to the ligaments connecting their pelvic floor muscles to the bone.
 
The two keys to effective Pelvic Floor Training are that it needs to be undertaken consistently and with the supervision of a professional Women's Health Physiotherapist.
 
An information sheet on PFT from Physiotherapy New Zealand can be found here: Pelvic Organ Prolapse - What is it and How Can Physio Help?
 
For our readers in New Zealand, this page also has a link to help you find a qualified Women's Health Physiotherapist.
 

Saturday 28 June 2014

Psyllium for Bowel Management


Psyllium husk, often prescribed for constipation
 
One of the main lifestyle changes you can make to manage your prolapse is to avoid constipation. Straining to pass a bowel motion can put a lot of pressure on your pelvic floor, which should be avoided to prevent your prolapse from getting worse.  
 
While you should begin by drinking enough water and getting enough fibre in your diet, your doctor may also prescribe medication to help you have regular bowel motions.
 
One product often suggested is Psyllium. Because this is a natural supplement, it can be more difficult to get scientific information about how effective it is, and about how it interacts with other medication.
 
Luckily, New York University Medical Centre has put together a very thoroughly researched fact sheet on the uses of Psyllium, including preventing constipation: Psyllium.
 
There is some very important information on this sheet that you should read, including when to take Psyllium to prevent it from interfering with the absorption of other medications. I strongly recommend you read this information before using this product.

The Importance of Getting Your Prolapse Information from Professional, Scientific Sources


Make sure you are selective when getting medical information from online sources such as You Tube
 
The internet is a great tool for managing your prolapse. Considering that many doctors still do not have a good awareness of prolapse, it is a place where you can find out more about your condition. Even though most people feel uncomfortable discussing prolapse in person, online you can find lots of people willing to share their experiences with you.
 
However, there is a downside to using the internet as your primary source of information, and that is making sure that the information is accurate, based on science, and that the person giving you the information has no ulterior motive.
 
A good example of this problem is You Tube videos about mesh surgery. A recent report presented at the American Urological Association 2014 Annual Scientific Meeting found that two thirds of all videos about mesh surgery for prolapse were posted by legal firms. Lawyers are not generally recognised as experts in women's health. It is more likely that they posted these videos, usually very critical of mesh surgery, to try and find women who had experienced complications from mesh surgery and would like to sue. You can read an article on this case here: Patient Perceptions of Vaginal Mesh From YouTube and TV.
 
When looking for information on managing your prolapse, think carefully about what the person who produced the information may be hoping to achieve.
 
A good place to start is here, at the Prolapse Information Project. I have no financial share in any prolapse-related products, and I strive to bring you only scientifically-backed information from reputable sources.

Friday 27 June 2014

Mesh Surgery in the News

Elevate prolapse repair mesh

A common type of prolapse surgery currently being used involves using a synthetic mesh to support the pelvic organs. It is the alternative to the more traditional type of surgery known as 'native tissue' surgery, which uses the woman's own muscle and ligaments to do this.
 
Mesh surgery is controversial because although it has worked well for many women, it has a relatively high rate of complications. These include incontinence, pain during sex, and complications from the mesh eroding the vaginal walls. You can read more about this in the Cochrane Review of Prolapse Surgery.
 
The controversy about mesh surgery has been in the news recently.
 
You can read about the halt to all use of mesh surgery for prolapse in Scotland here: "Cheers and tears for brave mesh victims as controversial operations are suspended."
 
This article from the Wall Street Journal details the large-scale Embrace study currently underway in America, testing the safety and effectiveness of one the most common mesh products, following a recent FDA advisory on the topic: "American Medical Systems Enrolls First Patient in Embrace."
 
Links to news articles are provided only to keep you up to date with what is happening around the world with the issue of prolapse. These articles are from mainstream newspapers, not scientific sources, and are not intended to provide information about how to manage your prolapse.
 

