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POP Goes the Rehab: Pelvic Floor Rehabilitation for Pelvic Organ Prolapse

The pelvic floor consists of muscles forming a hammock across the pelvic outlet, supporting pelvic organs like the uterus, bladder, and bowel. Pelvic organ prolapse (POP) arises when the connective tissue and muscles that support the said organs stretch and weaken, causing one or more of these organs to descend into the vaginal space.

It is reported that up to 70% of parous women (those who have had a baby) will experience POP  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 birthed babies
  • Vaginal delivery
  • Excessive strain on the pelvic floor like obesity, chronic cough, chronic constipation, heavy lifting, and straining

HOW GOOD ARE SURGICAL OUTCOMES?

You may have heard of the mesh debacles, but let’s talk about something more hopeful!

Women face an 11% risk of undergoing at least one POP surgery by age 79 (Miedel et al., 2008). However, the long-term outcomes of post-surgical correction are challenging. A prospective study revealed that 41% of women experienced POP recurrence within five years, with 10% undergoing a repeat POP operation within the same timeframe (Olsen et al., 1997).

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

While there’s limited research supporting physiotherapy and POP repair, strong evidence in non-surgical populations indicates that pelvic floor muscle training (PFMT) guided by a women’s health physiotherapist can prevent the worsening of POP (Hagen et al., 2011). Additionally, 1:1 physiotherapy for women with stage 1 to 3 prolapse of any type is likely to be effective in improving symptoms (Brækken et al. 2013).

HOW DOES PELVIC FLOOR REHABILITATION WORK?

The goal of pelvic floor rehabilitation is to improve muscle tone and structural support through regular strength and endurance training, typically spanning up to six months with consistent effort (Brækken et al., 2010). This approach helps women consciously contract pelvic floor muscles to prevent the descent of pelvic organs and tissues during activities that increase intra-abdominal pressure (Miller et al., 1998). PFMT demonstrated pelvic organ elevation, suggesting its potential to prevent POP (Brækken et al., 2010; Bok et al., 2006).

Rehabilitation with a professional also greatly benefits you because of the following:

  1. Improves bladder health (incontinence, retention, urgency, frequency, voiding dysfunction).
  2. Manages changes in bowel function (constipation, defecation dysfunction).
  3. Provides guidance on intimacy-related concerns, including lubricants, positions, and devices.
  4. Prevents risk factors such as constipation and straining.
  5. Assists with symptom management during exercise and in the workplace.
  6. Prescribes an exercise programme to minimise symptoms, helping you embrace life.

 

TIP FOR LIVING WITH POP

We may be biased, but see a women’s health physiotherapist immediately! For more information about conservative management click here.

Here at Embrace Physiotherapy, we want to help you embrace and regain control of your life through physiotherapy. If you have any questions about pelvic floor rehabilitation and how it can help you following your surgery, please call or WhatsApp us at 9780 7274, or email us at help@embracephysiotherapy.sg.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.

References:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
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Always love coming to embrace. Both preet and brenda have been nothing but really encouraging and supportive on my journey to solve my lower back pain. Feels really comfortable going to them, knowing that it is a journey and they will recommend me suitable exercises to do at home as well. Special mention to the receptionist who assisted me one time when i had sharp pain in my back and had to urgently drop by for a visit! highly recommended!

sherry lu Avatar sherry lu
May 11, 2023

the work the professionals at this clinic do is so important - often women’s issues are overlooked as part and parcel of pregnancy and childbirth and it’s essential to realise these conditions don’t have to be just tolerated. i visited this clinic for rehabilitation regarding my csection birth and for other bodily issues proceeding from childcare and over the months i was seeing brenda i have not only managed those issues but also gained a better understanding of how my body works and how to help prevent future recurrence of such problems. everyone working at embrace is wonderfully considerate and approachable - they put you at your ease from the very first moment. cannot recommend this clinic enough. thank you so much for looking after me so well!

helen vs Avatar helen vs
June 13, 2022

Was recommended by a friend to embrace physiotherapy, I was having bad recurring blocked ducts/mastitis and was desperate. I’m served by a very welcoming and friendly counter lady (forgot to get her name) and my therapists Preet and Brenda are very professional and helpful, they helped get my stubborn blocked ducts cleared in 3 sessions. Preet also referred me to someone who helped with the recurring mastitis. Will probably still experience the same problem if I haven’t visit them, super thankful for the help!

Kate Oxyz Avatar Kate Oxyz
September 2, 2022

Embrace life. Embrace Physiotherapy.

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