A woman in her 70s with pelvic organ prolapse (cystocele and uterine prolapse) had preoperative pain in the perineal and hip joints.

She had tenderness in both obturator internus muscles, and after starting rehabilitation, her hip pain disappeared, leading to the cancellation of her hip surgery (although surgery might still be recommended due to existing deformities). It’s challenging to determine which pain is related to “hip pain,” “perineal pain,” or “pelvic organ prolapse.”

We performed a hysterectomy (preserving the descending branch of the uterine artery and the vaginal artery), and placed a mesh between the bladder and vagina, achieving a neat result. Postoperatively, she was able to get out of bed after three hours and did not have a urethral catheter, so she was able to urinate on her own in the restroom. She was discharged the next day.

This patient was also being seen by a gynecologist. The gynecologist said, “Abe-chan, you’ve been focusing on the obturator internus muscles lately, right? Seems like she no longer needs hip surgery.”

The “importance of obturator internus muscle rehabilitation” is gradually gaining wider recognition.