Free Physiotherapy Instructional Videos

There is increasingly strong evidence for using physiotherapy by a trained Women's Health Physiotherapist to manage prolapse.

Michelle Kenway is an Australian Women's Health Physiotherapist. She is passionate about educating women about pelvic floor exercises and safe exercise for prolapse, and has produced a number of free publicly-available resources for women.

It can be difficult for women with prolapse to get accurate information about exercise. Michelle Kenway's You Tube channel has a number of videos about this topic, including many showing pelvic-floor safe exercise. You can find this here: Michelle Kenway on YouTube.

Here is one of her videos "Back Exercises for Women that Safely Strengthen and Tone":



At the Prolapse Information Project, I strongly recommend getting advice from a Women's Health Physiotherapist before beginning any exercise routine. However, I recognise that due to your location or economic circumstances this isn't always possible. Exercise information on the Prolapse Information Project is only intended as a general guide and may not be appropriate for every woman.

Thursday 26 June 2014

GPs: What do Your Patients Want when They Come to See You?



Women with prolapse often feel disheartened after an appointment with their family doctor. They report feeling as if the GP didn't believe them, or didn't understand the impact prolapse has on their lives. This is a real barrier to women managing their prolapse effectively.
 
However, prolapse and the constellation of symptoms around it can be difficult to deal with as a GP with no special training in women's health. It can also be hard to fit in an impromptu counselling session if you only have 10 or 15 minute slots in which to see your patients.
 
A useful way of trying to overcome this problem is to ask the question: What do your patients want when they come to see you?
 
Of course patients want medical advice. However, in order for you to deliver this advice effectively, and for patients to follow it, it may be helpful to think about what else your patients want when they come to your surgery.
 
  1. Patients want to be heard. Many women with prolapse have suffered in silence for months or even years. You may be the first person they have spoken to it about. Discussing symptoms to do with their genitals, sex life, or continence may be very embarrassing and distressing - it may have taken a long time for them to get up the confidence to see you. Repeating the symptoms they have described back to them as confirmation is one way you can show you have heard them.
  2. Patients want to have their concerns taken seriously. You may feel that a patient has nothing to be concerned about. But if they have made the time to come and see you about a taboo topic like their genital health, then they are concerned nonetheless. Saying something as simple as "It sounds like your symptoms are distressing" shows that you respect the patient's experience of their own body, without invalidating any reassurance you then give them.  
  3. Patients want you to be honest, including being honest about your level of knowledge. GPs are in a difficult position, because patients often expect them to have an encyclopaedic knowledge of every condition. You may feel that you have to maintain this illusion in order for your patients to respect you and listen to your advice. However, the vast majority of your patients would much rather you refer them to a specialist if you are unsure about how to diagnose or treat their prolapse.
Early detection and management of prolapse can vastly improve the health of many women, and GPs have a vital role in making that happen.
 
If you know a GP or other health professional who would be interested in this resource, or who may benefit from using it as part of their practice, please feel free to direct them to this website.

Wednesday 25 June 2014

A Not-For-Profit Organisation Providing Cheap Continence Aids in Australia


Independence Australia


 
Independence Australia is a not-for-profit organisation that aims to help people with disabilities lead full lives.
 
They fund their work partially through their store, which sells a variety of disability aids and continence products. You can visit their store online here: Independence Australia.
 
Because Independence Australia want more people to be able to access the items that they sell, they often offer good discounts. They also offer online shopping, and discreet delivery. Any profits go to supporting their other work, such as providing attendant care and counselling to people with disabilities.
 
This information is provided merely to make you aware of the services available. The Prolapse Information Project has no association with Independence Australia, and does not endorse any one retailer or product.

Tuesday 24 June 2014

Bethesda Hospital Prolapse Information Video

You may have already had a look at the information sheets and diagrams that can be found by clicking the Information Sheets tab. But you may have found the language confusing, or the diagrams unclear. You may find this information easier to understand presented in the following video.

