Pelvic Organ Prolapse, Therapeutic Intervention, and Myofascial Release
By Walt Fritz, PT
Pelvic organ prolapse is a common referral to a physical therapist, with pelvic floor musculature strengthening the most common intervention. But there are other views on causative factors, as well as treatment approaches.
When one researches pelvic organ prolapse on the major Internet medical sites, muscular weakness is an oft repeated cause for many prolapse issues. Weakness of the musculature or overstretching of lower pelvis soft tissue can certainly be at the root of prolapse. Weakness is said to result from childbirth, including cesarean section, as well as a myriad of other pelvic surgeries. What is missing from these explanations is the profound tightness that can develop secondary to surgeries and childbirth, especially scar tissue tightness. It can be this tightness that FORCES an organ to move from its original position. While traditional strengthening, including various types of electrical stimulation, can improve certain issues, often the treatment is incomplete. Unless the tightness is addressed, an increase in tightness may be the result.
Myofascial release is an accepted therapeutic modality practiced by physical therapist, occupational therapists, and massage therapists. Having a bit of an education regarding the most effective types of myofascial release is in order, as there are many variations. Both direct and indirect myofascial release have been used for decades, first by osteopaths and eventually therapists. Direct myofascial release involves a deeper, more forceful type of pressure that is typically short in duration. Indirect myofascial release is gentler and is typically sustained for a longer time period. While I was trained in both methods, I find that the indirect approach is both better tolerated and also provides more lasting results. A trained myofascial release therapist will be proficient in evaluating and treating a wide variety of pelvic pain and dysfunction syndromes. A recent GoogleScholar search gives a large number of examples of myofascial release being used effectively in the treatment of pelvic organ prolapsed.
You may be wondering what myofascial release treatment is like? While all therapists evaluate and treat in different ways, there should be some commonality. After a thorough history taking, your therapist may perform a head to toe evaluation, in standing, sitting face up and face down. This is an important aspect of myofascial release, as tightness, injury, or surgery in other areas of the body can influence the pelvis. They will then narrow the scope of their evaluation to the area of dysfunction. Gentle pressure into the lower abdomen will often reveal a great deal of information to both the therapist as well as to you. You may be surprised as to how easily your therapist can reproduce familiar sensations of tightness, pain, or pelvic organ dysfunction with just a small amount of pressure placed into very specific area.
(It is important to note that in certain circumstances it may be necessary for your therapist to perform evaluation and/or treatment vaginally or rectally. Individual state licensure laws vary. Physical therapists are often permitted to perform internal examination and treatment. It is important to note that internal treatment is NOT always needed to successfully resolve pelvic organ prolapse issues. Your therapist should exhaust external treatment before proceeding further and only with your consent. In my experience it is only occasionally necessary to treat internally. If you feel pressured by your therapist in any way, find another therapist.)
Treatment with indirect myofascial release involves the therapist placing mild to moderate pressure into an area of tightness and maintaining that pressure for time frames up to or exceeding five minutes per technique. Typical sessions last an hour. Frequency of treatment can vary, but your therapist may wish to see you more often for the first few sessions. Trying to predict the necessary length of treatment is difficult, but when working with a well-trained and experienced myofascial release therapist, one can expect to notice lasting, positive changes in as little as three sessions. While it may take longer than three sessions to find full relief, you should be able to determine in a short length of time whether myofascial release is working for you. Your therapists will also recommend home stretching to allow you to continue to progress.