Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study

Purva Abhyankar, Isabelle Uny, Karen Semple, Sarah Wane, Suzanne Hagen, Joyce Wilkinson, Karen Guerrero, Douglas Tincello, Edward Duncan, Eileen Calveley, Andrew Elders, Doreen McClurg, Margaret Maxwell

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Abstract

Background: Pelvic organ prolapse is a common urogenital condition affecting 41–50% of women over the age of
40. To achieve early diagnosis and appropriate treatment, it is important that care is sensitive to and meets
women’s needs, throughout their patient journey. This study explored women’s experiences of seeking diagnosis
and treatment for prolapse and their needs and priorities for improving person-centred care.
Methods: Twenty-two women receiving prolapse care through urogynaecology services across three purposefully
selected NHS UK sites took part in three focus groups and four telephone interviews. A topic guide facilitated
discussions about women’s experiences of prolapse, diagnosis, treatment, follow-up, interactions with healthcare
professionals, overall service delivery, and ideals for future services to meet their needs. Data were analysed
thematically.
Results: Three themes emerged relating to women’s experiences of a) Evaluating what is normal b) Hobson’s
choice of treatment decisions, and c) The trial and error of treatment and technique. Women often delayed seeking
help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to GPs, their
symptoms were often dismissed and unaddressed until they became more severe. Women reported receiving little
or no choice in treatment decisions. Choices were often influenced by health professionals’ preferences which were
subtly reflected through the framing of the offer. Women’s embodied knowledge of their condition and treatment
was largely unheeded, resulting in decisions that were inconsistent with women’s preferences and needs.
Physiotherapy based interventions were reported as helping women regain control over their symptoms and life. A
need for greater awareness of prolapse and physiotherapy interventions among women, GPs and consultants was
identified alongside greater focus on prevention, early diagnosis and regular follow-up. Greater choice and
involvement in treatment decision making was desired.
Conclusions: As prolapse treatment options expand to include more conservative choices, greater awareness and
education is needed among women and professionals about these as a first line treatment and preventive
measure, alongside a multi-professional team approach to treatment decision making. Women presenting with
prolapse symptoms need to be listened to by the health care team, offered better information about treatment
choices, and supported to make a decision that is right for them.
Original languageEnglish
JournalBMC Women's Health
Volume19
Issue number45
DOIs
Publication statusPublished - 15 Mar 2019

Keywords

  • Prolapse, Person-centred care, Shared decision making, Women’s experience, Health services, Women’s choice

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    Abhyankar, P., Uny, I., Semple, K., Wane, S., Hagen, S., Wilkinson, J., Guerrero, K., Tincello, D., Duncan, E., Calveley, E., Elders, A., McClurg, D., & Maxwell, M. (2019). Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study. BMC Women's Health, 19(45). https://doi.org/10.1186/s12905-019-0741-2