Skip to main content

Advertisement

Log in

The Past, Present and Future of POP and Physical Therapy

  • Pelvic Organ Prolapse (KL Noblett, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Pelvic organ prolapse (POP) is a very common condition of women worldwide. Research is ongoing to determine the “perfect” surgery for anatomical correction of the various support problems within the pelvic floor. In tandem to the surgical research, there are ongoing studies investigating the role of pelvic floor physical therapy as conservative management to prevent surgery or the need for recurrent repairs after a surgical procedure. As the research matures, there is stronger evidence that pelvic floor physical therapy may be efficacious in the management of POP. A review of recent research supports this finding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012;119(4):852–60.

    Article  PubMed  Google Scholar 

  2. Jelovsek JE, Maher C, Barber MD. Lancet. 2007;369(9566):1027–38.

    Article  PubMed  Google Scholar 

  3. Cardozo L. Prolapse. In: Whitfield CR, Dewhurst J, editors. Dewhurst’s Textbook of Obstetrics and Gynaecology for Postgraduates. 5th ed. Oxford: Blackwell Science Inc.; 1995.

    Google Scholar 

  4. Maher C et al. Surgical management of pelvic organ prolapsed. In: Abrams C, Khoury W, editors. 5th International Consultation on Incontinence. Paris: Health Publication Ltd.; 2013.

    Google Scholar 

  5. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003;188(1):108–15.

    Article  PubMed  Google Scholar 

  6. Olsen AL et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  PubMed  Google Scholar 

  7. Elkardy EA et al. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol. 2003;189:1551–8.

    Article  Google Scholar 

  8. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment for urinary incontinence in women. Cochrane Database Syst Rev. 2010;20, CD005654.

    Google Scholar 

  9. Hagan S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;12, CD003882.

    Google Scholar 

  10. Pauls R et al. Impact of physical therapy on quality of life and function after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg. 2013;19(5):271–7.

    Article  PubMed  Google Scholar 

  11. Barber MD et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapsed: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34.

    Article  CAS  PubMed  Google Scholar 

  12. McClurg D et al. Pelvic floor muscle training as an adjunct to prolapsed surgery: a randomised feasibility study. Int Urogynecol J. 2014. doi:10.1007/s00192-013-2301-x.

    PubMed Central  PubMed  Google Scholar 

  13. Lakeman MME et al. Peri-operative physiotherapy to prevent recurrent symptoms and treatment following prolapsed surgery: supported by evidence or not? Int Urogynecol J. 2013;24(3):371–5.

    Article  PubMed  Google Scholar 

  14. Hagan S et al. Individualised pelvic floor muscle training in women with pelvic organ prolapsed (POPPY): a multicentre randomised controlled trial. Lancet. 2014;383(9919):796–806. A large, multicenter, well designed study of PFMT for the treatment of POP with a long-term follow-up supporting a change to clinical practice.

    Article  Google Scholar 

  15. Wiegersma M. Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care. Maturitas. 2014;77:168–73.

    Article  PubMed  Google Scholar 

  16. Kashyap R, Jain V, Singh A. Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapsed. Int J Gynaecol Obstet. 2013;121:69–73.

    Article  PubMed  Google Scholar 

  17. Miedel A et al. A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1593–601.

    Article  PubMed  Google Scholar 

  18. Weber AM et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):178–86.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Jarvis SK et al. Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapsed surgery: results of a randomized controlled trial. Aust N Z J Obstet Gynaecol. 2005;45(4):300–3.

    Article  PubMed  Google Scholar 

  20. Frawley HC. Perioperative physiotherapy as an adjunct to prolapsed surgery: an in-depth analysis of a study with a negative result. Curr Bladder Dysfunct Rep. 2010;5:48–55.

    Article  Google Scholar 

  21. Braekken IH et al. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e1–e7.

    Article  Google Scholar 

  22. Hagen S. A randomised controlled of pelvic floor muscle training for stage I and II pelvic organ prolapse. Int Urogynecol J. 2009;20:45–51.

    Article  Google Scholar 

  23. Piya-Anant M et al. Integrated health research program for the Thai elderly: prevalence of genital prolapsed and effectiveness of pelvic floor exercises to prevent worsening of genital prolapsed in elderly women. J Med Assoc Thai. 2003;86:609–15.

