Pelvic Organ Prolapse Archives - Page 7 of 7 - Revitalize Physical Therapy

As a pelvic floor physical therapist, I am often asked this question by concerned women who may be experiencing pelvic organ prolapse (POP), a weakness disorder of the pelvic floor. POP is defined as “the descent of one or more of the anterior wall, posterior vaginal wall, the uterus (cervix) or the apex of the vagina (vaginal vault or cuff scar after hysterectomy)” by the International Continence Society.

There are several different types of POP, including:

Uterine/cervix prolapse- when the uterus prolapses directly down through the vagina
Cystocele/anterior prolapse- when the front vaginal wall is pushed down by the bladder
Rectocele/posterior prolapse-when the back vaginal wall is pushed down by the rectum
Rectal prolapse- when the rectal tissue prolapses through the anus. This is often related to chronic pushing and straining

Ordinarily, the pelvic floor organs are held in their upright position via intact endopelvic fascia and suspensory ligaments, especially the uterosacral ligament. Furthermore, the hammock-like levator ani (deep pelvic floor) muscles rest below the organs and prevent them from descending. Similar to postural muscles, the levator ani muscles provide continuous dynamic support to the pelvic floor, and they contract prior to movement to support the organs during movement. The ligaments serve as primary support from above and the pelvic floor muscles serve as backup support from below.

Many factors contribute to POP development. One such cause is pregnancy and childbirth. In fact, after an individual’s third vaginal delivery, the relative risk for POP development increases significantly. This risk rises even higher if instruments (forceps or vacuum) were used during delivery. Even those who have underwent C-section delivery are not necessarily in the clear either. Pregnancy alone even without vaginal delivery increases the risk of developing POP. This is due to the loosening effects created by the hormone relaxin which circulates in the blood at increased levels during pregnancy.

Other factors that contribute to POP development include chronic straining (ex. history of constipation), activities involving increased intra-abdominal pressure (ex. jobs that involve heavy lifting), obesity (which increases POP risk 30-50%), lower abdominal surgeries (which may disrupt the ligaments which provide support to the organs), aging, race (POP is seen more frequently in Hispanic women and less in Black/African American), and genetics.

POP severity is graded on a scale from zero (no prolapse) to four (the organ has completely extruded from the body, which is rare and requires surgery). Approximately 50% of women who have given birth experience POP at some point during their lives, and it is one of the leading reasons for women to undergo hysterectomy. In fact, 11.1% of community dwelling women undergo POP or incontinence surgery, however physical therapists are aiming to decrease these numbers through education about conservative treatment.

To Be Continued…

The Washington Post Article Includes Pelvic Floor Physical Therapy

You know you have successfully convinced your friends about the importance of your profession when not one, but several friends email you the latest major shout out to your profession- an excellent article in the Washington Post about the benefits of pelvic floor physical therapy (link to article). On December 22, 2015, Tara Bahrampour published her article, “The hidden medical epidemic few women have been willing to talk about, until now” which mainly addresses pelvic organ prolapse, descent of the pelvic floor organs. The article also discusses urinary and fecal incontinence.

I’ll recap some of the facts and statistics from the article that I most appreciated:

The age of onset of pelvic floor dysfunction is 56 years old for the average American female
10% of women who experience pelvic floor dysfunction eventually undergo surgical intervention
Pelvic floor muscles tear in approximately 10-15% of vaginal deliveries, thereby interfering with their ability to support the pelvic floor organs
As with many medical related matters, genetics plays a significant role in the development of prolapse, and the condition tends to run in families
Approximately 200,000 of the 320,000 annual pelvic floor corrective surgeries are prolapse related
Invest stock in Depends rather than Always, because more pads are sold for incontinence than for menstruation in the USA. (Even better- tell others about the benefits of pelvic floor physical therapy. No offense to incontinence products, but I look forward to the day when the success of my field will make them obsolete.)
In France, postpartum women are routinely referred for ten sessions of physical therapy after vaginal deliveries

While clearly there were many excellent points raised in the article, I will express my disappointment over one issue. In my humble opinion, pelvic floor physical therapy was only briefly touched upon as an effective intervention. Further elaboration about what to expect during the process and what physical therapists actually teach would have been helpful. There was too much emphasis on pessaries and surgery, and not enough discussion about Kegels, biofeedback, and endurance training. Therefore, I will take the liberty to do so right now. (That comes with the poetic license of writing a blogJ).

Pelvic floor muscle contractions are colloquially referred to as Kegels, and these are the subtle yet powerful exercises that pelvic floor physical therapists teach to appropriate patients who are undergoing a strengthening, or uptraining, program. Biofeedback is a tool utilized by some therapists to help patients create a mind-body connection. Oftentimes, women arrive at physical therapy without prior knowledge of the very existence of their pelvic floor muscles. It is therefore understandable that these women do not know how to properly contract these obscure and small muscles. Biofeedback provides visual cuing to patients, which makes it an especially helpful device when teaching visual learners. A patient is able to see on a computer screen or handheld biofeedback device the amount of electricity being generated by the muscles, represented by a bar or line, at rest, during contractions, and after contractions. Furthermore, the treating therapist can challenge the patient to squeeze the pelvic floor muscles and to hold the contraction for as long as they can. This allows the therapist to assess the patient’s muscle endurance, and it helps them set appropriate endurance goals. Often times, patients experience an “Aha moment” while using the biofeedback (“Oh! That’s what it looks like when I’m contracting the muscles properly? Ok cool, I get it now”), and there is nothing more rewarding for a teacher than watching the integration and understanding of knowledge unfold before their very eyes.

According to Bahrampour, “Pelvic floor physical therapy can help reduce the tension on the ligaments by strengthening the surrounding area, but the service can be hard to find.” If you are reading this blog, then you are one step ahead of the game, for you have already found a clinician who can help you or your loved ones. If you are geographically too far to benefit directly from the amazing services offered at Revitalize Physical Therapy, then it would be our pleasure to help direct you to someone closer who can help. Please contact us with any questions you may have- it is our pleasure to assist you along your healing journey.

Category: Pelvic Organ Prolapse

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The Washington Post Promotes Pelvic Floor Physical Therapy