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Zhao H, Liu XN, Liu LN. Effect of structured pelvic floor muscle training on pelvic floor muscle contraction and treatment of pelvic organ prolapse in postpartum women: ultrasound and clinical evaluations. Arch Gynecol Obstet 2024; 309:2177-2182. [PMID: 37755534 DOI: 10.1007/s00404-023-07226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. METHODS Sixty patients who volunteered for a PFMT assessment at 6-8 weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). RESULTS Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. CONCLUSIONS Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women.
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Affiliation(s)
- Hui Zhao
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China
| | - Xiu-Ni Liu
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Lin-Na Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China.
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Bø K, Anglès-Acedo S, Batra A, Brækken IH, Chan YL, Jorge CH, Kruger J, Yadav M, Dumoulin C. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training. Int Urogynecol J 2022; 33:2633-2667. [PMID: 35980443 PMCID: PMC9477909 DOI: 10.1007/s00192-022-05324-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP. METHODS An international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0-10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0-10). RESULTS After exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT. CONCLUSIONS There are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, The Norwegian School of Sport Sciences, PO Box 4014, Ullevål stadion, 0806, Oslo, Norway.
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
| | | | - Achla Batra
- Department of Obstetrics & Gynaecology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Ingeborg Hoff Brækken
- Kolbotn Physical Institute, Nordre Follo Municipality, Nordre Follo, Norway
- The Pelvic Floor Centre, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Yi Ling Chan
- Department of Obstetrics and Gynaecology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Cristine Homsi Jorge
- Department of Health Science Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Manisha Yadav
- Paropakar Maternity and women's hospital, Thapathali, Kathmandu, Nepal
| | - Chantale Dumoulin
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Effects of Pelvic-Floor Muscle Training in Patients with Pelvic Organ Prolapse Approached with Surgery vs. Conservative Treatment: A Systematic Review. J Pers Med 2022; 12:jpm12050806. [PMID: 35629228 PMCID: PMC9142907 DOI: 10.3390/jpm12050806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/23/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this systematic review was to explore the effectiveness of pelvic-floor muscle training (PFMT) in the treatment of women with pelvic organ prolapse (POP) who had undergone either surgery or only conservative treatment, based on a selection of randomized clinical trials (RCT). The search was carried out in PubMed, Cochrane, Scopus, CINAHL, and PEDro databases between April 2021 and October 2021 using the following MeSH terms or keywords: “pelvic organ prolapse”, “POP”, “pelvic floor muscle training”, “pelvic floor muscle exercise”, “kegel exercise”, and “surgery”. The methodological quality of the studies was assessed using the PEDro scale. Eighteen RCTs were included in this review. The findings showed improvements in symptoms associated with POP, in pelvic-floor function, and in quality of life in women who performed a PFMT protocol. However, PFMT did not produce significant changes in sexual function, and the results of the change in POP stage were inconclusive. When viewing PFMT as a complementary treatment to surgery, no significant improvements were observed in any of the analyzed variables. In conclusion, a PFMT program is an effective way to improve the pelvic, urinary, and intestinal symptoms associated with POP; function of the pelvic floor; and quality of life. PFMT as an adjunct to surgery does not seem to provide a greater benefit than surgical treatment alone. RCTs of higher methodological quality, with a larger sample size and a longer follow-up, are needed to confirm the results.
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Hutchison D, Ali M, Zillioux J, Ortiz NM, Smith R, Rapp DE. Pelvic Floor Muscle Training in the Management of Female Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wang T, Wen Z, Li M. The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis. Int Urogynecol J 2022; 33:1789-1801. [PMID: 35312800 DOI: 10.1007/s00192-022-05139-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/21/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at evaluating the effect of pelvic floor muscle training (PFMT) as a conservative treatment for patients with pelvic organ prolapse (POP). METHODS A comprehensive search to identify eligible randomized controlled trial (RCT) studies was conducted using electronic databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase up to 10 June 2021. Results were presented as risk ratio (RR), the weighted mean difference (WMD), with 95% confidence interval (95% CI) using the random effects model. Outcome variables were pooled using Review Manager version 5.3. RESULTS Thirteen studies were included. Our results demonstrated that women who received PFMT intervention had a greater improvement than controls in prolapse symptom score (POP-SS; mean difference [MD] -1.66, 95% CI -2.36 to -0.97, p < 0.00001] and POP stages (risk ration [RR] 1.51, 95% CI 1.14-2.01, p = 0.004). The number of participants who felt better after PFMT was higher (RR 1.98, 95% CI 1.21-3.24, p = 0.006). Subgroup analysis showed that the symptoms of prolapse and the degree of prolapse were improved significantly in the short term, but there was no significant difference in the long-term effect. In addition, there was no significant difference in the impact of PFMT on the elderly and the quality of life. More RCTs are needed to evaluate the effect of PFMT on the elderly and whether the quality of life can be improved. CONCLUSIONS We found that PFMT can improve subjective symptoms and objective POP severity. More research is needed on the long-term effect.
