Pioneers in patient care: consultants leading change
Midlands
Innovation: A perineal trauma clinic based at Birmingham Women’s Hospital for women who have sustained injuries following childbirth and developed symptoms such as anal incontinence
Mr Simon Radley
Queen Elizabeth Hospital and Selly Oak Hospital, Birmingham
Job title: Senior lecturer and honorary consultant surgeon
Specialty: General and colorectal surgery
Women who sustain injuries during childbirth are often very traumatised and are rarely given a thorough follow-up service or access to counselling, says Birmingham senior lecturer and honorary consultant surgeon Mr Simon Radley. “These women are often first-time mothers who are passed between ‘pillar and post’ within the hospital setting which makes them understandably angry and makes their symptoms more difficult to treat,’ he adds.
In a bid to improve these women’s experiences, a monthly perineal trauma clinic has been set up to give women who have sustained an injury and a repair after a vaginal birth access to specialised advice and care from an obstetrician, a urogynaecologist and Mr Radley, a consultant colorectal surgeon.
He says: “These women leave the hospital and they are seen by a midwife. They may get a follow-up appointment with an obstetrician, but that’s not universal. We felt that these women needed extra input and so six weeks after their baby arrives they are referred to the clinic and we investigate the extent of their injuries, whether they have symptoms such as anal incontinence or perineal pain and we give them advice on possible treatment.
“It’s not a huge number of women, about 30-40 a year at this hospital, who are affected and neither is it a life threatening disease, but this is a serious quality of life issue. Many of these women have minor or major forms of anal incontinence and have not felt able to leave the house since they’ve had their baby. Many have not been able to talk to anyone about it. They may experience pain during intercourse and are frightened about what will happen if they want to have another baby.
“We try and talk through what has happened to them, what their symptoms are and how we are going to manage them. We can give them advice about surgery which gives a 70 – 80 per cent chance of improving their continence and we can also give them dietary advice and information about bulking agents and anti-diarrhoeal agents which help in many cases. We don’t have all the answers but at least we can give patients a feeling somebody is interested and prepared to listen.
The clinic has been running for nearly a year and is funded by existing resources and the women who have come through are very grateful for the support they have had," says Mr Radley. “By investigating this cohort of women, we hope to measure the impact the clinic has on their ability to cope in the future.”
Mr Radley works 10-hour days and is regularly on call. He says: “I need more time for everything and patients with complicated problems need time. I like talking to patients and if I could spend more time with them I could solve more problems. A five minute appointment is not enough and patients would not be impressed, it depends on whether you want quality or quantity.”