Introduction
Pelvic organ prolapse (POP) is a distressing and common symptom in the female population and has been reported in up to 10% of the adult female population when based on a bulging sensation into the vagina.1 However, the prevalence of anatomic POP is higher; a population-based study which included pelvic examinations showed a prevalence of 31% among women aged 20-59.2POP is defined as a loss of support for the vaginal walls, the uterus, bladder, colon and rectum resulting in partial or complete prolapse of the affected organs coming down or through the vagina.3 The prevalence of POP in the early postpartum period is sparsely investigated. According to Reimers et al,4 anatomic POP stages ≥2 were found in 9% of primiparous women six weeks postpartum with no significant difference between women after vaginal delivery (VD) or cesarean section (CS). In another study evaluating anatomic POP in primiparous women at 5-22 weeks postpartum stage 2 POP was noted in 35.5% of the women, of whom 7.6% had this after CS vs. 43% for VD .5 We recently showed an overall prevalence of self-reported POP symptoms 6-10 weeks after first childbirth of 29%, thereof 33% in the VD- and 12% in the CS groups.6 POP symptoms in the immediate postpartum period have been found to be related to pre-labor maternal characteristics, such as a larger levator hiatal area, a longer distance from the urethral meatus to the anus and a more caudal position of the anterior vaginal wall at mid-pregnancy.4 Later in life, POP has also been associated with a low body mass index, higher parity, higher birthweights, operative and instrumental VD, levator ani trauma and constipation.7–10
The International Consultation on Incontinence concluded that there is 1A level of evidence for pelvic floor muscle training (PFMT) to be useful as first line treatment for POP stages I-III in the general population.11 However, there is scant knowledge on the effects of PFMT in the early postpartum period. In a systematic review and meta-analysis outcomes with regard to postpartum POP symptoms have been reported.12 The authors concluded that quality of evidence was low for the primary outcome of POP symptoms, and that the question of whether postpartum PFMT has a beneficial effect on POP symptoms remains unanswered. The aim of this study was to evaluate the effects of individualized, postpartum physiotherapist-guided PFMT on the rate of symptomatic POP and perceived bother.