In what ways can GPs improve care for Women with Anal Incontinence due to Childbirth Injury?
Problem
Over 20% of women develop anal incontinence within five years of vaginal birth. Some experience problems after childbirth, whilst others’ symptoms develop or worsen during menopause. Anal incontinence has undesirable and often life-changing effects on psychosocial and emotional wellbeing as women may struggle to achieve their basic activities of daily living. Less than 25% of women discuss their problems with GPs unless prompted and it takes on average 7 years to be seen by a professional with the experience and training to improve her symptoms. The literature examining GPs’ and women’s experiences of postnatal consultations regarding anal incontinence is lacking. This study aimed to identify barriers and facilitators to providing appropriate GP care for women experiencing anal incontinence soon after labour, or around the time of menopause.
Approach
This qualitative study combined two phases of data collection and analysis, firstly a series of in-depth interviews with women experiencing anal incontinence caused by childbirth injuries (n=41), followed by three focus groups with GPs (n=13) stratified by experience. Thematic analysis was conducted and relevant themes from across the two datasets were examined to explore women’s experiences of healthcare services and GPs’ perspective about providing care for women potentially experiencing these symptoms.
Findings
Many women with such injuries talked about frustrations they experienced when trying to access care. They often felt that it took a long time to gain recognition and access appropriate care. Various factors appeared to contribute to this delay and missed opportunities for care. The GPs had varied levels of confidence in providing care for women with anal incontinence due to labour injuries, often related to their experiences of training and years as a GP. Mediating factors in GP care for women with anal incontinence caused by childbirth injuries centred around three key themes: Access and Pathways; Role of the GP; and Communication.
Consequences
Analysis of data from both interview and focus group datasets allowed identification of gaps in care within each overarching theme: Access and Pathways; Role of the GP; and Communication. Based on these we developed recommendations for GPs when consulting women with potential anal incontinence caused by childbirth injuries. Broadly, these related to knowledge and continuity regarding referrals; access to resources; information about tears and long-term impacts; long term follow-up; proactivity; and the balance of sensitive, yet clear, language.