Service Evaluation:
Exploring the experiences of 140 Women with pelvic organ prolapse accessing a private hypopressives service
Authors: Alice Housman BSc (Hons) Adult Nursing & Emily Housman BSc (Hons) Midwifery, BSc Psychology
As research into hypopressives continues to grow, there is still relatively little published evidence describing outcomes from routine practice. We carried out this service evaluation to better understand the experiences of women completing the Create Lift® Hypopressives Programme, monitor changes in pelvic organ prolapse symptoms and quality of life, and continually improve the care we provide.
This page presents the findings from our service evaluation of 140 women with a diagnosed pelvic organ prolapse. The evaluation found broadly positive self-reported improvements in prolapse symptoms and quality of life, while also identifying opportunities to further develop the service.
Many more women accessed our service during this 4 year period but due to the huge volume of data and special interest in hypopressives for pelvic organ prolapse, we conducted the evaluation looking at the outcomes and experiences of this client group. Other primary reasons for accessing this service are: incontinence symptoms, diastasis recti, core weakness and prolapse recurrence after surgery.
The findings presented on this page relate specifically to the Create Lift® Hypopressives Programme and should not be assumed to apply to all hypopressives programmes, which may differ in programme structure, breathing instruction, progression and coaching format.
You can get a copy of the summary and full text PDF here.
KEY FINDINGS
73%
Median improvement in self-reported prolapse symptoms and quality of life
94%
Reported an improvement of 50% or more
61%
Reported an improvement of 70% or more
37 months
Average length of time living with symptoms
4 weeks
Average time to noticing their first improvements
44%-10%
Considering surgery before and after the programme
These findings are based on a four-year service evaluation of 140 women with a diagnosed pelvic organ prolapse completing the Create Lift® Hypopressives Programme. Background, aims and approach, findings and discussion are presented below.
BACKGROUND
Hypopressives are a system of physical exercises characterised by an apnoea breath that have been found in published research to have beneficial outcomes for pelvic organ prolapse (POP) and urinary incontinence (UI). On ultrasound, hypopressives have been shown to lift the pelvic floor without a conscious contraction, and studies have reported improvements in pelvic floor muscle strength, resting muscle tone and levator ani muscle thickness, similar to those achieved through pelvic floor muscle training (PFMT).
However, while the evidence base for hypopressives continues to grow, further high-quality research is still needed to support its use for pelvic organ prolapse and urinary incontinence.
Pelvic organ prolapse affects approximately 50% of women. Although some women experience no symptoms, others experience uncomfortable physical symptoms including vaginal bulging, heaviness, bladder and bowel dysfunction. These symptoms can have a significant impact on emotional wellbeing, body image and quality of life.
This service evaluation was undertaken to better understand the experiences and outcomes of women with a diagnosed pelvic organ prolapse completing the Create Lift® Hypopressives Programme.
What is pelvic organ prolapse?
Pelvic organ prolapse (POP) is a common condition affecting approximately 50% of women. While some women experience no symptoms, others develop vaginal bulging, heaviness, bladder or bowel symptoms that can significantly affect daily life, emotional wellbeing and quality of life.
AIMS AND APPROACH
Aims
This private service offers the Create Lift® Hypopressives Programme for people wanting to learn hypopressives for a variety of reasons, including pelvic organ prolapse, urinary incontinence, diastasis recti, postnatal recovery, postural correction and core rehabilitation.
This service evaluation was conducted to assess the experiences of women with a diagnosed pelvic organ prolapse accessing the service. It explores the profile of service users, their reasons for accessing the programme, self-reported pelvic health outcomes and opportunities to further improve the service.
Approach
Routinely collected anonymised data from pre- and post-programme questionnaires were analysed with permission from service users.
The evaluation explored:
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The profile of service users
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Reasons for accessing the service
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Self-reported pelvic organ prolapse symptoms and quality of life outcomes
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Participant experiences
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Opportunities to improve the service
FINDINGS
The findings below summarise the profile of women who accessed the service, their reasons for seeking support, and the outcomes they reported after completing the Create Lift® Hypopressives Programme.
1. PROFILE OF SERVICE USERS
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140 women with POP
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Self funding
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Age range 28-69
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36% ≤ 1 year postnatal
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Av. time with symptoms = 37 months
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9% using a silicone pessary
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8% had previous hypopressives training
STANDARDISED HYPOPRESSIVES PROGRAMME
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14 WEEK PROGRAMME
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6 HRS 1:1 COACHING VIA VIDEO CALL / IN-PERSON
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PRE-PROGRAMME QUESTIONNAIRE
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17 DIFFERENT POSES TAUGHT AND BREATH WORK
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ANYTIME SUPPORT
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VIDEO CONTENT
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POST-PROGRAMME QUESTIONAIRRE
Number of prolapses:
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Single prolapse = 51%
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Double prolapse = 39%
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Triple prolapse = 9%
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Didn't know = 1%
92% = received online coaching via video call
44% stated they were considering surgery
MOST COMMON PROLAPSES REPORTED:
Anterior = 76%
Posterior = 47%
2. REASONS FOR ACCESSING THE SERVICE
Before starting the Create Lift® Hypopressives Programme, participants were asked "What are your main reasons for wanting to learn hypopressives?".