Bethesda Naval Hospital in America has created a great detailed video to explain prolapse to its patients.

This video can be accessed on YouTube, or viewed here:


The video covers the following points:
  • What is prolapse?
  • Different types of prolapse (explained using animated diagrams)
  • Types of treatment that are available
  • An overview of some types of surgery
  • A detailed explanation of Sacrocolpopexy surgery
  • A discussion of the risks and benefits of different types of treatments
These points are explained clearly in everyday language, making this video a great starting point to understanding prolapse.

Warning: This video includes footage of a Sacrocolpopexy surgery. This footage begins at 6 minutes. Please stop watching the video at this point, or do not watch the video at all, if this will be distressing to you or if it will stop you from seeking appropriate treatment.

Monday 23 June 2014

National Association for Continence "Tools for Patients"




The National Association for Continence is an American organisation that aims to help women and men with continence and pelvic floor problems.
 
They have put together a page of excellent resources for women with prolapse, both in America and around the world: Tools for Patients.
 
General resources that can be used by all women, and their advocates, include:
  • Information on patients' rights and informed consent, including a clear list of the information you should be given as a patient
  • A summary of the latest findings and FDA statements about the use of mesh in prolapse repair surgery
  • The questions that your surgeon should ask you before recommending a particular type of surgery, and the information you should be given about your condition and the suggested treatment
One of the most important parts of managing your prolapse is knowing the right questions to ask when you are talking to a health professional. This resource will help you to go into important conversations well-informed. It is also useful to read this if you will be advocating for a woman with prolapse at medical appointments.
 
For women in America, there is information on the 'Centres of Excellence' program, which identifies clinics that are specialists in dealing with prolapse. This is very important, as it can be extremely difficult to find a surgeon or practitioner who is experienced in dealing with prolapse and in whom you are confident. This program aims to take the guess-work out of the process by identifying health professionals who meet certain standards in training and results. 

Sunday 22 June 2014

Once You Have Chosen Surgery, What are Your Options?

the Royal Womens Hospital



Making decisions about which treatment path to take can be difficult when you have a prolapse. Each path (conservative management, pessary, or surgery) has benefits and drawbacks. There is a lot of conflicting evidence, and often not much objective research.
 
So it can be very disheartening if you make the decision to proceed with surgery to then find out that there are so many types available, and that there is a lot of controversy about many prolapse repair techniques.
 
The Royal Women's Hospital in Melbourne, Australia is a well-respected research hospital. They have put together the following information to outline the main types of prolapse repair surgery available, and the dangers and benefits of each: More about surgery.
 
Reading this resource can really help you to be informed about procedures that have been suggested to you. It can also help you to determine if your surgeon is right for you. If they are suggesting a type of surgery that seems less appropriate than another, considering your lifestyle and health, then it might be a good idea to seek a second opinion.
 
Surgery, like all forms of prolapse treatment, is a big decision that can have a huge impact on your quality of life. Make sure you are informed and confident before you proceed.

Saturday 21 June 2014

Wound Care - How to Look After Yourself Post-Operation or After Childbirth




 

There is a lot of conflicting information on the internet about how to care for wounds. Much of it is unfortunately not based on clear evidence.

Your first source of information should of course be the health professional who performed your surgery or delivered your baby. However, it can be difficult to know where to turn if the information you have received is insufficient, contradictory, or if you received no information at all.

The following page from Mater Hospital in Queensland provides up-to-date information on how to care for a third or fourth degree tear following childbirth: Recovering from 3rd or 4th degree perineal tears.
 
Though this page naturally includes specific information on third a fourth degree tears, it also has good general guidelines on caring for genital wounds. It also warns you against some of the incorrect advice circulating on forums (such as drying yourself with a hairdryer, which can put you at risk of burns if you have reduced sensation in the area). Remember, online forums are best used as a source of support, or as the start of your research into your treatment.
 