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Affiliation(s)
- Ting Wang
- Department of Gynecology and Obstetrics, Shuangqiao Hospital, Chaoyang District, Beijing, China
| | - Zhengfang Wen
- Department of Reproductive Medicine, The First Affiliated Hospital of Xinxiang Medical College, No. 88, Health Road, Weihui, Xinxiang, Henan, China.
| | - Meng Li
- Department of Gynecology and Obstetrics, The First Hospital of Qinhuangdao, Hebei, China
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Aitbayeva B, Iskakov S, Smailova L. Mini-review: Modern Concept of Pelvic Organ Prolapse. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Symptomatic pelvic organ prolapse (POP) has been increasing in recent years for both developed and developing countries. By 2050, as the adult population grows, the number of women with symptomatic POP will increase by 46%. Due to the increasing number of complications after surgery among women with POP, the current understanding of treatment has become extremely important for researchers and practitioners. There are many novel conservative and surgical treatment approaches under investigation. However, some primary surgical treatments show an approximate 30–50% risk of repeated pelvic floor reconstruction. Therefore, the review aims to summarize several conservative treatment options and identify critical areas of need for future research.
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Giagio S, Innocenti T, Salvioli S, Lami A, Meriggiola MC, Pillastrini P, Gava G. Completeness of exercise reporting among randomized controlled trials on pelvic floor muscle training for women with pelvic organ prolapse: A systematic review. Neurourol Urodyn 2021; 40:1424-1432. [PMID: 34058016 PMCID: PMC8362041 DOI: 10.1002/nau.24712] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/17/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
AIMS This systematic review aimed to assess the completeness of exercise reporting in randomized controlled trials (RCTs) on pelvic floor muscle training (PFMT) for women with pelvic organ prolapse (POP). METHODS MEDLINE, Cochrane Central, CINHAL, Embase, SCOPUS, and PEDro databases were searched up to October 2020. Full-text RCTs comparing PFMT to any type of intervention among women with any type and stage of POP were eligible for inclusion. Completeness of intervention was evaluated with t20he template for intervention description and replication (TIDieR) and the consensus on exercise reporting template (CERT). Inter-rater agreement for each item of the tools was calculated. RESULTS Twenty-six RCTs were included. None of the studies completely reported all intervention descriptors. On average 57.1% (6.8 ± 2.4; out of 12) of the overall TIDieR items and 35.3% (6.7 ± 2.9; out of 19) of the CERT were well described. In particular, 7 and 5 items were completely reported more than 50% of the time for the TIDieR and CERT, respectively. Frequent shortcomings were the undetailed reporting of information regarding tailoring and modifications of exercises and their adherence. Detailed descriptions of exercise repetitions to enable replication were missing in 53.8%. According to the CERT, only 11.5% of the RCTs sufficiently described the main providers' characteristics. CONCLUSION The completeness of PFMT reporting for women with POP is still below desirable standards and it is insufficient to ensure transferability into practice. The present results may add relevant knowledge and contribute to improving adequate reporting of exercise.
