Pelvic floor rehabilitation for Pelvic Organ Prolapse

The pelvic floor comprises a group of muscles that stretch out like a hammock across the pelvic opening. These muscles, along with the surrounding tissues maintain the position of the pelvic organs, namely, the uterus, vagina, bladder, small intestine and the rectum. Pelvic organ prolapse (POP) occurs when these muscles and tissues stretch or become weakened, causing one or more of the pelvic organs to descend into the vaginal space.

It is reported that up to 70% of parous women (who have had a baby) will experience pelvic organ prolapse irrespective of the type or severity. However, only up to 21% will be symptomatic (Slieker-ten et al. 2009).

WHAT ARE THE RISK FACTORS FOR PELVIC ORGAN PROLAPSE?

• Ageing and menopause
• Hypermobility
• Race- Caucasians
• Family history
• BMI (overweight and above)
• Parity (having babies)
• Vaginal delivery
• Conditions that cause excessive strain on the pelvic floor like obesity, chronic cough, chronic constipation, heavy lifting and straining

HOW GOOD ARE SURGICAL OUTCOMES?

Well I am sure you are familiar with the mesh debacles…let’s not go there…

Women have a 11% risk of undergoing at least one pelvic organ prolapse surgery by the age of 79 (Miedel et al. 2008). However, the long-term outcome following surgical correction of POP is poor. In fact, a prospective study showed that 41% of women had a recurrence of POP within five years and 10% of women underwent a repeat POP operation within five years of their index operation (Olsen et al. 1997).

WHAT DOES THE RESEARCH SAY ABOUT PELVIC FLOOR REHABILITATION AND POP?

Although, there is a lack of quality research to support physiotherapy as an adjunct to your POP repair, there is very good evidence among non-surgical populations that pelvic floor muscle training (PFMT) under the guidance of a Women’s Health Physiotherapist can prevent worsening of POP (Hagen et al. 2011). 1:1 physiotherapy for women with stage I to III prolapse of any type is likely to be effective in improving prolapse symptoms (Brækken et al. 2013).

HOW DOES PELVIC FLOOR REHABILITATION WORK?

The aim of pelvic floor rehabilitation is:

1. To build muscle tone and structural support of the pelvic floor muscles through regular strength and endurance training over time. (read: up to 6 months depending on how diligent you are with your homework) (Brækken et al. 2010)
2. Women can learn to contract their pelvic floor muscles (PFMs) consciously before and during an increase in intra-abdominal pressure and will continue to make such contractions as a behavioural modification in order to prevent the descent of the pelvic organs and tissue (Miller et al. 1998).
3. In addition, a study by Brækken et al. (2010) demonstrated elevation of the pelvic organs after PFM training and assumed that PFMT can be used in the prevention of POP (Bok et al. 2006).
4. Not only is pelvic floor rehabilitation concerned with giving you a stronger, supportive pelvic floor, it also addresses:
   1. Bladder problems such as incontinence, urinary retention, urgency, frequency, voiding dysfunctionChanges to bowel function such as constipation and defecation dysfunction
   2. Approaching intimacy with your partner i.e. advice on lubricants, positions, devices to use
   3. Addressing modifiable risk factors such as constipation and straining
   4. Managing symptoms during exercise and in the workplace
   5. Prescribing an exercise program that helps minimise your symptoms to help you embrace life.

TIP FOR LIVING WITH POP

Don’t push through. See a Women’s Health Physiotherapist. (slightly biased, I know ;P). To learn more about conservative management click here.

At Embrace Physiotherapy, we help women who are planning for a pelvic organ prolapse surgery or other gynecological surgeries or are recovering from one, through physiotherapy. If you have any questions about pelvic floor rehabilitation and how it can help you following your surgery, do email us or call/WhatsApp on 9780 7274.

You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.

References:

Braekken, I, Majida, M, Engh, M & Bø, K 2010, ‘Can Pelvic Floor Muscle Training Reverse Pelvic Organ Prolapse and Reduce Prolapse Symptoms? An Assessor-Blinded, Randomized, Controlled Trial’, American journal of obstetrics and gynecology, vol. 203, pp. 170.e1-7.

Bø, K 2006, ‘Can pelvic floor muscle training prevent and treat pelvic organ prolapse?’, Acta Obstetricia et Gynecologica Scandinavica, vol. 85, no. 3, pp. 263-268.

Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;(12):CD003882. Published 2011 Dec 7.

Miedel A, Tegerstedt G, Mörlin B, Hammarström M. A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1593-1601.

Miller JM, Ashton-Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46(7):870-874.

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501-506.

Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1037-1045.