Revisiting Pelvic Floor Essentials: Updates on Prolapse and Stress Urinary Incontinence
ellephysio physiotherapists Ivanka, Leah, and Karen recently completed a refresher course focused on the latest research and clinical insights related to pelvic organ prolapse and stress urinary incontinence. The course emphasized evidence-based approaches to care and helped reinforce key messages that are important for both clinicians and patients.
Specifically, this course provided an up-to-date, in-depth review of stress urinary incontinence and pelvic organ prolapse in clients assigned female at birth. It covered proposed mechanisms, prevalence, risk factors, and a full range of treatment options. Based on the latest research and international guidelines, the course explored approaches from watchful waiting and conservative care (including pelvic floor muscle training, manual therapy, and pessaries) to medical and surgical management. The goal of the course was to support evidence-informed recommendations and help practitioners provide their clients with informed healthcare decisions.
This course was taught by Marie-Josée Forget also known as MJ. MJ is a physiotherapist and pelvic health pioneer in Northern Ontario, where she was the first to offer pelvic health services. Bilingual and treating all genders, she has taught with Pelvic Health Solutions since 2011, mentors healthcare professionals, and speaks internationally. She has co-authored research on pelvic floor dysfunction, written on trauma-sensitive practice, and developed an internationally sold pelvic floor anatomical model.
What is a pelvic organ prolapse? A pelvic organ prolapse is a condition in which one or more of the pelvic organs, such as the bladder, uterus, and/or rectum, drop or press into the vaginal canal due to weakened or stretched pelvic floor muscles and supporting tissues.
Regarding pelvic organ prolapse, the course highlighted that treatment is not necessary in the absence of symptoms. Prolapse alone does not require intervention if it is not bothersome or affecting quality of life. Participants also reviewed current evidence showing that exercise is safe at all stages of prolapse and does not cause further harm. Importantly, prolapse is not an inevitable progressive condition; it does not automatically worsen with age. For individuals with larger or more symptomatic prolapses, conservative and medical options such as pessary use, as well as surgical interventions, may be appropriate and effective depending on individual needs and goals.
Stress urinary incontinence is a condition characterized by the unintentional leakage of urine during activities that increase pressure inside the abdomen, such as coughing, sneezing, laughing, running, or lifting heavy objects. It occurs when the pelvic floor muscles and the urethral sphincter are weakened and unable to adequately support the bladder and keep the urethra closed during physical strain.
In the section on stress urinary incontinence, the course underscored the importance of anatomy in continence. The position and support of the bladder play a significant role in effective muscle closure during activities that increase abdominal pressure. Practical tools such as direct pelvic floor treatment and pelvic cones were discussed as useful aids for strengthening exercises. The course reinforced that meaningful pelvic floor strengthening requires time and consistency, with approximately 16 weeks needed to achieve measurable improvements. Additionally, the role of the pudendal nerve was emphasized, as adequate stimulation and neuromuscular activation are essential components of pelvic floor function and continence.
Overall, the refresher course provided updated research and reinforced reassuring, empowering messages about pelvic health, highlighting both the resilience of the pelvic floor and the effectiveness of evidence-based management strategies. It also emphasized the importance of ongoing continuing education to ensure that care remains current, evidence-based, and aligned with best practices. Ivanka, Leah, and Karen are passionate about lifelong learning and are always seeking opportunities to expand their knowledge and skills. They are excited to apply what they’ve learned and look forward to treating clients with the most up-to-date, compassionate, and effective pelvic health care.