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Affiliation(s)
- Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tiziano Innocenti
- Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Movement Sciences, Amsterdam, The Netherlands
| | - Stefano Salvioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Alessandra Lami
- Division of Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Maria Cristina Meriggiola
- Division of Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Gava
- Division of Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Basnet R. Impact of pelvic floor muscle training in pelvic organ prolapse. Int Urogynecol J 2021; 32:1351-1360. [PMID: 33416965 DOI: 10.1007/s00192-020-04613-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This review article was aimed at evaluating the effectiveness of pelvic floor muscle training (PFMT) during conservative management and as an adjunct to prolapse surgery based on recently published articles. METHODS The PubMed and PEdro databases were searched from 2005 to 2020 for all types of studies reporting on PFMT as the primary treatment for conservative management of prolapse as well as an adjunct for prolapse surgery. RESULT The result of this review demonstrated that PFMT is effective in conservative management, especially in women with mild to moderate prolapse(stages I-III), for those who wish to have more children, who are not willing to undergo surgery, who are frail because of co-morbidities, and for those who need to delay surgery. However, results evaluating the effectiveness of PFMT as an adjunct to surgery demonstrated insufficient evidence to support the benefit of PFMT in addition to prolapse surgery over the use of surgery alone. CONCLUSION Through this review, we have concluded that PFMT shows a more prominent effect when applied as conservative management. Currently available evidence demonstrated no additional clinically significant augmentation of PFMT as an adjunct to surgery compared with prolapse surgery alone.
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Affiliation(s)
- Ritu Basnet
- Department of Physiotherapy, Scheer Memorial Adventist Hospital, Banepa, Kavre, Nepal.
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The Effect of Pelvic Floor Muscle Training on Pelvic Floor Dysfunction in Pregnant and Postpartum Women. PHYSICAL ACTIVITY AND HEALTH 2020. [DOI: 10.5334/paah.64] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gorji Z, Pourmomeny AA, Hajhashemy M. Evaluation of the effect of a new method on the pelvic organ prolapse symptoms. Low Urin Tract Symptoms 2019; 12:20-24. [PMID: 31448876 DOI: 10.1111/luts.12277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Previous studies of treatment for prolapse, patients have undergone pelvic floor muscle training (PFMT), but no exercises were performed for the hip muscles. Accordingly, this study investigated a new conservative treatment approach that was hypothesized to improve prolapse symptoms more than PFMT. METHODS Forty women with Stage 2 or 3 prolapse were randomly assigned to either the control or intervention group (n = 20 in each). In this study, patients are treated for 12 sessions (4 weeks and 3 sessions each week). In the control group, the pelvic floor muscle training is applied in for treatment. In the intervention group, in addition to pelvic floor muscle training, postural or positional inversion exercises are included in training. RESULTS There was a significant difference between the control and intervention groups in only three domains of the Prolapse Quality of Life questionnaire, namely general health (P = 0.010), physical limitation (P = 0.038), and social limitation (P = 0.010). Furthermore, International Consultation of Incontinence (ICIQ) scores for filling symptoms and bother scale differed significantly between the two groups (P = 0.035 and P = 0.045, respectively). There was also a significant difference in the stage of prolapse and pelvic floor muscle strength in both groups compared with baseline, although only pelvic floor. muscle strength differed significantly between the two groups (P = 0.041). CONCLUSION This new method of postural or positional inversion leads to a greater improvement in symptoms of pelvic organ prolapse.
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Affiliation(s)
- Zahra Gorji
- Pelvic floor Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas A Pourmomeny
- Pelvic floor Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Hajhashemy
- Pelvic floor Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Wiegersma M, Panman CMCR, Hesselink LC, Malmberg AGA, Berger MY, Kollen BJ, Dekker JH. Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse. Phys Ther 2019; 99:109-117. [PMID: 30329105 DOI: 10.1093/ptj/pzy114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 06/18/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although the effectiveness of pelvic floor muscle training in women with prolapse has been demonstrated in several studies, there seem to be subgroups of responders and nonresponders. OBJECTIVE The objective of this study was to identify factors that predict treatment success in women receiving pelvic floor muscle training for prolapse. DESIGN The design was a secondary analysis of data from 2 randomized controlled trials comparing conservative prolapse treatments. METHODS After 12 months, 172 women subjectively assessed treatment success ("better") or failure ("the same" or "worse"). Potential predictors were identified by a literature search and by consultation with experts in the field of urogynecology and pelvic floor muscle training. The relationship between potential predictors and treatment success was explored using logistic regression analysis. RESULTS Treatment was successful in 94 women (55%) and unsuccessful in 78 women (45%). The presence of ≥1 indicators of obstetric trauma (eg, high birth weight, episiotomy, perineal laceration during vaginal delivery, forceps delivery, or vacuum extraction) (odds ratio = 4.4; 95% CI = 1.6-12.0) and younger age (odds ratio = 0.94 per year; 95% CI = 0.9-1.0) independently predicted treatment success. The area under the receiver operating characteristic curve for the final model was 0.65 (95% CI = 0.57-0.74), and the model explained 11.7% of the variance. LIMITATIONS Although attempts were made to include all relevant predictors, the selection or operationalization of variables could have been incomplete or insufficient. CONCLUSIONS Identifying women who have prolapse and are likely to benefit most from pelvic floor muscle training is of great importance to clinical practice. In this study, 2 factors that independently predicted favorable outcomes were identified with this management approach. However, further research is needed to identify other predictive factors and to validate a new model in another population.
