Exciting Research Sheds Light on the High Failure Rate of Conventional Prolapse Repair Surgery

Professor Hans Peter Dietz, an Australian researcher revolutionising our understanding of pelvic floor imagery.

Professor Dietz, a researcher at The University of Sydney, has spent years trying to improve the way that imaging technology (such as ultrasounds) is used for diagnosis and treatment of pelvic floor disorders.

As part of this research, he and his team have discovered that pelvic organ prolapse (POP) generally occurs when the puborectalis (pelvic floor) muscle tears or becomes detached from the bone during childbirth. If this damage is serious, it can cause any surgical prolapse repair attempts to fail.

Though he has identified this problem, there is currently no way to prevent or repair this muscle damage. Professor Dietz currently has two studies going - one focused on a possible prevention and the other on a possible repair.

However, this improvement in our understanding of POP is already a great achievement.

Professor Dietz also shows a good understanding of the situation faced by many women with POP when he acknowledges that we often deal with medical professionals who are not aware of this new research. If you find yourself in that situation, you could direct your healthcare provider to Dr Dietz's website, or take along a printout of the section that is relevant to you.

There is so much information freely available on Professor Dietz's website that it is well worth visiting to explore in more detail. Begin with his 'General Info' page which summarises his knowledge of the field an explains some of the medical terms he uses in the rest of his website.

There is also extensive information available on this website for medical professionals, including a page of teaching resources.

Warning: This webpage includes a number of clinical images and videos of pelvic floor damage. Images from the labour room may be particularly upsetting to women suffering from birth trauma. If you would like to read the information without viewing the images, ask a friend or family member to copy the text into a document for you, without the pictures.

"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.

 

 

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.

 

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.

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.  

 

 

"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.

 

 

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.