Women who have suffered pelvic organ prolapse may be able to self-manage their condition effectively rather than having repeatedly to take time off to attend clinics.
The recommendation by the National Institute for Health and Care Research (NIHR) has followed research that suggested self-management of vaginal pessaries can also lead to fewer complications.
The £1.1m Treatment of Prolapse with Self-Care Pessary (TOPSY) study ran for six years and involved 340 women of all ages from 21 NHS centres across the UK.
It was undertaken by a team from Glasgow Caledonian University School of Health and Life Sciences’ Research Centre for Health in collaboration with Saint Mary’s Hospital at Manchester University NHS Foundation Trust.
Pelvic organ prolapse can happen after pregnancy and childbirth, especially if a woman has a long, difficult birth or gives birth to a large baby or multiple babies.
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It can also be caused by getting older and going through menopause, being overweight, having long-term constipation or a health condition that causes coughing or straining, having a hysterectomy, or having a job that requires a lot of heavy lifting.
It is estimated pelvic organ prolapse can affect as many as one in 10 women aged over 50. Although mild prolapse often causes no symptoms, it can affect quality of life.
This can include experiencing a feeling of heaviness or a dragging sensation in the pelvis, bladder and bowel symptoms, and making having sex feel different.
One common treatment option for prolapse is a vaginal pessary. The pessary is inserted into the vagina and holds the prolapsed organs back in place.
In the UK most women who use a pessary attend clinics for their care and have to return every six months for check-ups.
However, Glasgow Caledonian University’s Professor Carol Bugge and Professor Suzanne Hagen have identified benefits from pessary self-management, the NIHR has highlighted.
Professor Bugge said: “This research is great news for women in the UK who suffer from prolapse because it shows that women can safely self-manage their pessary from home. No matter their age, they may experience fewer complications and there will be less cost to the NHS in the long run by freeing up appointments.
“Pessaries are a very commonly-used treatment in the NHS and the mainstay of treatment is that women have to return to clinics roughly every six months, which can be inconvenient and costly. This is why we have been looking into self-management for women. Our belief is that by giving the control of their health back to the women it would make their quality of life better,” she added.
Professor Bugge highlighted that it is hoped self-management can be rolled out more widely across the UK. However, more research is needed into how it can be made routine practice.
“We have created materials that help train health professionals in self-management. Practitioners need to have the skills to teach patients how to self-manage and that’s why we need more research to look into how best to make this happen on a larger scale,” she added.
The NIHR recommendation has been backed by the government. Minister for the government’s Women’s Health Strategy Maria Caulfield said: “This is an important step for women to manage their ongoing care for pelvic organ prolapse in the comfort of their own homes. It means women can continue to live their lives as usual and reduces the need for frequent visits to see clinicians.
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“We recently announced a nationwide pelvic health service, backed by £11m, to come into effect in 2024, while a £25m investment into women’s health hubs is already improving access to diagnosis and treatment for conditions, including pelvic organ prolapse,” she added.
