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.  

 

 

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 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.

 

Where to Find Information on Prescription Medications

One of the benefits of taking prescription medications rather than alternative remedies is that drug companies are obliged to produce detailed up-to-date information about each of their products.

 

You can access this information as a consumer on a number of websites:

• Medicines.org.au (which has a policy of adding new information immediately after receiving it from drug companies, and is therefore very up to date)
• Medicines Guide (produced by the Australian Government's 'Better Health Chanel')
• NPS Medicinewise (produced by a coalition of healthcare professional organisations)

An example of an information sheet for a drug commonly given to patients with prolapse is Lactulose (a laxative). The drug information sheet for Lactulose on Medicines.org.au can be found here: Duphalac.

 

These websites are not a substitute for professional advice from a pharmacist or doctor, but they can be useful to 'fill in the blanks' or to give you additional information that a GP may not be aware of (considering the variety of medications that they deal with on a daily basis).

 

If you are unsure about something you have read, you can call an information line such as Medicines Line in Australia (1800 633 424) to speak to a pharmacist. If the information on these sheets conflicts with information a health professional has given you, you can go back to them to seek clarification, or get a second opinion.