Pelvic Organ Prolapse
Topic Suggestion
1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?
Currently no standardized screening protocol for pelvic organ prolapse (POP) occurs during routine pelvic exams, despite pandemic prevalence, or childbirth and menopause being the leading causal factors. Statista.com confirms the 2019 United States female population is approximately 168 million. Research estimates that up to 50% of the female populace will experience POP at some point during a woman’s lifetime. [1;2]. Despite POP prevalence data frequently being quoted in research, it is currently a relatively unsubstantiated paradox, considering the condition is not routinely or effectively screened for during wellness examinations.
The age demographic impacted by POP is massive, mid-teens through end-of-life. A multitude of lifestyle, behavioral, and comorbid conditions additionally compound female risk of experiencing POP, such as:
- Heavy lifting (employment, behavioral - lifting children, or lifestyle - fitness activities),
- Hard foot-strike fitness activities (marathon running, jogging),
- Chronic constipation (both a POP cause and symptom),
- Chronic coughing (bronchitis, emphysema, allergies),
- Diastatis rectus abdominus (long abdominal muscle stretches during pregnancy),
- Hysterectomy (the vaginal apex is often not secured during hysterectomy, resulting in vaginal vault prolapse in 29% of women) [3],
- Genetics,
- Neuromuscular disease (Marfan, Ehlers Danlos Syndrome, MS).
Comorbid conditions that may cause POP, or that may shift in both cause and effect directions, such as spinal cord injury or spina bifida depletion of pelvic floor function, interstitial cystitis-related pain, and the complex management of anterior support and pelvic angle in women with bladder exstrophy, are all concerns that could benefit from deeper analysis. Women suffering with Ehlers-Danlos syndrome, a seldom recognized or screened for genetic condition that may cause joint flexibility and hyper-elastic tissue integrity, have a particularly difficult path to navigate
Minimally, diagnostic clinicians should be required to ask a few basic questions during routine pelvic exams, to clarify whether POP may be occurring, and explore more deeply if it is. While some practitioners may screen for POP organ bulge, the standard pelvic exam dorsal lithotomy position enables organs to shift back into normal position, reducing POP severity and visibility. For the non-sub-specialist eye, a neutral standing position palpation exam may be a more time efficient and effective screening tool, but this practice is seldom illuminated in gynecologic curriculum, or practiced during examinations.
References:
1. Kowalski JT, Mehr A, Cohen E, Bradley CS. Systematic review of definitions for success in pelvic organ prolapse surgery. Int Urogynecol J. 2018; 24(08).
2. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783-90.
3. Davilla GW, Isaacs C. Vaginal Vault Suspension. Medscape. https://emedicine.medscape.com/article/1848619-overview Accessed 2019; October 31.
2. Why are you struggling with this issue?
POP has been medically documented since the Egyptian Kahun Gynaecological Papyrus circa 1835 B.C., nearly 4000 years ago. [4] Unfortunately, POP continues to evade the female pelvic and vaginal health awareness and wellness spotlights. The stigma of embarrassing symptoms shroud POP in silence on both patient and practitioner sides of the female pelvic healthcare fence. Discovery upon diagnosis is the status quo for the majority of patients.
POP impacts women’s quality of life (QOL) in multiple significant ways and is relatively well documented, dissecting physical, emotional, social, sexual, fitness, and employment aspects of day-to-day navigation. Vaginal tissue bulge, urinary or fecal incontinence, urine retention, chronic constipation, pain with intimacy, lack of sexual sensation, vaginal and rectal pain or pressure, and tampons pushing out are clearly significant symptoms that need to be acknowledged and screened for, but typically skirt the traditional dialogue occurring during pelvic examinations because of the awkwardness of the subject matter.
Within online patient support spaces, communications occur between women with very individual types of and in various stages of POP development. Patient voice is growing loud and strong. Women want to know why they were not informed of or screened for POP sooner.
The potential for a women’s pelvic healthcare train-wreck looms large. POP awareness will likely explode overnight as the result of mainstream media exposure, dramatizing the multiple QOL impacts of POP. Millions of women will recognize symptoms they have navigated for years and will demand screening and treatment. How will healthcare address their needs effectively?
Today’s pro-active patient is internet informed and participates more directly in health decision making. As a result, given this trend in self-help internet health education, traditional models of patient-provider relationship and communication strategies must adapt to a changing environment. Patients want to be believed, they want to be listened to, and they want their opinions to be respected.
A noteworthy diagnostic clinician practice gap permeates women’s health despite widespread prevalence of POP and thousands of years of medical documentation. The evolution of POP treatment will continue to expand considerably over the coming years. POP awareness, healthcare practice, research, device development, and both diagnostic and specialist practice and policy will progress side by side. There is little doubt that POP will stimulate the next significant evolution of women’s health directives.
Continual evaluation of best practices in medicine is a core aspect of healthcare evolution. The value of both research and patient voice to clarify reality and need are equally priceless. It is essential that patients, advocacy, healthcare, academia, research, industry, and policy makers come together for the greater good of women’s vaginal and pelvic health evolution.
References:
4. Downing KT. Uterine Prolapse: From Antiquity to Today. Obstetrics and Gynecology International. Volume 2012, Article ID 649459, 9 pages. http://dx.doi.org/10.1155/2012/649459 Accessed 2019, October 31.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
[redacted: organization name]'s long-term goals are: 1. Standardized routine POP screening for all women. 2. Accurate POP statistical data capture. 3. Advance diagnostic clinician POP curriculum.
Our organization is deeply embedded in communication in the POP arena with patients, healthcare, academics, research, industry, and in baby steps of policy bridging. We feel strongly that all sectors must share insights freely with each other to advance the status quo of this most significant and prevalent health condition. FemTech is evolving at a brisk pace in this sector. Sub-specialists are recognizing more clearly the value in acknowledging and addressing patient needs. Patient voice however will always be the most critical to clarify evolutional direction.
4. When do you need the evidence report?
Thu, 12/31/2020
5. What will you do with the evidence report?
[redacted: organization name]'s is hopeful a report of this nature would provide the fuel we need to accompany efforts to:
1. Validate the need to establish a standardized pelvic organ prolapse screening process during routine pelvic exams.
2. Evolve diagnostic clinician pelvic organ prolapse curriculum to address insufficient practitioner awareness and lack of appropriate clinical best practice.
3. Assist our campaign on the Hill to stimulate awareness of the POP pandemic.
Supporting Document
[redacted: document included organization information]
Title or short description: Forum member by age
Comments or notes about this file: A common misconception about pelvic organ prolapse is that it is an "old lady" condition. Attached is an old PP slide from well over a year ago (we now have 13,000+ members in our closed online support forum). However it indicates the diverse age demographic for POP. We have patients in their mid-teens who have never been pregnant, but Ehlers Danlos tissue integrity issues caused POP.
(Optional) About You
What is your role or perspective?
patient advocate
If you are you making a suggestion on behalf of an organization, please state the name of the organization:
Association for Pelvic Organ Prolapse Support
May we contact you if we have questions about your nomination?
Yes
Title:
Founder/CEO
