When to See a Pelvic Floor PT After Prolapse Surgery

Given how common pelvic organ prolapse is — as many as 76% of women over the age of 18 have it — it's easy to feel like you're the only one who has had to deal with this uncomfortable issue. The symptoms of prolapse aren't something most people are willing to talk about, even with friends. Sensations like pelvic pressure or heaviness in the vagina, a bulge inside the vagina, or even the feeling that your pelvic organs could actually fall out can be too scary to share.

When it comes to talking to a medical professional about prolapse symptoms, it's clear that most people just don't. For some, their symptoms may not be bothersome enough to disrupt their day-to-day life. Others may be convinced that their pain or discomfort is "just part of being a woman," and not even realize that treatment is available.

If you're one of the many people who have had prolapse surgery — 300,000 people per year in the U.S. have the procedure— you may finally be feeling better. According to research, 70% of those who undergo the procedure are satisfied with the results, even 5 years later. Unfortunately, the other 30% face complications, side effects, new pelvic symptoms, and the need for additional surgical repairs. For these patients, getting expert support after surgery is critical.

Why post-op care for prolapse is so important:

• As many as 37-41% of patients report return of bulge symptoms within 5 years of undergoing surgery
• 8-11% will require a repeat surgery or ongoing pessary use to manage symptoms
• Up to 23% will develop stress urinary incontinence as a result of the surgery
• Prolapse surgery has been linked to vaginal shortening, sexual dysfunction, and trauma to surrounding nerves and structures
• Up to 9% of patients report newly developed dyspareunia (pain with sex) after prolapse surgery

Experiencing pelvic symptoms post-surgery? It's important to know that you're not alone and that getting the support of a pelvic floor physical therapist may help. Keep reading to find out why.

The Structures that Hold Your Pelvic Organs in Place

To understand the efficacy of prolapse surgery and what can happen after recovery, it helps to understand some pelvic anatomy. Two structures are responsible for supporting the organs that rest within your pelvis (i.e. the uterus, rectum, and bladder):

• The pelvic ligaments and connective tissue that surround your organs
• The pelvic floor musculature that lies beneath your organs

Prolapse occurs when either or both of these become compromised and our pelvic organs are able to move out of place. While a prolapse is not life-threatening, those symptoms can absolutely be life-altering. They can impact your tolerance to exercise, your quality of life, your libido, and your mental health.

Why Pelvic Floor PT is an Alternative to Surgery

Pelvic floor physical therapy is considered the first line of treatment for pelvic organ prolapse, which means that experts agree that anyone experiencing prolapse symptoms should see a PT who specializes in pelvic health.

Pelvic floor physical therapy sessions can involve one or many of the following treatments:

• Pelvic floor muscle training
• Biofeedback
• Electric stimulation (it's not scary, we promise)
• Vaginal weights or other tools
• Education on strategies that can reduce symptom
• Behavioral and lifestyle modifications to manage intra-abdominal pressure
• Full body strengthening and conditioning with a focus on the pelvic floor

Pelvic floor physical therapy is proven to have a positive effect on prolapse severity and symptoms. In one recent study, 55% of those with symptomatic prolapse found pelvic floor muscle strengthening to be successful in improving their symptoms. For those who don't get significant relief with pelvic floor PT, it may be because their prolapse symptoms are due to problems with the ligaments and connective tissue that surround their pelvic organs.

If pelvic ligaments and connective tissue aren't providing enough support, a good option to try is a pessary, which a pelvic floor physical therapist is happy to incorporate into your care plan. A pessary is basically a brace for your vaginal canal. It's inserted into the vagina and comes in a variety of shapes and sizes to ensure a comfortable, effective fit. If a doctor prescribed a pessary for you, you were likely fitted for one (often by a gynecologist or urogynecologist) to make sure it would work with your body.

Once fitted and in place, pessaries have been proven to:

• Reduce prolapse symptoms
• Prevent the progression of a prolapse
• Eliminate the need for surgery in up to 72% of those who use it properly and consistently

Surgery Can Be a Great Option for Some

If conservative methods aren't enough to help, surgery for pelvic organ prolapse can be an ideal option for the right candidate. There are many different surgical approaches and techniques available depending on the type of prolapse, the extent of symptoms, and your medical history.

Reconstructive surgery is the most common type of pelvic organ prolapse surgery and aims to restore organs to their correct position. This surgery can be performed through an incision in the vagina or an incision in the abdomen. Laparoscopy can also be used and involves making a smaller incision and using a tube-like surgical instrument to perform the procedure. Obliterative surgery for prolapse, which involves narrowing or closing the vaginal opening to keep the pelvic organs inside the body, is also highly effective although much less common.

As discussed above, prolapse surgery isn't always a total success, and many people experience a relapse and/or have new symptoms like bladder issues, pelvic pain, and sexual dysfunction.

What to Do if You Have Symptoms After Prolapse Surgery

Any time you experience chronic pelvic pain (including pain with sex) and/or have bladder or bowel issues, it's highly likely that a pelvic floor physical therapist can help. Pelvic floor physical therapists are trained in assessing your pelvic floor muscle function and helping you find ways to get lasting relief. While more research is needed to fully understand the role of pelvic floor physical therapy in supporting prolapse surgery recovery, one study found that patients who were provided pelvic floor muscle therapy in addition to lifestyle guidance experienced a better recovery.

As frustrating as it may be to have to go back to your doctor to talk about prolapse, we encourage you to ask about a referral to pelvic floor PT. Your PT can be a life-changing source of expertise and support as you work toward feeling good in your body again.