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Pelvic floor physical therapy’s groundbreaking study

Does it help women after prolapse surgery?

Pelvic organ prolapse is a health issue faced by many women.

In fact, Marc Ashby, MD, a urogynecologist with Southwest Ohio Unrogyenolcogy says that nearly one out of three women have some form of pelvic organ prolapse and unfortunately, it’s often not a subject that they want to openly discuss.

“Pelvic organ prolapse is really an epidemic — it can greatly effect a woman’s quality of life,” Dr. Ashby said. “They feel embarrassed and uncomfortable (both physically and mentally) and their self-esteem, time with family and friends and even their intimacy can be affected.” While both surgical and non-surgical treatment options are available, more and more women are turning to prolapse surgery in hopes of getting their life back.

Now, in addition to surgery, a groundbreaking study conducted by Rachel Pauls, MD, a urogynecologist with Cincinnati Urogynecology Associates, a TriHealth physician partner, shows that adding pelvic floor physical therapy following prolapse surgery can build better muscle strength, control and relaxation and actually help women to regain a better quality of life.

“We have long known that physical therapy helps patients who have had orthopedic surgery,” said Dr. Pauls. “I wanted to see if it would help women after prolapse surgery. This is the first study of its kind.”

Dr. Pauls conducted the three-year randomized study with 50 participants — the median age of the study participants was 58 years old and the average body mass index was 28. All had delivered babies vaginally. Half of the women in the study group were enrolled in 12 weeks of physical therapy after surgery, and the other half were not. Physical therapist Kathleen Novicki helped design the study and her therapists at the Center for Pelvic Floor and Core Rehabilitation Center locations at Good Samaritan Hospital and West Chester treated all patients. Muscle function in the physical therapy subjects was superior when assessed after that time. The study also included a survey that rated women’s satisfaction with the surgery and their health outcomes.

“Overall, results indicated that women who had pelvic floor physical therapy had much better muscle coordination in strengthening and relaxing muscles as measured by electromyography (EMG), which tests electrical activity in muscles,” said Pauls. “Having strong pelvic floor muscles that can also be relaxed are especially important for emptying the bladder as well as enjoying sex.”

While Dr. Ashby agreed with the findings of his colleague’s study, he went a step further. “I think the study was very well done and does suggest that there is some benefit to pelvic floor therapy following prolapse surgery,” said Dr. Ashby. “I think that there could even be some benefit in adding additional therapy sessions before the surgery as well.”

Pelvic floor physical therapy has been used for a variety of complaints related to pelvic floor dysfunction, including urinary incontinence, fecal incontinence, pelvic pain and bladder pain. “However,” explained Dr. Pauls, “we lack an understanding of the role that physical therapy can play following vaginal reconstruction.” She says that despite evidence in other surgical fields that therapy improves muscle function and quality of life after joint replacement, the available literature assessing the impact of physical therapy impact following pelvic surgery has been scant.

In conclusion, although long-term data are not yet available, study results support that pelvic floor physical therapy should be offered as an option to all women undergoing vaginal reconstructive surgery. “The rationale is the global improvement in coordination of the pelvic floor seen in the study with potential benefit to an improved quality of life,” said Dr. Pauls. “Future studies may help shed more light on the advantages of this kind of therapy.”

Dr. Pauls conducted the study on a grant from the TriHealth Medical Education Research Fund. She presented the findings at the Society for Gynecologic Surgeons convention recently in Charleston, South Carolina. The Female Pelvic Medicine and Reconstructive Surgery journal features the research in its September/October issue.

What is pelvic organ prolapse?

“Think of it like a hernia,” said Dr. Ashby, “where the pelvic organs have dropped/lowered from their normal position.”

What are the risk factors?

While vaginal childbirth is typically the most common risk factor for developing pelvic organ prolapse, other factor can include a family history of pelvic organ prolapse, advancing age and obesity and a conditions that chronically increase intra-abdominal pressure, such as asthma or constipation.

What are the symptoms?

In mild cases, symptoms include feeling a heaviness or pressure in the pelvic area, urinary incontinence, constipation or overactive bladder. In severe cases, patients report seeing or feeling a “ball” protruding from the vagina. Thankfully, mild cases of pelvic organ prolapse rarely affects sexual function but severe cases can lead to a decrease in sexual activity.

What is a urogynecologist?

A urogynecologist specializes in the treatment of women with pelvic floor disorders such as urinary or fecal incontinence and prolapse (bulging or falling) of the vagina, bladder and/or the uterus.

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