EP644 - Perspectives on Pelvic Health Physical Therapy in Rectal Prolapse: Insights from Patients and Colorectal Surgeons

Purpose/Background: Rectal prolapse can substantially impair a patient's quality of life and is often associated with pelvic floor weakness and debilitation, necessitating multidisciplinary care. Although international guidelines support lifestyle interventions and pelvic health physical therapy (PHPT) for pelvic organ prolapse (POP), data specific to rectal prolapse remains scarce and largely extrapolated from other POP populations. While PHPT is considered safe and is often utilized as first-line therapy for obstructed defecation and fecal incontinence, when focusing on rectal prolapse, there is limited understanding about patient and clinician perspectives regarding its role and efficacy. This study aims to evaluate and understand differences in perspectives and utilization of PHPT in rectal prolapse.

Methods/Interventions: We conducted a descriptive survey for patients and clinicians (colorectal surgeons (CRS), urogynecologists (URO), and pelvic health physical therapists (PT). Patients were recruited from a pelvic organ prolapse registry, and colorectal surgeons were recruited from the Pelvic Floor Disorders Consortium. Patient surveys collected demographics, the impact of prolapse on lifestyle, and perceptions of PHPT. Surgeon surveys assessed demographics, attitudes toward lifestyle and exercise, and PHPT utilization in practice.

Results/Outcomes: Ninety-two clinicians completed the survey (72.5% CRS, 11% URO, 16.5% PT) and represented a wide range of clinical experience (66.3% >10 years, 17.4% 5-10 years, 16.3% < 5 years) and locations (1% Africa, 9.6% Asia, 5.4% Australasia, 20.4% Europe, 53.8% North America, 9.7% South America). Most surgeons consider PHPT important or very important to care (86.2% CRS, 80% URO, 100% PT). Most surgeons also report referring patients to PHPT (93.5% CRS, 100% URO). Referral pattern recommendations varied by clinician types (CRS: 66.2% both pre- and post-operatively, 13.8% pre-operatively only, 13.8% post-operatively only, and 4.6% never; URO: 70% both, 20% pre-operatively, 10% post-operatively; PT: 93.3% both, 6.7% pre-operatively). Clinicians reported long wait times as a barrier to their patients receiving PHPT (CRS: 34.6%, URO: 44.4%, PT: 33.3%). Perception of PHPT availability, however, varied across clinician groups (CRS: 21.5%, URO: 0%, PT: 0%). Among 30 patients (92.6% female, mean age 68.9 ± 11.7 years), 43% patients did not find PHPT helpful or were neutral toward its benefit. Furthermore, only 53.3% of patients continued daily or weekly PHPT exercises.

Conclusion/Discussion: Clinicians widely recognize PHPT as an important component of prolapse management, yet referral practices lack consensus and barriers to timely access remain an issue. Clinician perceptions of PHPT were also variable across specialties. Many patients do not find PHPT beneficial and adherence to long-term exercise remains low, potentially limiting sustained outcomes. These findings highlight the need for deeper investigation into clinician practice patterns to optimize PHPT utilization and maximize therapeutic benefit in rectal prolapse care. Further exploration of patient experiences with and understanding of the need for PHPT may help identify targets to improve long term adherence.

Figure 1. Recommended timing of PHPT referral for prolapse by clinician type.