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.

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.

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. 

Once You Have Chosen Surgery, What are Your Options?

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.

Which Health Professional Should You be Seeing?

 

 

Being diagnosed with a prolapse can plunge you into a world filled with unfamiliar medical terminology.

 

One of the most confusing things can be navigating which type of professional you should seek help from. A continence nurse? A women's health physio? A urogynaecologist? What the heck even is a urogynaecologist?

 

The Continence Foundation of Australia has put together a really informative page that tells you what the qualifications of each of these professionals are, and in what situation they can help you. This is particularly important when finding a properly qualified physiotherapist, or when choosing which type of professional should perform your surgery (if you choose to have surgery).

 

This great resource is available here: Which Health Professional?
 

Remember, the Continence Foundation of Australia can also help you to find an appropriate practitioner close to where you live. Call their help line 1800 33 00 66 Monday to Friday 8AM to 8PM.