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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

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A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

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Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

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Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

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I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

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Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

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