Thursday, 10 July 2014

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.

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