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.

Talking to Your Partner About Prolapse

Talking to your partner about prolapse may be difficult, but is worth it.

 

Being diagnosed with a prolapse can feel very socially isolating. Worse, it may feel as if you can't even discuss the condition in detail with your partner. This may be because you are concerned it will cause them to see you differently, or it may be because you feel that you can't discuss symptoms such as incontinence.

 

However, if you can overcome your reservations, and share your condition with your partner, you may find that not only are they a great ally in your struggles, but that it may deepen your intimacy and strengthen your relationship.

 

Talking about prolapse with your partner may not be easy, particularly if you are not used to talking about your genitals with your partner, or about your health issues. The following websites cover communication skills. It may be useful for you, and your partner, to review these prior to discussing your prolapse in detail, in order for you to both have a positive experience of the discussion.

• "How can we communicate better?" is produced by the charity LoveIsRespect.org, which promotes healthy relationships
• "Effective Communication" is from HelpGuide.org, an online charity that provides accurate, up to date, mental health information
• "Communication" is produced by Relationships Australia, a large Australian charity that gives people skills to have positive interpersonal relationships

For an example of a supportive partner, P. R. Newton's memoir And Then My Uterus Fell Out may be useful. Newton shared her problems with her husband, who proved to be a true partner to her.

If you have a pre-existing reason not to trust your partner, do not feel obliged to share information about your health with them. Use your judgement, and consider your emotional and physical safety. Sharing private details will not 'fix' a relationship that already has problems.

A Tool for GPs to Begin Conversations with Patients About Urogential Health

Though I am not a medical professional, I recognise that there is sometimes a lack of training and support, particularly for GPs, when it comes to diagnosing and treating prolapse. With that in mind, posts with the tag 'For Health Professionals' aim to share resources created by specialists for other health professionals.

Sue Croft, who is trying to raise awareness among other health professionals about pelvic health

 

 

Sue Croft is a qualified Women's Health Physiotherapist, who also works to raise awareness of pelvic floor health among the general public, and among other health professionals.

 

In a conversation with the Jean Hailes Foundation and some of her colleagues, she came across the attitude among health professionals that they were often frustrated by their patients' reticence when it came to talking about conditions like prolapse. Croft felt that the best solution to the problem was giving health professionals, particularly GPs, a tool that they can use to start this conversation with their patients.

 

Croft has come up with an acronym that GPs can use to remember to check for all of the common symptoms of pelvic floor dysfunction, including prolapse. They could use this at each PAP smear they perform, or even during the yearly physical check-up for each adult woman they treated.

 

The acronym is, appropriately enough, PIPES:

Prolapse

Incontinence

Pain

Exercise

Sex

 

You can read more about how to use this tool as part of your medical practice, including suggested diagnostic questions and treatments for each topic, at Croft's website: Incontinence and Sex - How do we get Patients to Tell us their Problems?

 

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, or directly to Croft's.  

The Importance of Being Able to Discuss Your "Down There" Anatomy

Most readers of this blog will live in a culture where you are not meant to discuss your private parts - certainly not with a stranger, and in some cases not even with an intimate partner. This means that when we absolutely have to, we use generalisations (see if you can spot the two used so far in this article).

So what's wrong with this, and how does it relate to prolapse?

Embarrassment about discussing our genitals is a big reason why some women do not seek treatment for their prolapse. It also means that when women do seek treatment, they often use vague descriptions that may give medical practitioners  an unclear idea about the situation. Unless you have a GP with truly phenomenal people skills, you are much less likely to get examined if you say "Things have been a bit different down there since childbirth" than if you say "I have a lump at the entrance of my vagina and my perineum is very sore."

One of the diagrams from Scarlet Teen

 

 

Here is a great resource from Australian sex ed website Scarlet Teen that takes you on a guided tour of your genitals: The Vagina, Clitoris, Uterus and More. While you may not feel comfortable looking closely at your genitals or touching them in certain ways, the diagrams on this website will really help you to identify and name each of the parts of your anatomy.

 

The next step is to practise using this terminology. You could do this by saying the terms aloud to yourself, or talking to an intimate partner or trusted friend. If you find yourself really unable to say these terms, consider using them in a written explanation of your symptoms which you can then give to your doctor. You may even wish to show this page to someone acting as your advocate, and ask them to speak to the doctor on your behalf.

"And Then My Uterus Fell Out" by P. R. Newton

 

Like many of us, P. R. Newton had never heard about prolapse until it happened to her.

 

Following the birth of her first child, she was plunged into an unfamiliar world of disability, conflicting medial advice, and a lack of truly feasible treatment options. She spent years dealing with not only her level 3 uterine prolapse, but also depression - a common experience for women diagnosed with prolapse. 

 

In part, I enjoyed her memoir "And Then My Uterus Fell Out" so much because I empathised with the way that Newton dealt with her prolapse. She wrote about her experiences to try and help other women, and also to find meaning in what had happened to her. That is exactly why I started this blog - to try and combat the silence that surrounds prolapse.

 

Another strength of Newton's account is its completeness. While online support forums can be a great source of information, they can also give an overwhelmingly negative view of living with prolapse. This makes sense because most people post on these forums while in crisis. One of the really enjoyable aspects of Newton's memoir is that it shows her experience of prolapse in the context of her whole life - her life before she fell pregnant, and the good and bad times in her life after the prolapse occurred. This gives newly diagnosed women a much more balanced view of life with a prolapse than panicked one-paragraph posts on a forum.

 

Regardless of whether you agree with the treatment and management options that Newton chooses, or if you share her belief that things happen for a reason, Newton's memoir will be helpful to anyone who just wants to see that someone else has gone through similar experiences.

 

Newton's humorous and unflinchingly honest account would be a valuable addition to the discussion about prolapse, even if there were many more like it. Because detailed accounts of living with prolapse are so few and far between, it makes Newton's work all the more valuable.

 

 

The review copy of this book was purchased by the reviewer, who has no financial interest in this book. This review is provided only as a subjective opinion, rather than a commercial endorsement.

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).

Voices for PFD 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.

'Take the Floor' is a website about Pelvic Floor Dysfunction (including prolapse), produced by the American Urogynecologic Society.

Here is the page of frequently asked questions: Take the Floor.

The strengths of this information sheet include:

• The fact that it is produced by a reputable professional organisation
• It presents both the pros and cons of different treatment options
• It includes some information on conditions that other information sheets may not, and which some GPs and even Gynaecologists may not be aware of (such as underlying incontinence that can be revealed by a cystocele repair)

One weakness is the lack of diagrams, which may make it difficult for readers to get a clear understanding of what is actually going on inside a person with a prolapse.