Want to do everything you can to avoid repeat prolapse and have a successful repair?
Unfortunately successful prolapse surgery isn’t guaranteed. Some women have prolapse surgery only to find that their prolapse returns months to years later.
Prolapse surgery can repair the stretched tissues that contribute to prolapse. Surgery doesn’t repair the pelvic floor muscle problems and individual risk factors that also caused your prolapse in the first place.
Gynecologists are increasingly working with pelvic floor physiotherapists to address the problems that surgery doesn’t fix to help their patients gain the best possible long-term outcomes from prolapse surgery. This is because pelvic floor physiotherapy can improve prolapse surgery outcomes 1.
Read on to learn Physiotherapy:
- Preparation for prolapse surgery
- Treatment for recovery after prolapse surgery
Prolapse Exercises e-Book
International best selling prolapse exercise guide for women with prolapse and after prolapse surgery.
Prolapse Exercises teaches you how to:
- Exercise safely after prolapse surgery
- Reduce your risk or repeat prolapse
- Avoid unsafe exercises
- Choose pelvic floor safe exercises
- Reduce your risk of prolapse worsening
- Improve prolapse support
- Increase your strength and fitness
- Strengthen your core
- Lose weight
Physiotherapy Preparation for Prolapse Surgery
You may be referred to a pelvic floor physiotherapist before your surgery.
Here’s what you can expect …
Physiotherapy treatment before prolapse surgery involves 2 main approaches:
1. Assessing and Training Your Pelvic Floor Muscles
Your Physiotherapist will help you train your pelvic floor muscles before your surgery.
Why the need for pelvic floor training before prolapse surgery?
The pelvic floor muscles work with the strong tissues that prevent prolapse. Your surgeon will repair these strong tissues however repaired tissues can stretch and fail causing repeat prolapse. They will be more likely to stretch and fail if the pelvic floor muscles aren’t working well too.
Pelvic floor exercises (Kegels) before surgery increase the strength of pelvic floor muscles after prolapse surgery 1. Training your pelvic floor muscles so that they’re working well before prolapse surgery aims to establish a good hammock of support to hold up your pelvic organs as your tissues heal and then as you become more active long-term.
Training your pelvic floor muscles before prolapse surgery is just like doing knee strengthening exercises to prepare for knee surgery. Knee strengthening leg exercises can help support the knee after surgery.
When to start pelvic floor training?
Pelvic floor exercises (Kegels) for prolapse surgery are ideally started a number of months before prolapse surgery. The more time you have to prepare, the better. It can take up to 5 months to strengthen very weak pelvic floor muscles so start your rehab as soon as you can.
If you’re unsure about how to train your pelvic floor see a pelvic floor physiotherapist who can assess your pelvic floor muscles and guide your rehabilitation.
2. Identifying and Modifying Your Lifestyle Risk Factors
It’s helpful to address your prolapse risk factors before surgery to improve your surgical outcomes.
You may have risk factors that load your pelvic floor contributing to prolapse including:
- Constipation, heavy lifting, obesity 2
- Inappropriate general exercises e.g. high impact exercises or intense core abdominal exercises
- Coughing with chest problems, asthma, smoking or hay fever
Your Physiotherapist can help you identify and manage your risk factors for repeat prolapse before your surgery with the goal of improving your long-term results.
For example if you’re accustomed to straining with constipation, it’s well worth learning and practicing good bowel management and correct bowel emptying technique rather than trying to manage constipation during your post operative recovery.
Some daily activities and actions increase pressure on the pelvic floor much more than others for example coughing, sneezing and heavy lifting. Knowing how to manage these factors before your surgery will help you modify these risks during your recovery after prolapse surgery.
Physiotherapy Treatment for Recovery After Prolapse Surgery
During your in-hospital stay your Physiotherapist helps you know:
- How to rest your pelvic floor to promote recovery
- Your daily routine for walking and sitting out of bed
- Techniques to protect your prolapse repair especially if you need to cough or sneeze
- Most comfortable resting positions
- How to minimize your risk of lower back pain
- How to move in and out of bed without straining your prolapse repair
2. Physiotherapy After Discharge From Hospital
Physiotherapy treatment after prolapse surgery when you’ve been discharged from hospital can assist in a number of ways with your overall recovery.
1. Progressive pelvic floor muscle training
Most women commence pelvic floor training approximately 4-6 weeks after prolapse surgery however this varies according to the surgical procedure, post operative complications and the surgeon’s protocol. Some women are advised to wait longer before recommencing pelvic floor exercises.
Your Physiotherapist will work with you implementing your surgeon’s guidelines for recommencing pelvic floor exercises.
Pelvic floor training starts with brief gentle pelvic floor exercises lying down. Exercises are then progressed and training in upright positions (sitting and standing) are encouraged. Pelvic floor exercises after prolapse surgery should always feel comfortable and pain free.
Your pelvic floor training will initially focus on maintaining your pelvic floor muscles while your tissues repair. Training progresses to maximize your pelvic floor strength and support before prescription of a long term maintenance program.
Post operative physiotherapy treatment also involves helping women with post operative problems that may arise.
Women can experience a variety of problems after prolapse surgery such problems with bladder emptying, constipation, lower back pain or bladder control problems. You can read access more information in the further reading section below.
Your Physiotherapist will understand how to treat these problems and help you manage them should they arise.
3. Advice for safe return to work, exercise and regular activities
Gradual return to regular activities is usually paced to match the rate of tissue healing and overall recovery. You may be provided with specific activity guidelines form your specialist to follow. Your Physiotherapist will work within these guidelines.
Your Physiotherapist will guide you through:
- Post operative return to pelvic floor safe general fitness and strength exercises.
- How to modify your return to work which is particularly important for women who work in physically demanding occupations. Sometimes your Physiotherapist will liaise with your employer to help you organize appropriate work hours and safe duties for your return to work.
- General activities of daily living such as safe lifting looking after children/grandchildren, safe bending during home duties such as house cleaning, gardening and shopping.
Research tells us that women who receive pre and post operative physiotherapy for prolapse surgery have better outcomes in terms of better quality of life, decreased urinary incontinence and stronger pelvic floor muscles 1. Good preparation and post operative physiotherapy management can help you ensure that you get the best possible result and ensure your complete recovery after prolapse surgery.
1. Jarvis S, Hallam T et al (2005) Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: results of a randomised controlled trial. Aust N Z J Obstet Gynaecol., 45(4), pp. 300-3.
2. A Miedel A, Tegerstedt G, et al (2009) Nonobstetric risk factors for symptomatic pelvic organ prolapse Obstet Gynecol, 113, pp. 1089-1097.
3. Kruger J, Hayward L et al (2013) Design and development of a novel intra-vaginal pressure sensor. Int Urogynecol, 24(10), pp. 1715-21.