The most important thing to remember is that your wound requires regular cleaning and monitoring. Though you may not want to look at or touch the area, particularly if you have just had a traumatic birth, it is vital that it receives proper attention. If you can not bring yourself to care for your wound, ask a trusted family member or friend to help you. If you do not feel comfortable doing this, then you need to urgently seek help from your doctor or hospital. You are at risk of infection or other complications if you do not keep your wound clean. If you cannot get help anywhere else, go to your local hospital emergency department, and explain that you need mental health support in dealing with your wound.
 
As always, I encourage you to ask for the help you need, and to continue asking until someone helps you.  

At the Prolapse Information Project, I always recommend you seek professional medical advice, even if it means that you need to seek a second opinion in order to feel confident about what you have been told. The information in this article is provided only to help you become informed about your care.

Friday 20 June 2014

The Best Evidence for Oestrogen Use in the Management of Prolapse





 
In the previous articles summarising current research about pessary use and physiotherapy, I explained that a Cochrane Review is a one-stop-shop when it comes to finding out what the latest research tells us.

This article is about the Cochrane Review of Oestrogen to prevent prolapse, which can be found here: Oestrogens for treatment or prevention of pelvic organ prolapse in women.

Oestrogen is a hormone. It is often prescribed to women with Prolapse,  usually in the form of a cream used internally in the vagina. When women go through menopause the amount of Oestrogen in their bodies decreases and this often leads to thinning of the vaginal walls. Doctors therefore believe that Oestrogen cream may thicken the vaginal walls.

The common reasons that women with prolapse are prescribed Oestrogen include:
  • Their symptoms have become worse, or noticed for the first time, since menopause
  • They are about to undergo or have just had prolapse repair surgery, and it is hoped that the cream will help in their healing
  • They are using a Pessary, and the cream is being used to try and prevent irritation or injury caused by the Pessary
  • The prescribing health professional hopes that by thickening the vaginal walls they can lessen the symptoms of the prolapse, or stop it from getting worse
Considering how widely it is prescribed, you may be surprised to hear that the Cochrane Review found no studies about Oestrogen for prolapse.

This doesn't necessarily mean that it doesn't work, or that it is dangerous. However, it does mean that we don't have any clinical evidence either way. Many women report that they find it helpful - and by all means continue to use it if you are one of them.

However, this review does clearly indicate an urgent need for more research on this topic so women with POP can make an informed choice. It is simply not good enough that a medication is being prescribed so widely without firm evidence to back it up.
 

Thursday 19 June 2014

Do Genetics Contribute in Some Cases to the Failure of Prolapse Repair Surgery?

Charbel Salomon and Patrick Culligan, two of the lead researchers


One of the main issues that prolapse researchers are working on is trying to unravel the reasons behind the unacceptably high failure rate for prolapse repair surgery.

A team of researchers in the Atlantic Health System in New Jersey are currently in the last stages of a study trying to determine if there is a genetic factor in women for whom the repair fails without an obvious cause soon after surgery. Their research design (a summary of what they hope to achieve and how they are going to go about it) can be found here: Do Patients With Early Post Operative Recurrence of Pelvic Organ Prolapse Have a Genetic Predisposition?

No results have been published from this study yet, so it is far too early to draw any conclusions. However, if these researchers do find a genetic link to unsuccessful surgeries, it could help practitioners more accurately determine who is an appropriate candidate for surgery.

I will keep you updated on how this research is progressing.

Wednesday 18 June 2014

June is Prolapse Awareness Month

Share this prolapse inforaphic from the National Association for Continence, to help raise awareness of prolapse
 
June is prolapse awareness month. It was started by the Association for Pelvic Organ Prolapse Support (APOPS), which is an international organisation that raises awareness of prolapse.

Like all prolapse organisations, including the Prolapse Information Project, APOPS was only formed recently and still largely depends on the participation of supporters. So, while there are some official APOPS events for Prolapse Awareness Month, APOPS is encouraging women and health professionals to organise their own events.

