Dott.ssa Silvia Baccini, fisioterapista, Master riabilitazione del pavimento pelvico
Dott.ssa Cantù Daniela
A questionnaire based on the most recent evidence about pelvic organs prolapse has been
created and issued to a pool of physiotherapists specialised in pelvic floor rehabilitation.
The final goal is to compare all of the data available in literature with the actual
professional clinical execution.
Research on the latest POP rehabilitation revisions has been performed, together with
analysing guidelines and RCT which have been published on the PubMed platform
between the years 2020 and 2023. Based on its results, a list of 22 questions, subdivided
into 4 main topics, has been drawn up: 1) competencies, training and clinical experience of
the physiotherapist; 2) profile of the patient with POP who receives the physiotherapeutic
treatment; 3) treatment tools and techniques; 4) outcome and modality of its achievement;
5) pre and post surgery physiotherapy. The data gathered has finally been discussed and
compared to the relevant evidence outlined in specialised literature.
The questionnaire has been filled out by 86 physiotherapists who are either expert or
specialised in pelvic floor rehabilitation. The collected data has been compared both with
guidelines and the most recent articles issued in relation to the physiotherapeutic treatment
of patients affected by POP. The data concerning the choices of treatment has come out to
be different compared to what it would have been expected based on the evidence in
literature. The choice to use PFMT as a treatment technique for POP patients’
rehabilitation, has involved 67% of the physiotherapists. This percentage has been rather
unexpected considering that popular guidelines such as NICE 2019 recommend it as an
option for patients affected by POP. Also, other figures emerged to be in disagreement
with the current literature: this is the case of hypopressive exercise and the use of pessary.
The future objective would be to implement qualitative and meaningful studies and
research in order to recognise the effectiveness of physical rehabilitative techniques for
POP patients, including radiofrequency and hypopressive exercise, for which there is not
much evidence still.
It is necessary to strengthen studies and scientific evidence of the rehabilitative treatment
applied in prevention of post-surgery relapse. Currently, there are no studies that can
compare the long-term outcome preservation within groups of patients with prolapse
setbacks, who have been treated with physiotherapy both before and after surgery, versus
similar patients who have not undergone a physiotherapeutic cycle. Another relevant piece
of data is about physiotherapists proposing pessary as a treatment option: only a very
minimal percentage of colleagues do so. It is crucial to identify the reasons behind this, in
light of the large amount of literature in support of the many benefits and advantages of
this therapy option.
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