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Pelvic Floor Rehabilitation | Image Courtesy of Annie Spratt via Unsplash
Pelvic Floor Rehabilitation | Image Courtesy of Annie Spratt via Unsplash

Pelvic Floor Rehabilitation for Prolapse Surgeries

Including both Pre and Post Operative Situations

Suffering from symptoms of pelvic heaviness? Experiencing a feeling that there is a bulge down there or something is falling out of your vagina? Have trouble having a bowel movement or experiencing incontinence? These are all common symptoms of pelvic organ prolapse (POP). Unfortunately, 2-48% of women may experience symptoms of POP.

Pelvic Floor Rehabilitation Treatment Options

There are treatment options such as pelvic floor rehabilitation through physical therapy techniques including lifestyle modifications such as managing intraabdominal pressure, promoting healthy bowel/bladder habits, as well as physical therapy, manual therapy, and strengthening exercises to decrease pelvic heaviness.

Other pelvic floor rehabilitation treatment options include:

  • pessaries,
  • pharmacological agents to help with incontinence or frequency,
  • and/or surgery

There is an 11% risk of needing surgery to correct the prolapse by age 80. Unfortunately, 41% of women had a recurrence of prolapse after 5 years of surgery, and 10% of women had a repeat surgery within 5 years of the first surgery. Risk factors for requiring a second surgery include:

  • Older age
  • Postmenopausal status
  • Parity
  • Higher body mass index

As you can see, surgery alone may not be the best option. There is evidence that trying conservative treatments first, namely pelvic floor physical therapy, may prevent worsening of prolapse and may improve your symptoms significantly to the point where surgery is no longer recommended. Regardless of the treatment path you choose, having both pelvic floor physical therapy and surgery may help relieve some symptoms and prevent you from having that repeat surgery!

Studies on the role of pelvic floor rehabilitation and prolapse treatment 

A systematic review in 2011 concluded that there is evidence of a positive effect from participating in pelvic floor muscle training for prolapse symptoms and severity. They find that it is best to have at least six months of supervised pelvic floor rehabilitation in order to decrease symptoms. This systematic review also found evidence that pelvic floor physical therapy results in stronger muscles and improvement in urinary symptoms. 

Another study compared women’s pelvic floor muscle assessments between two groups: an intervention group that received pelvic floor physical therapy before and after surgery and a control group that did not receive any physical therapy. They found that the treatment group significantly scored better on quality of life measures and urinary symptom questionnaires compared with the control group. The authors “postulated that the longevity of the procedure could be improved due to greater support of pelvic organs by the pelvic floor muscles during the crucial period of postoperative healing.” 

What would pelvic floor rehabilitation include?

  • Assess your pelvic floor musculature for strength, coordination, and endurance 
    • Based on your assessment, provide an individualized treatment plan for you! It may include pelvic floor contractions (or Kegels), or it may not 
  • Education and practice on minimizing intra-abdominal pressure and how it may worsen prolapse
    • Teach how to utilize the “knack” exercise to help with coughs, sneezes, jumps, exercises
  • Education on how to minimize constipation and straining on the toilet
  • Education on how to prevent bladder urinary frequency and unwanted leakage 
  • Exercises (not just pelvic floor, but your hips, core, low back muscles) to help improve overall pelvic strength

Think of it as any other surgery, for example, total knee replacement surgery. Most doctors would recommend a pre-rehab and post-rehab program for new knee recipients to maximize their potential for success and decrease their need for another future surgery. The same thing applies to gynecologic surgeries! It is truly beneficial to have a better understanding of why you developed prolapse in the first place, how your pelvic floor functions, habits/strategies to promote healthy bladder and bowel function in order to minimize symptoms and maximize your potential for success! If you think you may have prolapse or are already thinking about surgery, give us a call or contact us through our website.

 

References: 

Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women (Review). Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD003882. DOI: 10.1002/14651858.CD003882.pub4. 

Jarvis SK, Hallam TK, Lujic S et al. Peri-operative physiotherapy improves outcomes for undergoing incontinence and or prolapse surgery: Results of a randomised controlled trial. Australian and New Zealand J of Obstetrics an Gynaecology 2005;45: 300-303. 

McClurg D, Hilton P, Dolan L et al. Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study. Int Urogynecol J 2014;25:883-891. Doi: 10.1007/s00192-013-2301-x

What Our Patients Have to Say

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Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

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