Reasons for delay in pelvic organ prolapse treatment revealed

Many women do not seek early treatment for pelvic organ prolapse due to confusion and a lack of awareness around the condition’s symptoms – and feelings of shame and embarrassment – according to new research.

The PROPEL study, led by the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU) at the University of Stirling, Glasgow Caledonian University (GCU), and conducted in collaboration with the University of Leicester and NHS Greater Glasgow and Clyde also found that a lack of awareness among GPs, their dismissive responses to women’s symptoms and a lack of proactive care further contributed to delays in diagnosis and treatment of prolapse.

Pelvic organ prolapse is very common – affecting about 40 per cent of women over 40 years of age. It occurs when pelvic organs – the bladder, bowel or womb – descend into the vagina, causing distressing symptoms that adversely affect quality of life.

The condition often causes pain and discomfort, incontinence, sexual difficulties and psychological distress. Conservative treatments – such as physiotherapy, pessaries and lifestyle changes – can be effective if prolapse is detected early, before needing surgical repair.

Based on research – the POPPY trial published in the Lancet Journal – led by the GCU NMAHP-RU team, which confirmed the benefits of pelvic floor muscle exercises for prolapse, the PROPEL study is now investigating how best to implement this evidence within the NHS.

GCU Professor Suzanne Hagen, who led the POPPY trial, said: “It is really important that women and healthcare professionals know that these exercises are an option when symptoms first occur, which is why we want to speak to women to find out what their experiences are currently when they seek help.”

Dr Purva Abhyankar, a lecturer at the University of Stirling, who led the new PROPEL study, said it involved a total of 22 women who have received prolapse care through urogynaecology services across three NHS UK regions.

Women were asked about their experiences of living with prolapse and of interacting with health professionals when seeking help for symptoms, receiving a diagnosis, making treatment decisions, undergoing treatments, and follow-up care. They were also asked about their thoughts on improving services and care in future to meet the needs of women.

The team found that women received little or no choice in terms of prolapse treatment and had little involvement in decision-making. Health professionals often influenced treatment decisions by the way they outlined the available options and there was little or no discussion around the pros and cons of certain treatments, women’s lived experience of prolapse, and experience of any prior treatments.

Dr Abhyankar added: “We found that women’s own confusion and lack of awareness around prolapse symptoms, coupled with feelings of shame and embarrassment, prevented them from seeking early help for symptoms.

“Even when they did seek assistance from their local doctor, symptoms were often dismissed as being ‘not too bad’ or a ‘bit loose’. Women reported that they were ‘not taken seriously’ until their symptoms became more severe.

“By the time prolapse was suspected and a specialist referral made, the condition had progressed to the extent that surgery was the only viable option left.”