Their responses highlighted the physical and emotional impact of living with prolapse symptoms, together with a desire to improve quality of life, return to everyday activities and explore another conservative treatment option.:
“Improve physical and mental health and a better quality of life.” (SU 10)
“To be able to feel normal again! To be able to run, swim, walk without fearing something might happen, to avoid surgery where possible.” (SU 20)
“Improvement in sensation of something in my vagina all the time mainly – frustrated with little progress so far.” (SU 26)
“Mainly hoping to ease the constant sense of something falling out, hopeful of being able to ease bowel and bladder symptoms too.” (SU 38)
“Kegels didn't help.” (SU 56)
“Nothing else I'm trying currently is working.” (SU 60)
“Have not found relief with physio.” (SU 68)
KEY FINDINGS:
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To improve quality of life
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Other treatments had not worked
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Emotional and physical impact of living with prolapse symptoms
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To avoid surgery
"What other treatments have you tried so far?"
“Them all! See physio every 9 months.” (SU 11)
“Pelvic floor exercises, biofeedback, electrical stimulation.” (SU 15)
“Pelvic floor exercises and pessary.” (SU 30)
“Fascia release, massage, Pilates, meditation.” (SU 57)
“Numerous appointments with women's health physio.” (SU 73)
“Emsella chair, Perifit, weights, PFEs.” (SU 122)
“15 appointments with women's health physio. Kegels, clinical rehab Pilates.” (SU 127)
KEY FINDINGS:
Women accessing the service had already received standard care from healthcare providers (NHS and or private) and tried various different conservative treatments
"What symptoms or lifestyle impact is bothering you the most at the moment?"
Participants described the physical and emotional impact of living with pelvic organ prolapse, together with the effect it was having on their confidence, exercise, work and family life.
“Feeling that everything is slipping out bothers me the most and makes me fearful of everyday movement.” (SU 17)
“Constant sensation of something falling out of my vagina which gets worse and ‘heavier’ the more I move or stay upright. I haven't been able to walk more than about 3km.” (SU 38)
“Awareness of a bulge feeling when walking / carrying children.” (SU 72)
“Feeling of dragging and not being able to use a sling.” (SU 90)
“That I'm too scared to play with my kids - run after them, dance, be silly.” (SU 121)
“Just a continual bulgy feeling, unable to exercise as I used to (running) as pessaries that I've tried don't support.” (SU 125)
KEY FINDINGS:
Women described uncomfortable prolapse symptoms that were negatively impacting their quality of life, including heaviness, dragging and a feeling of bulging into the vagina.
3) PELVIC ORGAN PROLAPSE AND QUALITY OF LIFE OUTCOMES
This evaluation found the median improvement for 140 women in self-reported prolapse symptoms and quality of life scores was
73%
4 weeks = average time to start noticing improvements
94%
61%
of service users (131) reported improvements ≥ 50%
of service users (86) reported improvements ≥ 70%
44%
10%
considering surgery pre-programme
considering surgery post-programme
Data analysed from 15 questions, including a modified version of the POP-SS.
POP symptoms and QOL impact was scored by service users 0-10, with 10 indicating symptoms all the time or the highest impact.
Similar median improvements were found for the 51 women who were ≤ 1 year postnatal
75%
For all 140 women, improvements from baseline scores included:
78% improvement in Q8 "Using fingers to push up the prolapse to ease discomfort"
73% improvement in Q3 "An uncomfortable heaviness or dragging feeling in the lower abdomen"
69% improvement in Q1 "A feeling of something coming down from or into your vagina"
69% improvement in Q7 "A feeling that your bowel hasn't emptied completely"
64% improvement in Q10 "Using fingers to push up the prolapse to empty your bowel"
"What has changed for you since doing the programme?"
“New hope for the future with steady improvements to my symptoms. I can bounce on the trampoline with my kids after avoiding it for years, also no visible prolapse bulge anymore.” (SU 7)
“I now rarely experience sensation or discomfort in my vagina. I am able to go for longer walks and do other forms of exercise without increasing symptoms. I don't think about it all the time anymore and can focus on my life again!” (SU 28)
“Dragging/heaviness very much improved and rarely experience that.” (SU 48)
“Heavy feeling has very much improved. Posture is much better. Waistline has reduced by 2.5 cm.” (SU 62)
“Minimal symptoms now.” (SU 75)
KEY FINDINGS:
Women frequently described improvements in prolapse symptoms that positively impacted their quality of life.
