One Third of Childbirth Repair Surgery Fails?….Why?

shutterstock_55118254By Marianne Ryan PT, OCS
Clinical Director MRPT Physical Therapy

Did you know that “a common surgery often performed to repair damage caused by childbirth fails one-third of patients within seven years, a new study shows”?

Yup, it is the surgery women have done to cure incontinence and other problems caused by pelvic organ prolapse (POP), which often occurs as a result of childbirth.

An article written by Liz Szabo, for USA Today, goes on to explain:

1. “In nearly one-third of cases, surgical repair failed or women saw symptoms return”

2. “About 225,000 women undergo some kind of pelvic organ prolapse surgery each year”

3. “Some surgeries can be prevented; pelvic physical therapy can cure many milder cases”

Szabo also mentioned “about one in four women suffer either prolapse or incontinence at some point, and studies show that 11% to 19% of women undergo surgery for it.”

Let me repeat: 25% of all women develop incontinence or pelvic organ prolapse. That is one out of four of your female friends!

Cheryl Iglesia of the Georgetown University School of Medicine was quoted in Szabo’s article as saying, vaginal deliveries increase the risk of developing pelvic organ prolapse (POP), and in the future doctors will need to perform C-sections rather then vaginal deliveries for women at high risk for prolapse.

Yikes! Iglesia’s answer to the problem is more surgery and more C-sections?

What about more physical therapy?

The article does mention that studies show that “pelvic physical therapy, which includes Kegel exercises that strengthen pelvic floor muscles, can reverse many mild cases of prolapse”, but there is no mention on how pelvic physical therapy can prevent POP. There are also studies that show pelvic physical therapy can reduce the level of prolapse, for example reduce a grade 3 to a grade 2, etc.

If pelvic physical therapy can reverse pelvic organ prolapse, why aren’t women knocking down my door to get physical therapy treatment? 

Why? Because I don’t think we take postpartum recovery seriously in our country. Women traditionally receive excellent prenatal and obstetric care during delivery, but postpartum care is lacking. 6 Weeks after delivery, women are usually given a pat on the back and told “good job done” and that they can resume sexual activity. What about postpartum rehabilitation? In our country women are left to fend on their own after delivery.

In other countries, such as France, they take postnatal care seriously. Did you know all French women receive free physical therapy after they give birth. I have been told by some of my patients that postpartum physical therapy is “mandatory” in France and they go for about 20 visits focusing on rehabilitating the pelvic floor and abdominal muscles after every baby they deliver. 
In a light hearted article written by Claire Lundberg, “The French Government Wants to Tone My Vagina”, for Slate Magazine, Lundberg discusses the positive experience she had with the French postpartum rehabilitation program called la rééducation périnéale and how she was glad “a medical professional was paying attention to what happened down there.”

What about more physical therapy after one of these surgeries?

Did you know that after having surgery for pelvic organ prolapse most women do not receive pelvic physical therapy?

I recently asked a urogynocologist, who refers patients to my practice, why she did not refer her patients to physical therapy after preforming these types of surgeries. The answer was that she did not think it was necessary, and was not convinced that physical therapy would help the patient recover. 
It is common practice to go for physical therapy treatment after surgery on other body parts, like the shoulder or knee; why isn’t is considered part of the rehabilitation process with pelvic surgeries? 
If surgeons started sending their patients for physical therapy treatment after prolapse surgery; doesn’t it follow logic that it would help them reach better outcomes? Maybe physical therapy treatment could prevent surgical failures? 
(Just in case you didn’t know, you can go directly to a physical therapist without a doctor’s referral in most states.)

More surgery is not the answer. More physical therapy is the key to solving pelvic organ prolapse. 

References:

http://www.usatoday.com/story/news/nation/2013/05/22/common-pelvic-surgery/2325055/

http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.html

 

9 thoughts on “One Third of Childbirth Repair Surgery Fails?….Why?

  1. Lynn Schulte-Leech

    Awesome article Marianne! It’s sad that doctors aren’t aware how we can help them improve surgical outcomes. What’s even more sad is PT can most likely prevent the need of surgery in the first place! Thanks for bringing this to our awareness!