Because the Prolapse Information Project is based online, I am encouraging readers to post the infographic above on any social media sites they use, such as Facebook, Twitter or Pinterest. It provides basic information about prolapse, and explains how common it is.

Many readers would not have heard of prolapse before being diagnosed with it. Still others may have lived with their symptoms for years, thinking they were the only ones with those symptoms. While you may feel hesitant to raise awareness of prolapse because it may make people realise that you have a prolapse, you have the potential to really change the life of someone you know who is suffering in silence. Something as simple as sharing this infographic could have a huge impact on the life of one of your family or friends.

It is time for it to be as socially acceptable to say "I have a prolapse" as it is to talk about any other serious health condition. This change starts with each of us.

Tuesday 17 June 2014

The Best Evidence for Pessary Use in the Management of Prolapse


Types of pessaries: Ring (A), and Gellhorn (C) are the two most common types used to manage prolapse symptoms

As the article The Best Evidence for Conservative Management of Prolapse will tell you, a Cochrane Review is an article written by experts in a medical field summarising the latest research about a particular condition.

The article mentioned above provides information about conservative treatment (mainly physiotherapy) of prolapse.

The following Cochrane Review gives you a summary of the latest information about the effectiveness of using a pessary: Pessaries (mechanical devices) for managing pelvic organ prolapse in women.

A pessary is a support for the vaginal walls, usually made from silicone, that is worn internally. While some women find that a pessary will not stay in place or is not comfortable due to other injuries or conditions, many women find that using a pessary can reduce their prolapse symptoms and even allow them to do a greater variety of activities.

As always, I recommend that you read the summary of the review yourself, and draw your own conclusions, but here are some of the key findings:
  • Only one study of the effectiveness of pessary use has been conducted
  • This study compared two of the most commonly used types of pessaries, the ring and Gellhorn
  • The study found that both types were effective for the 60% of women who completed the study, and that they worked as well as each other
Because there has only been one study about pessary use, there still needs to be a lot more research before any firm conclusions can be drawn. It is promising, however, that this initial study has had positive results.

Monday 16 June 2014

The Best Evidence for Conservative Management of Prolapse




 
I strongly believe that it is important for women with prolapse to be as informed as possible about their condition and management options - particularly considering that many health professionals unfortunately do no have an in-depth knowledge of prolapse.

However, it can be a bit daunting for someone from a non-scientific background to access information that may rely heavily on statistics or technical language.

A good place to start for scientific information on any health condition is to see if there is a Cochrane review about it. A Cochrane review is a report published by experts in a medical field that summarises all of the current research on a particular topic. It means that rather than having to find and try to understand lots of specialist scientific papers, you can read the summary of one report and get a good idea about what the latest research is telling us about prolapse.
 
The Cochrane review about conservative management of prolapse can be found here: Conservative Management of Pelvic Organ Prolapse in Women. 'Conservative treatment' refers to non-surgical methods for managing prolapse including physiotherapy and pessary.
 
It is well worth reading the short summary of this review, but some of the key points include:
  • There has not been much research on this topic, which means that there is still a lot of questions that need to be answered
  • Pelvic floor muscle training (PFMT) seems to improve bladder and bowel function in many women with prolapse
  • PFMT seems to improve prolapse level by around 17% in many women with prolapse
  • PFMT, perhaps not surprisingly, seems to improve the general functioning of the pelvic floor
This review concludes that conservative treatment, particularly physiotherapy, can provide at least a small improvement in symptoms for many women suffering prolapse. Further research is needed to see which women are more likely to benefit, and which physiotherapy treatments provide the greatest benefit in each case.
 
Cochrane reviews are also a great resource for busy health professionals who want to keep up to date with the literature on a number of topics. These reviews are updated frequently, which means that you can check back every now and then to see what the latest consensus is, without having to read and synthesise every new piece of research that comes out.