Improvements in quality of life are considered one of the most important outcomes when evaluating exercise programmes for pelvic organ prolapse.
Some said they found the apnoea breath challenging to learn, others said it was easy, not not many commented:
“How easy it is and relaxing.” (SU 1)
“It's more challenging than I thought it would be.” (SU 36)
“How quick and easy it is to practise.” (SU 46)
“How difficult it was to get the rib stretch.” (SU 88)
Some participants also described additional benefits that surprised them beyond improvements in prolapse symptoms:
“I was surprised how quickly my core felt stronger. I no longer have backache despite lifting my youngest a lot.” (SU 6)
“How it has helped improve my full body strength as well as the unexpected benefit of the meditative state that my practice puts me in - calms everything down.” (SU 25)
“It's very relaxing and the lift you feel whilst doing it is really great.” (SU 36)
“My back pain disappeared!” (SU 55)
“How gentle it was but was strengthening my core.” (SU 98)
KEY FINDINGS:
Participants described different experiences of learning hypopressives. While some found the technique easy to learn and relaxing, others reported that aspects of the breathing technique were initially more challenging. Many also described additional benefits beyond improvements in prolapse symptoms, including feeling calmer, stronger and more confident.
4) HOW WOMEN SAID WE COULD IMPROVE THE SERVICE
Participants were asked how they felt the programme could be improved. Most did not suggest any changes. Where improvements were suggested, they most commonly related to additional video content and the use of an app. Some participants also said they would have preferred face-to-face coaching if a local coach had been available.
Participant feedback has helped shape the ongoing development of the Create Lift® Hypopressives Programme. In response to suggestions from women completing the programme, we have expanded our video library, provide additional free practice videos through our YouTube channel, and offer monthly practice calendars to support ongoing home practice.
DISCUSSION
This service evaluation was carried out to explore the experiences of women with a diagnosed pelvic organ prolapse accessing the Create Lift® Hypopressives Programme in a private hypopressives practice.
Overall, participants reported positive experiences of the service together with broadly positive self-reported improvements in pelvic organ prolapse symptoms and quality of life. The median improvement across all participants was 73%, with 94% reporting improvements of 50% or more.
Many women described meaningful improvements in everyday life, including returning to walking, exercise and playing with their children. Others reported feeling more confident, less fearful of movement and more optimistic about the future. These findings are consistent with the positive improvements in quality of life reported in the wider hypopressives literature.
Many participants had already received standard NHS or private care and had tried a range of conservative treatments before accessing the programme. Some had experienced benefit from pelvic floor muscle training, while others reported that they were continuing to experience symptoms despite previous treatment.
Research has shown that pelvic floor muscle training remains the recommended first-line conservative treatment for pelvic organ prolapse. However, current evidence also suggests that not all women experience sufficient improvement, highlighting the need for continued research into additional conservative treatment options.
The findings from this service evaluation relate specifically to the Create Lift® Hypopressives Programme and are consistent with the growing body of published research reporting positive outcomes associated with hypopressives. However, further high-quality research is needed to better understand the effectiveness of different hypopressives programmes and approaches.
Suggestions for improving the service were limited and were primarily related to additional video resources and programme delivery. Participant feedback has been used to further develop the supporting resources available alongside the programme.
As with any service evaluation, these findings are specific to the service evaluated. They have been used to better understand participant experiences, monitor outcomes and support the ongoing development of the Create Lift® Hypopressives Programme.
CONCLUSION
This service evaluation has provided valuable insight into the experiences of women with a diagnosed pelvic organ prolapse completing the Create Lift® Hypopressives Programme.
Overall, participants reported broadly positive self-reported improvements in prolapse symptoms and quality of life, supported by their written accounts of how these changes affected their everyday lives.
To the best of our knowledge, this is the first UK-based published service evaluation of a standardised hypopressives programme for women with pelvic organ prolapse. The findings are specific to the service evaluated and contribute to the growing evidence base for hypopressives in pelvic health.
Further research is needed to evaluate the effectiveness of the programme in comparison with other conservative approaches and to continue building the evidence base for hypopressives in the management of pelvic organ prolapse.
Get your copies here
This webpage summarises the published service evaluation. You can also download the full report and summary report below:
Summary PDF: A concise overview of the background, methodology, key findings and conclusions.
Full Service Evaluation: Complete report including methodology, findings analysis, discussion and full reference list.