    Reply
  2. Zayna

    Thank you for spreading awareness of this neglected issue. I’m a belly dance instructor and notice almost every day that the majority of women are so disconnected from their own bodies. Many, regardless of age, don’t even dare to activate their muscles “down there” because they somehow consider it inappropiate. But pelvic strength is absolutely necessary – it enables us to dance mindfully (it makes a stunning visual difference when those muscles are active), lift heavy weights (I’m into bodybuilding training as well, and am grateful for the ability to squat deeply without worrying about my pelvic muscles) and of course, most important, recover from giving birth. Sadly, few people know what physical therapy even means, especially in context of post-partum treatment. Exactly what kind of treatment/training is necessary in your opinion? Is basically it the same for all women or are there other factors to consider?

    Reply
  3. MRPT Physical Therapy Post author

    Thanks for your comment Zayna. Yes, I think we do have many “shy” people in our country who freak out whenever the “V” word is mentioned.
    Muscles in the pelvis get stretches out and injured during childbirth and they deserve the same respect as other parts of the body. If a typical person took a fall and injured their hamstring muscle, they wouldn’t think twice about going to a physical therapist for soft tissue mobilizations and a progressive exercise program. Why don’t they think it is appropriate for the pelvis after childbirth?
    As far as physical therapy treatment goes, each case is treated on an individual basis because there can be several different types of conditions that can occur from childbirth.
    I hope to make more people aware of how pelvic physical therapy can assist in a full recovery after childbirth.
    Please follow our blog to read future blogs on this subject. Also, feel free to look at earlier blog posts.

    Reply
  4. Akotimolla Mary

    Thanks Marianne Ryan.This is one of the very important thou a sensitive issue to talk about. In my country currently people don’t take postpartum check up as a serous thing.In fact the women themselves take it as a waste of their time,for them when the baby is born vaginally then there is no need to go back to a midwife/a doctor except to take the baby at 6weeks for immunization(1st DPT & Polio).Until recently we are trying so hard to let the mothers appreciate that there is need for them the get back to the health facility for postnatal care 6 hours,6 days,6 weeks and 6 month. There is great need for ongoing sensitization to our population/mothers who are not only ignorant about their rights, but also have poor health seeking behavior.

    Reply
    1. MRPT Physical Therapy Post author

      I agree with you Akotimolla, postpartum health is very important and not taken seriously in many countries. I am hoping to spread awareness of physical therapy treatment options for new moms and not so new moms.
      Many of the symptoms and problems that develop from pelvic organ prolapse (POP) does not show up for years after childbirth. There is an Australian study that showed women who reported normal voiding habits right after giving birth developed incontinence 6 years after childbirth. Patients of mine are often shocked when I explain to them that their pelvic dysfunctions are most likely a direct result from childbirth, even if it was 10, 20, 30 or more years ago. Awareness will help these women and their doctors to connect the dots.
      The good news for women is that physical therapy can prevent and reverse some cases of pelvic organ prolapse, no matter what age they are…my favorite motto is “once postpartum, always postpartum, which means it is never too late to try conservative treatment.
      BTW, what country are you from?

      Reply
      1. Akotimolla Mary

        Thanks again Marianne Ryan. I could not agree with you more. I am from Uganda(East Africa). I promise you I will help you spread that gospel because to me there is nothing as painful as seeing women become social outcast as a result of afterbirth complication as it is the case in my country. I can tell you that cases of Vesico Vaginal Fistula(VVF) and even Recto Vaginal Fistula(RVF) is not uncommon in my country. I thing similar study ought be done here in Uganda and our student midwives need to be taught and to take seriously postpartum health for the benefit of our women.

  5. Pingback: Prevent Pelvic Organ Prolapse (POP) with Better Birthing Techniques. | MRPT Physical Therapy

  6. RippedMuscle

    Everything said made a great deal of sense. But, consider this,
    suppose you were to create a awesome post title?
    I ain’t suggesting your content isn’t good., however what if you added something to possibly grab people’s attention? I mean One Third of Childbirth Repair Surgery Fails?….Why?
    | MRPT Physical Therapy is kinda boring. You could peek at Yahoo’s
    front page and see how they create news titles to get
    viewers to open the links. You might add a related video
    or a picture or two to get people interested about everything’ve got to say.

    Just my opinion, it would make your posts a little bit more interesting.

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s