An abstract recently presented at the International Continence Society Conference in Glasgow (September, 2011) won the Prize Award of Best Clinical Abstract. Well respected Melbourne physiotherapist Dr Helena Frawley, from the University of Melbourne was a co-author on this paper.
The article titled “A multi-centre randomized controlled trial of a pelvic floor muscle training intervention for women with pelvic organ prolapse” (Hagen, Stark, Glazener, Sinclair, Wilson, Norrie, Dickson, Logan, Frawley, Moore, Walker) has confirmed via a randomized controlled trial what Continence and Women’s Health Physiotherapists have been aware of for many years –
…..that educating women comprehensively about the conservative management of pelvic organ prolapse by Continence and Women’s Health physiotherapists does make a significant difference in reducing prolapse symptoms, is cost-effective as an intervention and should be recommended as first-line management for prolapse.
The study was conducted through many centres around the world and was randomized meaning that a computer allocated the participants to each of the groups. There was a control group – where the women received a lifestyle advice sheet through the post only and an intervention group which received pelvic floor muscle training (PFMT) at 5 appointments over 16 weeks from an appropriately trained Physiotherapist, on top of the lifestyle advice. The lifestyle advice would have probably included: teaching the ‘knack’ – engaging the pelvic floor muscles prior to functional activities which increase intra-abdominal pressure such as coughing, sneezing, lifting, bending etc – teaching correct bladder and bowel postures and habits and advice about safe exercise, sport and lifting limits.
This research is empowering for women as it validates the value of conservative, self-directed management of prolapse following expert instruction and training from a Continence and Women’s Health Physiotherapist – with as few as 5 treatment sessions. Many women are fearful of undergoing surgery for prolapse and knowing that conservative interventions do make a difference will ensure that they can ask their doctor about seeking help from a physiotherapist as a first line of treatment.
Of course, there are degrees of prolapse and there are many women for whom surgery is unavoidable. But the knowledge they will have gained from seeing a physiotherapist and learning these strategies, as well as having correct pelvic floor muscle training and safe abdominal muscle strengthening, will enhance the chances of ensuring that their surgery will have a greater chance of lasting their lifetime. This of course was the premise on which I wrote my book “Pelvic Floor Recovery: A Physiotherapy Guide for Gynaecological Repair Surgery”.
Helping women to take responsibility for their repair once the surgeon has done their part has been a long-term goal for me. So many women, in their endeavours to get ‘fit and strong’ after their surgery, then find that over-zealous exercising at Pilates, yoga or the gym has, in fact, caused the surgery to fail. What I have found over the years is that women are hungry for the correct information to assist in the maintenance of their operation and the feedback from patients once they have read the book is refreshing and encouraging. Another book which is very helpful in advising about ‘Pelvic Floor Safe’ exercising is “Inside Out” by Michelle Kenway.
So thank you to all the researchers in this multi-centre trial for their hard work and I commend to all in the medical fraternity this article and encourage them to exercise optimal duty of care by recommending that all patients with pelvic organ prolapse initially undergo conservative management initially (assessment and treatment) from a Continence and Women’s Health Physiotherapist.