Grant: Project Grant

Childbirth is a major risk factor for pelvic floor muscle (PFM) trauma. In one third of women, stretching of the PFM will result in an avulsion injury (i.e. disconnection of the muscle from its insertion points on the pubic symphysis). Recent advances in imaging have led to the discovery of this previously unknown major injury and further research now enables its diagnosis with readily available techniques. Avulsion injury has alarming consequences because it has been associated with a higher rate of stress urinary incontinence (SUI) in the postpartum period as well as the long-term development of other major urogynecological conditions such as pelvic organ prolapse and anal incontinence. Women with avulsion are not only confronted by severe symptoms with significant related impacts on physical activities, overall well-being and quality of life, but they also present a higher rate of surgical failures. Moreover, it is still unknown whether the most recommended first-line treatment for SUI -PFM physiotherapy- is effective in women with this major trauma. Until now, only a pilot study conducted by our team supports the rationale and the efficacy of physiotherapy for improving PFM function in women with avulsion, despite their major muscle injury. The proposed study aims to further investigate the efficacy of physiotherapy for SUI in this sub-population with major obstetrical injuries. Women with an avulsion injury will be randomized either to receive physiotherapy or to be in a waiting-list control group for which treatment will be available after a 9-month follow-up. The current proposal addresses the urgent need to evaluate whether or not women with an avulsion -a prevalent and debilitating long-term condition- could benefit from physiotherapy treatment as a first-line intervention. It will enable women with avulsion to be directed to appropriate treatment options and, if proven effective, PFM physiotherapy could be proposed as a cost-effective first-line treatment.