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.

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.

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.

 

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.

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.

Women's Health Queensland Prolapse 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 Women's Health website from the Queensland Government has detailed fact sheets on many common health conditions. Their fact sheet on Prolapse can be found here: Genital Prolapse Fact Sheet.

The strengths of this fact sheet include:

• The level of detail it provides
• It includes information about less common forms of prolapse, such as Enterocele and Urethrocele
• Clear diagrams of different types of prolapse, and a diagram showing how a Pessary sits when inserted properly

The main feature of this fact sheet is that it includes a good outline of what examinations your health professional should do when diagnosing your prolapse. This means that you can go to your appointment mentally prepared for the physical examination. It also empowers you to make sure your health professional is doing a thorough job, particularly if you are seeing someone like a GP without specialist training.

RANZCOG Prolapse Information Sheet

This series covers information sheets about Pelvic Organ Prolapse (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 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has put out a short information sheet about prolapse: Prolapse of the Pelvic Organs. 

 

Though it has some information on what is referred to as 'conservative treatment' (which may include monitoring, physiotherapy or insertion of a Pessary), its main focus is on surgery.

 

The main strength of this fact sheet is that it includes a video that explains laparoscopy (a common form of prolapse repair surgery), and shows what happens during a laparoscopy.

 

While I encourage women to be as informed as possible about their prolapse and any treatment they undertake, you know yourself best. If watching a video like this will make you more anxious about surgery, then it may be better to read about what happens during the surgery rather than watching it.

 

Warning: The end of the video shows how laparoscopy can be used to treat Ectopic pregnancy. Stop it before the end, or do not watch it at all, if this will be distressing to you.

Prolapse Management: Are You Going to the Toilet Correctly?

Are you going to the toilet correctly?

It might sound like a trick question, but for a woman managing her prolapse, there is a 'correct' and 'incorrect' way to go to the toilet.

Making sure that you are in the correct position to empty your bowels is important for two reasons. The first is that women who have prolapse often also have urge or stress incontinence. Some types of incontinence can be managed better by improving toileting habits. Secondly, one of the main things that all women are told when they are diagnosed with prolapse (or should be told) is to avoid constipation and straining. This is because either of these things can put a lot of downward pressure on the pelvic floor, potentially worsening the prolapse. One of the ways to avoid this is to position your body in a way that makes passing stools as easy as possible.

Sue Croft, a Women's Health Physiotherapist and advocate has put together a great resource explaining how the bowels work, the importance of regular bowl movements for a woman with prolapse, and how to achieve this. Her resource includes clear diagrams, and can be found here: Managing Your Bowels Well.

This is a topic we are taught not to discuss, or even necessarily to think about, but it is a relatively small change that you can make privately and without seeing a specialist that, in some cases, may make a big difference to your continence and prolapse management.

Jean Hailes Foundation 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 Jean Hailes Foundation is an Australian charity that promotes research and awareness of women's health issues.

Their prolapse information sheet can be found here: Prolapse and Bladder Weakness.

Their information sheet on prolapse is quite detailed, and has a really clear focus on giving women accurate information on which to base their decisions.

The key strengths of this information sheet include:

• A clear diagram showing types of prolapse
• A table showing the degrees of prolapse
• A table showing the different types of tests that you may have to undergo, and what they involve
• A table showing treatment and management options
• It was updated recently (January 2014), to bring it in line with current research

The Jean Hailes Foundation may also be able to help you with other women's health issues. They can be contacted within business hours on 1800 JEAN HAILES (532 642).