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.