    Google Scholar 

  24. Hay-Smith EJ. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011;12, CD009508.

    PubMed  Google Scholar 

  25. Bo K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012;30(4):437–43.

    Article  PubMed  Google Scholar 

  26. Wl H et al. Physical activity and public health: updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34.

    Article  Google Scholar 

  27. Bo K, Morkved S. Motor learning. In: Bo K, Morkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. Edinburgh: Churchill Livingstone Elsevier; 2007.

    Google Scholar 

  28. Hyland G, Hay-Smith J, Treharne G. Women’s experiences of doing long-term pelvic floor muscle exercises for the treatment of pelvic organ prolapse symptoms. Int Urogynecol J. 2014;25:265–71.

    Article  PubMed  Google Scholar 

  29. Tibaek S, Dehlendorff C. Do women with pelvic floor dysfunction referred by gynaecologists and urologists at hospitals complete a pelvic floor muscle training programme? A retrospective study, 1992-2008. Int Urogynecol J. 2013;24:1361–9.

    Article  PubMed  Google Scholar 

  30. Goldthwait JE. The relation of posture to human efficiency and the influence of poise upon the support and function of the viscera. Boston Med Surg J. 1909;161(2):839–49. In spite of being early 1900 literature it gives the current researcher information to consider when developing PFMT programs.

    Article  Google Scholar 

  31. Iason AH. Hernia. Philadelphia: The Blakiston Company; 1941.

    Google Scholar 

  32. Penrose CB. A Text-book of Diseases of Women. Philadelphia: W. B. Saunders; 1908.

    Google Scholar 

  33. Gilliam DT. A Text-book of Practical Gynecology. Philadelphia: F. A. Davis Company; 1908. A very simple explanation, yet appropriate, for current day understanding of the importance of the abdominal wall in pelvic organ support.

    Google Scholar 

  34. Hirst JC. A Manual of Gynecology. Philadelphia: W. B. Saunders Company; 1925.

    Google Scholar 

  35. DeLee JB. The Principles and Practice of Obstetrics. Philadelphia: W. B. Saunders Company; 1933.

    Google Scholar 

  36. Anspach BM. Gynecology. Philadelphia: J. B. Lippincott & Company; 1921.

    Google Scholar 

  37. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J. 2007;18:321–8.

    Article  Google Scholar 

  38. Ranney B. Diastasis recti and umbilical hernia. Causes, recognition and repair. S D J Med. 1990;43(10):5–8.

    CAS  PubMed  Google Scholar 

  39. Mast BA. Alleviation of urinary incontinence after abdominoplasty. Ann Plast Surg. 1999;42(4):456–7.

    Article  CAS  PubMed  Google Scholar 

  40. Guneren E et al. Urinary incontinence was improved after abdominoplasty using a very low incision. Plast Reconstr Surg. 1999;104(5):1582–4.

    Article  CAS  PubMed  Google Scholar 

  41. Widgerow AD. Abdominoplasty following colostomy. Ann Plast Surg. 1992;29(5):454–6.

    Article  CAS  PubMed  Google Scholar 

  42. “posture.” Dorland’s Illustrated Medical Dictionary. 30th ed. Elsevier, Philadelphia; 2003.

  43. “posture, normal.” Mosby’s Dental Dictionary. 2nd ed. Elsevier, Philadelphia; 2008.

  44. Keith A. Man’s posture: its evolution and disorders. Br Med J. 1923;1(3249):587–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Mattox TF et al. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol. 2000;183:1381–4.

    Article  CAS  PubMed  Google Scholar 

  46. Nguyen JK et al. Lumbosacral spine and pelvic inlet changes associated with pelvic organ prolapse. Obstet Gynecol. 2000;95(3):332–6.

    Article  CAS  PubMed  Google Scholar 

  47. Lind LR, Lucente V, Kohn N. Thoracic kyphosis and the prevalence of advanced uterine prolapse. Obstet Gynecol. 1996;87:605–9.

    Article  CAS  PubMed  Google Scholar 

  48. Brubaker L et al. Pelvic floor fitness using lay instructors. Obstet Gynecol. 2008;111:1298–304.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Rhonda K. Kotarinos and Elizabeth Kotarinos declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rhonda K. Kotarinos.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kotarinos, R.K., Kotarinos, E. The Past, Present and Future of POP and Physical Therapy. Curr Obstet Gynecol Rep 3, 180–185 (2014). https://doi.org/10.1007/s13669-014-0088-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-014-0088-5

Keywords

Navigation