Introduction: Pelvic organ prolapse (POP), the bulging of pelvic organs into the vagina, is a common condition thought to be caused by weak pelvic tissue. There is a paucity of evidence supporting current treatment approaches. This case series proposes a new biotensegrity-focused hypothesis that POP is caused by taut pelvic tissue and that releasing pelvic tension will improve POP. Methods: Three retrospective patient cohorts are presented illustrating the development of the new biotensegrity-focused therapy (BFT) approach. All women received: postural assessment; pelvic tissue examination; and myofascial release of taut pelvic tissue, trigger points, and scar tissue. A standard assessment SOTAP Subjective experience, the Objective assessment, the Treatment plan, Assessment of treatment outcomes, and subsequent treatment and self-care Plans. Cohort three additionally self-reported symptoms using the short-form PDFI-20 questionnaire at baseline and after final treatment. Results: Twenty-three women participated (Cohort 1 n=7; Cohort 2 n=7; Cohort 3 n=9). Fourteen (61%) presented with cystocele, 10 (44%) urethracele, 7 (30%), cervical descent, and 17 (74%) rectocele. Seven (30%) presented with single prolapse, 8 (35%) double, 6 (26%) triple, and 2 (9%) quadruple. Median treatments received was 5 (range 3-8). All women reported improved prolapse symptoms. Cohort 3 (n=9) reported clinically meaningful reductions (mean 56%) in PFDI-20 total after final treatment. Conclusions: This case series offers preliminary evidence for the association between POP and pelvic tissue tension. Further research is needed to explore these findings and to determine the efficacy of BFT for treating POP in a wider sample.

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Background Traditional treatments for pelvic organ prolapse (POP) assume weak pelvic tissue as the cause. Pelvic floor muscle training has been shown to improve POP symptoms but not prolapse stage and does not reduce rates of referral for future treatment (e.g., pessary or surgery). An alternative hypothesis is proposed that excessive tissue stiffness causes tension and pulling, which disrupts pelvic organ arrangement. Objectives Treating pelvic tissue stiffness through Biotensegrity Focused Therapy is anticipated to improve organ position and prolapse symptoms. Study Design Non-randomised prospective clinical case-series. Methods Women presenting to a private physiotherapy practice in the United Kingdom with POP received Biotensegrity Focused Therapy. Treatment included a series of 1hour physiotherapy sessions focusing on identifying areas of stiff pelvic tissue and using a direct myofascial release technique to normalise elasticity to restore dynamic equilibrium within the pelvis. Prolapse grade (mild, moderate, severe), pelvic floor strength (Modified Oxford Grading Scale), and self-reported symptoms (Pelvic Floor Distress Inventory, PFDI-20) were assessed at baseline and after final treatment. Results 33 women received treatment. At baseline 23/33 (70%) presented with moderate to severe prolapse. After final treatment 3/33 (9%) had moderate and 0/33 (0%) had severe prolapse. 12/33 (36%) achieved complete recovery of organ position and shape. 27/33 (81.82%) women improved by at least one prolapse stage. Pelvic floor strength improved from mean 1.28 (SD 0.85) at baseline to 3.33 (SD 0.78) after final treatment. Self-reported PFDI-20 scores corroborated clinical observations, reducing from mean 98.77 (SD 42.43) at baseline to 49.87 (SD27.28) after final treatment, suggesting a clinically meaningful improvement. Mean treatments received was 6.06 (SD 2.28) sessions over a duration of 4.39 (SD 2.46) months. Discussion Biotensegrity Focused Therapy was shown to have a beneficial impact on organ position and prolapse symptoms and may be an appropriate treatment for women with POP.