Wednesday, 8 August 2018

Is Pelvic Floor Physiotherapy Effective in Treating Pelvic Organ Prolapse?

Is Pelvic Floor Physiotherapy Effective in Treating Pelvic Organ Prolapse?

Prolapse is defined as a symptomatic descent of the vaginal wall or vault from the anatomical position. Symptoms might include some or all of the following: bladder, bowel, vaginal, back, abdominal or sexual abnormalities or dysfunction(1). My clients that come in with symptoms will often say that it feels like something wants to fall out. They report feeling heaviness and pressure at the end of the day, or they say that they can see/feel something at the opening.

So what causes prolapse?

Some risk factors include pregnancy, vaginal delivery, increased age, family history, obesity, heavy lifting, and constipation(1).

Is pelvic floor physio effective in reducing symptoms?

Yes, pelvic floor physiotherapy helps decrease symptoms greater than just daily lifestyle changes.
Let’s examine a study.

477 women of varying ages were randomly separated into two groups. Each group consisted of women with varying stages of prolapse, number of children, etc. The control group only received a pamphlet outlining lifestyle changes, such as advice on weight loss, constipation, avoiding heavy lifting, coughing and high-impact exercise. This group was not provided any information on pelvic floor anatomy or function.

The second group (pelvic floor muscle training group) had 5 one-to-one sessions with a women’s health physiotherapist over the course of 16 weeks. They got education about pelvic floor muscles and function, as well as, all the tips the other group received. Additionally, the second group got individualized pelvic floor exercises which included slow endurance contraction and fast contractions.

Throughout the study, they tracked patient progress with self-reported questionnaires about symptoms such as bowels, bladder, pain and sexual function but also the women’s ability to do activities and impact on their quality of life. The participants were also separately assessed by an OBGyn that followed a specific objective measure 6 months into the study and again at 12 months.
Here are the results.
  • Those in the pelvic floor muscle training (PFMT) group had fewer symptoms than the control group at 6 and 12 months. They were less likely to report prolapsed symptoms.
  • 52% of participants in the PFMT group reported feeling better at 6 months compared to 17% in the control group.
  • 50% of women in the control group went in for additional treatment after the 12 months compared to 24% in the exercise group.
  • Women going for surgery after 12 months was 11% in the PFMT group and 10% in the control group likely because there was an even distribution of women who were set on surgery anyway.
  • Interestingly, 27% of women in the control group were referred for physiotherapy compared to 1% of the PFMT group that needed additional physio.
  • Also 80% of women in the exercise group continued their pelvic exercises after 12 months.
  • In terms of costs, this study was done in England so amounts were in pounds.
  • On average surgery costs: £1044, pessary £229.45, phsyio £170.24,
  • The average cost of treatment in physio group was £268.23 which is far less than surgery.  
I want to highlight that some women in the exercise group did need further treatment.
As mentioned 11% had surgery, 5% needed pessaries, 10% estrogen treatment. As pelvic floor therapists our job is to take a multidisciplinary approach and optimize other forms of treatment when needed.

In my practice I do see women after prolapse surgery because they have prolapsed again. Even if surgery is needed physiotherapy can help women prepare. I.e. get stronger muscles before surgery, educate on lifestyle and reduce risk factors, aid in recovery of muscles and take a prevention role.
I have also seen clients who couldn’t use pessaries because their muscles were too weak to hold the pessary. Pelvic floor Physiotherapists can help women strengthen for this.

What I want to say is that physio is a conservative therapy that should be our first line of defense. Thus if additional treatments are needed, we have optimized those treatments for success. With physiotherapy the patient is also an active participant in their health.

The Pelvic Health Lady

Hagen et al. 2014. Individualized pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicenter randomized controlled trial. The Lancet 383: 796-806.


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