Equity in access to care for women following vaginal prolapse 

Background

Vaginal prolapse is caused when pelvic organs like the bladder, bowel, or uterus (womb) slip down from their usual position and into the vagina, which causes a bulge or a feeling of heaviness. It’s very common after childbirth – up to 50% of women will have a prolapse in their lifetime and 43% of women are still experiencing severe symptoms a year after giving birth. 

Prolapse can make everyday activities like lifting a baby or pushing a pram painful or difficult and can cause problems with emptying the bladder and bowel. It can also affect a woman’s sex life, and women with a prolapse are five times more likely to have postnatal depression.

Treatments include pelvic floor exercises, pessaries (devices placed in the vagina), or surgery. Most GPs don’t offer pessaries to postnatal women, mainly because they are not always trained in fitting them and there is a perception that pessaries are for treating prolapse in older women. Surgery can cause long-term pain and complications – and repeat surgery rates are high.

Although treatment is available from GPs, doctors who specialise in women’s health, nurses or physiotherapists, many new mothers struggle to access appropriate care. The ‘Better for Women’ report (2019) suggests that this could be because women are embarrassed about having a prolapse, don’t know where to go for help, or even believe that pelvic floor dysfunction is normal after having a baby. The Women’s Health Summit highlighted that women are also frustrated about the three to four appointments it takes on average before a referral is made for pelvic health.

A service designed specifically for and by postnatal women with a prolapse could offer them better treatment options, speed up their access to care, and reduce pressure on GPs. Our research will explore whether a service like this, created with input from people with experience of a prolapse would work and be acceptable.

Approach

• We will review the current NHS pathways for treating postnatal prolapse conservatively (without surgery). We will ask clinicians and NHS managers to complete questionnaires and interviews to help us find out about the variations and problems with existing pathways. Then, we’ll analyse the results to identify where the key decisions about treatment are currently being made.
• The insights we get from the first stage will help us to find out what needs improving and shape the starting framework for the next stage. To help us design the new service, we’ll hold workshops that involve both women who have experienced prolapse and clinicians. The resulting treatment model might include clearer referral pathways, a combination of conservative prolapse treatment methods, educational packages for women, defined leadership roles and support systems for patients. 
• We will test the new service model in a small trial at Cambridge University Hospital. Women will be randomly assigned to one of two groups: group one will try the newly designed service, and the other will receive the hospital’s standard care. This will check if the trial process works and whether the new model is acceptable within the NHS.

Project team

CB

Claire Brown

Cambridge University Hospitals NHS Foundation Trust

RK

Rohna Kearney

St Mary’s Hospital Manchester

SH

Suzanne Hagen

Glasgow Caledonian University

Professor Joanne McPeake

THIS Institute