Physiotherapy is a widely recognised postoperative rehabilitation tool for many different types of surgery or musculoskeletal injury. Patients are commonly recommended to visit a physiotherapist after ACL reconstruction, knee or hip joint replacement, back surgery and surgical repair of broken bones. Similarly, patients receive routine physiotherapy in the hospital after open heart surgery, lung surgery and major abdominal surgery.
But what about rehabilitation of the pelvic floor?
Pelvic floor dysfunction can present in a myriad of ways and can present insidiously after certain surgeries or injuries. Signs of pelvic floor dysfunction may include:
Bladder: urinary frequency, urgency, leakage, sensation of incomplete emptying, bladder pain, recurring UTIs
Bowels: constipation, diarrhoea, painful bowel movements, recurring haemorrhoids, bowel accidents, difficulty controlling wind
Sexual function: pain, anorgasmia, difficulty achieving penetrative intercourse
Pelvic organ prolapse: vaginal heaviness, sensation of a vaginal lump or bulge
Pelvic fractures and abdominopelvic surgery can disrupt nerves, blood vessels and connective tissue, which are integral for supporting pelvic floor function. This can result in pelvic floor impairments which may manifest long after discharge from hospital.
Recent studies have revealed that pelvic fractures can result in:
Bladder dysfunction symptoms in 41% of patients (Piccione et al., 2021)
Higher rate of stress urinary leakage and pelvic organ prolapse up to 5 years post injury (McConnell, 2020)
Bowel symptoms in 75% of patients, with up to 8% of patients experiencing bowel accidents for up to 1 year post operatively (Piccione et al., 2021)
Female sexual dysfunction in between 25-62% of patients post injury (Walton et al., 2021)
Furthermore, a recent study investigated the effect of pelvic floor rehabilitation in patients who underwent abdominal surgery for management of rectal cancer, which is known to cause various postoperative bowel symptoms. Patients who participated in pelvic floor rehabilitation early post surgery had a lower rate of bowel dysfunction and faster recovery (Asnong et al., 2022).
There are many factors surrounding surgery, which can contribute to the development of pelvic floor dysfunction:
Weakness: muscle atrophy/weakening from prolonged bed rest
Pain medications: use of strong pain medications can contribute to constipation and can have a direct effect on bladder function or prolapse symptoms (Muller-Lissner, 2017)
Muscle guarding: abdominal, hip and pelvic muscles often contract and protectively ‘guard’ when we experience pain, which can cause increased tension in the pelvic floor muscles…and a tight muscle doesn’t work very effectively
Compensatory patterns: disruption or injury to the abdominal wall, bones of the pelvis/hips and surrounding musculature can force the pelvic floor muscles to work harder to compensate for a loss of strength, thus fatiguing these muscles…and tired muscles don’t work very effectively either!
Catheters: whilst catheters are essential for many surgical procedures, catheter insertion and removal is linked in some cases with development of catheter related bladder discomfort, urinary tract infections or bladder/urethral irritation (NHS, 2023)
Scar tissue: scar tissue can cause pain/tightness and can result in loss of range of motion in surrounding tissues, including the abdominals and pelvic floor muscles
Below are some examples of common surgical procedures and musculoskeletal presentations we see at MPPP which can affect the pelvic floor:
Laparoscopic (keyhole) or open abdominal surgeries: removal of endometriosis, fertility surgeries, hysterectomy, removal of ovaries or fallopian tubes, prolapse repair, removal of gallbladder, caesarean section
Prostatectomy
Surgeries, fractures or chronic pain/arthritis of the hip, pelvis, pubic bone and lower spine
Abdominal and pelvic oncological surgeries
Abdominoplasty and hernia repairs
Pelvic floor assessment pre and post surgery or after pelvic fractures can help to identify bladder, bowel, sexual dysfunction or pain early and accelerate recovery! If you’re not sure whether you may benefit from pelvic floor physiotherapy, contact our friendly team on 9337 9125 for more information.
References
Asnong, A., D'Hoore, A., Van Kampen, M., Wolthuis, A., Van Molhem, Y., Van Geluwe, B., Devoogdt, N., De Groef, A., Guler Caamano Fajardo, I., & Geraerts, I. (2022). The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial. Annals of surgery, 276(5), 761–768. https://doi.org/10.1097/SLA.0000000000005632
McConnell, C.L., et al. (2020). Pelvic floor dysfunction one year post-pelvic trauma: an observational pilot study. Australian and New Zealand Continence Journal, 26(4):98-102
Muller-Lissner, S., Bassotti, G., Coffin, B., Drewes, A. M., Breivik, H., Eisenberg, E., Emmanuel, A., Laroche, F., Meissner, W., Morlion, B. (2017). Opioid-Induced Constipation and Bowel Dysfunction: A Clinical Guideline. Pain Medicine, 18(10), 1837-1863. Doi: https://doi.org/10.1093/pm/pnw255
NHS. (03 February, 2023). NHS choices. https://www.nhs.uk/conditions/urinary-catheters/#:~:text=The%20main%20problems%20caused%20by,or%20a%20long%2Dterm%20catheter.
Piccione, F., Maccarone, M. C., Cortese, A. M., Rocca, G., Sansubrino, U., Piran, G., & Masiero, S. (2021). Rehabilitative management of pelvic fractures: a literature-based update. European journal of translational myology, 31(3), 9933. https://doi.org/10.4081/ejtm.2021.9933
Walton, A. B., Leinwand, G. Z., Raheem, O., Hellstrom, W. J. G., Brandes, S. B., & Benson, C. R. (2021). Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature. The Journal of Sexual Medicine, 18(3), 468-473. Doi: https://doi.org/10.1016/j.jsxm.2020.12.014
This blog post is written by Chloe Conroy.
Chloe is a Musculoskeletal and Pelvic Health Physiotherapist at Melbourne Pregnancy and Pelvic Physio who has expertise in dealing with the intersection of pelvic health and sports/musculoskeletal physiotherapy.
You can book an appointment online with Chloe.