What the Internet Says about Pelvic Organ Prolapse and Urinary Incontinence

Abstract & Commentary

By Frank W. Ling, MD, Clinical Professor, Departments of Obstetrics and Gynecology, Vanderbilt University School of Medicine, and Meharry Medical College, Nashville, is Associate Editor for OB/GYN Clinical Alert.

Dr. Ling reports no financial relationships relevant to this field of study.

Synopsis: Although university, government, and medical society-sponsored websites comprise the minority of websites offering information regarding pelvic organ prolapse and urinary incontinence, they provide more comprehensive, relevant, and accurate information.

Source: Minaglia S, et al. Assessment of internet-based information regarding pelvic organ prolapse and urinary incontinence. Female Pelvic Med Reconstr Surg 2012;18:50-54.

These authors from Louisiana State University and the University of Hawaii set out to evaluate the quality of information available on the Internet regarding pelvic organ prolapse and urinary incontinence. Using Google.com, Ask.com, and Yahoo.com, they searched the terms "urinary incontinence," "uterine prolapse," "dropped bladder," "dropped uterus," and "cystocele." The first 20 English-language websites listed for each search were then evaluated for content, accuracy, and relevance. Two evaluators were used for each review; one was a resident experienced with urogynecology, and the second was either a urogynecology fellow or faculty. A total of six reviewers participated. They provided both qualitative and quantitative assessment of the websites' information by using a uniform methodology.

One hundred sixty-nine prolapse-related websites were identified, of which 11.2% were sponsored by government, universities, or medical societies. Of the 51 incontinence sites, 23.5% were so designated. Private, community, and unknown groups accounted for 81.1% of prolapse sites (compared to 45% for incontinence) while 7.7% (29.4% for incontinence) were industry-sponsored. Only 49% of prolapse sites documented the year of site creation and only 62.8% documented a year of update. For incontinence, the percentages were 39 and 78.

The prolapse and incontinence sites provided information on the following items: definition (68.6% and 74.5%), causes (65.7% and 72.5%), and evaluation (37.2% and 68.6%). Treatment options included physical therapy (50.3% and 66.7%), pessary (60.9% and 49%), and surgery (75.5% and 62%). Overall, 45% of the sites for prolapse or incontinence were rated as mostly/completely relevant to the topic and 44% were considered mostly/completely accurate.

Government, society, or university-sponsored sites were more likely to: 1) include definition and surgical treatment of prolapse; 2) include definition, evaluation, and expanded treatment options for incontinence; and 3) be rated mostly/completely accurate and relevant.

Commentary

As you read this, you probably are thinking to yourself, "Welcome to my world!" Don't all clinicians deal with the reality that the Internet is intimately intertwined with patient encounters? It can be both a blessing ("Mrs. Jones, you can get really good information on this on the Internet.") and a curse ("Ms. Smith, I think that the information that you have read on the Internet is not necessarily providing a good picture of your condition."). We find ourselves sometimes in the business of disinforming patients (actually, I don't think such a term exists) in order to inform them. It's not that rumors, myths, bias, opinions, and incomplete data sets never existed before the worldwide web. It's just that they are more readily available to patients. I don't want to come off as someone longing for the "good old days," because I'm not that at all. In fact, on balance, it is my opinion that the Internet has helped me to provide better and more innovative care to more patients. Like any tool, we need to know how to use it.

There is, indeed, power in knowledge. The patient who is well-informed combined with a knowledgeable physician can create a beautiful relationship. When the Internet is the source of some or all of that information, i.e., the tool, it behooves everyone involved to understand the tool itself. Patients should know that "not all sites are created equal." Information gained from Internet sources may be deliberately or inadvertently skewed. For instance, industry-sponsored sites are often believed to be self-promoting since a particular product (i.e., drug or device) is solicited. However, that may or may not be true. Industry-sponsored sites can be an excellent purveyor of balanced, evidence-based information. The authors also point out that search engine optimization is sometimes used. Sponsors may choose to pay to have their sites appear higher on the search engine rank list. Both patients and physicians need reminding of this feature. Finally, information found on the Internet is not subject to peer review, a concept that sometimes is lost in our collective rush to gain new knowledge.

Although the authors suggest that a clinician could produce his/her own content for his/her own website, they also recognize that this can be difficult and time-consuming. Guiding the patient to more society websites with which the physician is familiar is a way to help the patient educate herself with more objective materials.

So what's a busy practitioner to do? Although the authors suggest creating our own Internet-based educational tool, many of us don't have time. I certainly don't want to "reinvent the wheel." I can't embrace the Internet fully, yet I can't very well ignore it totally. Here are a few suggestions that this article seems to support:

  1. Acknowledge the Internet and recognize that it has the potential to help you and your patients. (It isn't going away.)
  2. Familiarize yourself with key websites and their contents. (These will be the sites to which you can refer your patients.)
  3. Create your own content if you desire. (You have to determine if the time and effort is worth it compared to sending your patients to specific sites whose information you like.)
  4. Remember the information from this study. (There is a greater likelihood — not a guarantee — that university, government, or society-based sites will have more complete information.)
  5. Caution patients about the limitations of search engines as well as individual websites. (Some are actually quite good while others may not convey the message that you prefer or even contain incorrect or outdated information.)
  6. Don't forget that some patients don't access the Internet, so the "tried and true," old-fashioned, classical face-to-face patient encounter is still alive and well.