Pelvic Organ Prolapse After Childbirth: An Evidence-Based Case Report

Abstract

INTRODUCTION/BACKGROUNDAlmost one in four women in the United States have a pelvic floor dysfunction (PFD). PFD may include urinary incontinence (UI), fecal incontinence (FI), and/or pelvic organ prolapse (POP; Dieter et al., 2015). Pelvic floor therapy (PFT) has shown to improve pelvic floor function; however, access to care and awareness of PFT may be limited based on location.This is a case report on one woman’s experience with the lack of provider referral and access to care for pelvic floor physical therapy (PFPT) in a rural setting. Promising new research suggests that telerehabilitation is beneficial in the treatment of women with PFD, which, when available, may improve access to care for women in rural settings.CASE DESCRIPTIONA 32-year-old female was referred by her gynecologist to physical therapy with complaints of pelvic heaviness after her first vaginal delivery. The patient was concerned that she would not be able to return to her normal active lifestyle. The patient lived in a rural area with limited access to care. The patient was seen for evaluation and three additional visits over the course of 2 months for pelvic floor strengthening as clinical findings showed a weakness in pelvic floor endurance and power as well as mild prolapse, however, access to care limited her participation.OUTCOMESSubjective improvements were a reduction in pelvic pressure, reduced urinary leakage as well as improved ability to exercise with less fear of leakage. Objectively, the patient had improvements in pelvic floor strength as measured by the use of the PERFECT system. The mild prolapse noted on evaluation using the POP scoring system was still present.DISCUSSIONResearch has concluded that the field of pelvic health is going to continue to grow while access to care will be limited by a dwindling number of providers, an already apparent phenomenon in rural areas. The case patient had limitations in sessions she could attend due to access to care in a rural setting, which restricted progress. New research in telerehabilitation for women’s pelvic health dysfunction shows promise that women in rural areas will have improved access to the care they need.