
It’s important to highlight the significance of a Pelvic Floor Muscle Assessment as a crucial step in POP management. Research shows that up to 43% of women may bear down instead of lifting and squeezing their pelvic floor muscles, leading to incorrect muscle activation, and potentially exacerbating Pelvic Organ Prolapse (POP) symptoms. Many women thought they were elevating the pelvic floor and were surprised to see on ultrasound imaging that they were bearing down. Whether this bearing down pattern was a faulty motor control pattern or a lack of understanding of instruction. Of interest, women with POP appeared to bear down more than women with stress urinary incontinence.
Subjects who depressed their pelvic floor when instructed to elevate it appeared to adopt straining strategies via the generation of intra-abdominal pressure. This bearing-down pattern may have long-term negative implications for women with POP. Therefore, a thorough assessment of the pelvic floor muscles is essential to identify any weaknesses, asymmetries, or incorrect activation patterns that could contribute to POP or hinder treatment effectiveness.
A skilled Pelvic Health Physiotherapist can provide a comprehensive assessment of the pelvic floor muscles, including assessing resting tone (whether the tone is normal, increased, decreased, transient increased, or spasm), strength, endurance, and coordination. This can help to tailor an individualized treatment plan that addresses any weaknesses or asymmetries and teaches proper activation patterns for the pelvic floor muscles. With proper guidance and feedback, women can learn to effectively engage their pelvic floor muscles and prevent the bearing down pattern that can worsen POP symptoms.
Pelvic Floor Muscle Training (PFMT) is an evidence-based intervention that has been shown to improve pelvic floor muscle strength, endurance, and function in women with POP. Pelvic Floor Muscle Functional Training PFMFT a progression from isolated PFM contraction and has not been investigated in women with POP. PFMFT involves incorporating correct pelvic floor muscle contraction into activities of daily living, such as breathing, sitting, standing, and walking. The goal is to coordinate the pelvic floor muscles with other muscle groups of the body, elevating and best supporting the pelvic organs in everyday activities of life. However, the effectiveness of PFMFT can be limited if the pelvic floor muscles are not activated correctly. Therefore, it is crucial to have a Pelvic Floor Muscle Assessment before starting any PFMT program. This allows the Pelvic Health Physiotherapist to identify any incorrect activation patterns and provide feedback on how to correct them.
In addition to PFMT, other conservative management strategies for POP include lifestyle modifications such as weight loss, avoiding heavy lifting, and treating constipation. Pessaries, which are devices inserted into the vagina to support the pelvic organs, may also be used in some cases. Surgery may be considered in severe cases, but it is generally reserved for those who have tried conservative management without success. In conclusion, POP is a common condition that can significantly impact a woman’s quality of life. However, with early detection and appropriate management, women can prevent and manage their symptoms effectively. A thorough Pelvic Floor Muscle Assessment is a crucial step in POP management, as it helps to identify any weaknesses or incorrect activation patterns that may contribute to POP symptoms. Working with a skilled Pelvic Health Physiotherapist can provide women with individualized treatment plans that incorporate PFMT and other conservative management strategies to improve pelvic floor muscle function and alleviate symptoms. With proper care and support, women can maintain a strong, healthy body and continue to lead active and fulfilling lives.
Reference:
Thompson JA, O’Sullivan PB. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. Int Urogynecol J Pelvic Floor Dysfunct. 2003 Jun;14(2):84-8.
Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama’i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021 Jun;40(5):1217-1260.