TALKING TO YOUR DOCTOR ABOUT INCONTINENCE

It is always a good idea to see a physician expert who is well trained in the problems you are experiencing. But not all experts are equal. Sometimes you don’t communicate well with the practitioner or sometimes you do not feel comfortable with the recommendation. A second opinion is always an option.

If surgery has been recommended to you, a second (or even a third) opinion is an excellent idea. Very few things in medicine are black or white. There are often many different approaches for the same problem and many shades of gray in evaluating what is best for the individual patient. 

In the present managed care environment, some doctors cannot take the time to fully discuss your situation with you. They may not have the extra training needed to offer the best option. They may not be trained in newer or less invasive procedures. If doctors do not know how to perform a procedure, they may not be equipped to discuss or recommend it to you.

When seeing a new doctor for a second opinion, bring all the pertinent medical records including notes from previous doctors’ appointments and any relevant test results. If an X-ray, ultrasound, or MRI has already been performed, bring the actual films, a hard copy, or on a CD file, as the doctor may prefer to look at the films so that he or she can come to his/her own conclusions about the diagnosis.

WHAT TO EXPECT AT YOUR APPOINTMENT

For an individual seeking a second opinion, your doctor may begin with a consultation and a review of the records and then proceed to a complete physical examination. Your doctor will then often discuss the findings and answer any questions that you might have. 

Medical care should be a collaboration between patient and doctor. Together you and your doctor will discuss how best to approach the particular diagnosis. Your doctor may use illustrations, diagrams, and 3-dimensional models to demonstrate what the problem and potential solutions might be. At this point, your doctor may show you a list of one or more possible diagnoses and outline the treatment options available for each problem. Together you should collaborate and determine which choices that meet your needs.

Family members or friends should be welcome to participate in the consultation. Friends and family members can help to make sure all the concerns are addressed and to help the patient remember what is said as a lot of material is covered. 

Taking notes or having a companion who can record notes of what is asked and how it is answered is also helpful. It is a good idea to then digest the information at home to make the best decision. 

Patients should be encouraged to call the office with any additional questions they may have or for any clarification they might require after the consultation.

WHAT IF YOU DECIDE SURGERY IS RIGHT FOR YOU?

If you decide that surgery is right for your situation, you will need to choose the doctor to perform your surgery. There are a number of factors that should influence your decision. 

The first is to choose a doctor who will perform a procedure that fits your particular situation and problem. In most cases, you should have more than one option from which to choose. It is particularly important to discuss the risk factors for adverse, or negative, outcomes based on research, associated with each option.

The next concern is the skill of the surgeon. How many procedures does the doctor perform in a month? How many procedures like the one you are requesting are routinely performed? How many of these procedures have they performed in patients with problems like yours? How many and what kind of complications has the doctor had? 

Studies show that with more surgical experience for a particular surgery, the surgeon performs with fewer complications. In other words, surgeons who perform procedures frequently have lower rates of complications than those with less frequent experience. Many surveys show that some gynecologists and urologists perform as few as one or two major incontinence or prolapse operations a month. Choose your surgeon carefully.

It is important to know something about the training of your surgeon. Did they do any extra training in pelvic floor problems, such as a formal fellowship? Do they teach in an academic program? What is the experience of the surgeon’s support team and the facility where such procedures are routinely performed? What is their track record with respect to success versus failure and how is success defined? What is their track record with respect to complications?

It is also important to feel comfortable with your doctor. Do you get an opportunity to ask questions? Are they answered to your satisfaction? Is the doctor available by phone? Will the doctor be available after your surgery for follow-up and questions as well as support?

If you decide to have surgery, another visit should be scheduled with the doctor you have chosen to go over the specific details of the procedure you are planning. Again, it is nice to have someone accompany you. 

At this time you will go over, in writing, what you should expect from surgery. It includes the details of the operation to be performed, the specific risks of the procedure, the alternatives to the surgery, and the possible consequences if no surgery at all were performed. Continue to ask questions until you are comfortable.

During the “informed consent,” your surgeon is not trying to erode your confidence, but surgeons are legally and morally bound to tell you about things that could happen that might influence your decision to have surgery. Most people’s emotional reaction to this is some fear, which is understandable. 

To summarize, never hesitate to get a second opinion. If this threatens your doctor, you may need a new doctor. Transparency is the key to a good relationship and optimal outcomes.

If you are a woman experiencing incontinence and/or prolapse, you have the option to be treated by a fellowship-trained Pelvic Reconstructive Surgeon. This subspecialist can be a gynecologist, a urogynecologist, or a urologist. If a subspecialist is not available in your hometown it may be well worth your while to seek one out as close to home as possible somewhere in your region. 

Otherwise, there are general gynecologists and urologists with significant experience in this area, but you must ask questions to confirm adequate surgical experience with pelvic floor surgery. 

If you are a man with incontinence, urinary obstruction from the prostate, or other bladder dysfunction, a well-trained urologist is the best choice.