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Affiliation(s)
- Marian Wiegersma
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | | | | | - Janny H Dekker
- Department of General Practice, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Postbus 196/FA21, Groningen, the Netherlands
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Tso C, Lee W, Austin-Ketch T, Winkler H, Zitkus B. Nonsurgical Treatment Options for Women With Pelvic Organ Prolapse. Nurs Womens Health 2018; 22:228-239. [PMID: 29885711 DOI: 10.1016/j.nwh.2018.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/22/2017] [Accepted: 01/01/2018] [Indexed: 10/14/2022]
Abstract
Pelvic organ prolapse is a medical condition that can cause pelvic discomfort as well as urinary and bowel complications. Approximately 25% of women in the United States and roughly 50% of women worldwide develop this condition. Although pelvic organ prolapse is usually a non-life-threatening condition, it can result in decreased self-confidence and negative body image. Physical and emotional sequelae can limit physical activity, and decreased productivity could be a consequence. Evidence from the literature indicates that pessary use and pelvic floor muscle training are effective options when conservative treatment is desired. Additional research is necessary to determine long-term outcomes in women who choose nonsurgical treatments. Nonsurgical options are important for women for whom surgery is contraindicated or not preferred.
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Movement System Impairment-Guided Approach to the Physical Therapist Treatment of a Patient With Postpartum Pelvic Organ Prolapse and Mixed Urinary Incontinence: Case Report. Phys Ther 2017; 97:464-477. [PMID: 27587802 DOI: 10.2522/ptj.20160035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/21/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Women with postpartum pelvic organ prolapse (POP) and urinary incontinence are often treated by physical therapists specializing in women's health. Movement system impairments often coexist in this patient population. The purpose of this case report is to describe the physical therapist treatment of a woman with postpartum POP complicated by additional pelvic symptoms. CASE DESCRIPTION A 31-year-old woman presented with postpartum POP, diastasis recti, urinary incontinence, and constipation. Movement system impairments were consistent with a physical therapist diagnosis of femoral adduction-medial rotation syndrome exacerbated by levator ani muscle weakness and incoordination and impaired intra-abdominal pressure regulation. Interventions, based on a movement system guided approach, included postural correction; pelvic-floor, abdominal, and hip muscle strengthening; functional training to correct identified movement faults; and patient education. OUTCOMES Movement system impairment outcomes included: correction of femoral adduction-medial rotation and knee hyperextension during standing at rest, ambulation, and exercise; increased hip muscle strength; and effective regulation of intra-abdominal pressure (resolution of breath holding with the Valsalva maneuver) during all transitional movements and therapeutic exercise. The patient also demonstrated reductions in POP, urinary, and colorectal symptom severity that exceeded the minimal clinically important difference. Additionally, she demonstrated a reduction in diastasis rectus distance. DISCUSSION A movement system impairment-guided approach led the physical therapist to consider impairments outside the pelvic floor that could have contributed to the patient's pelvic symptoms. Using this approach, the patient achieved resolution of musculoskeletal and movement impairments and reductions in POP, urinary and colorectal symptoms, and symptom-related distress.
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Hagen S, Glazener C, McClurg D, Macarthur C, Elders A, Herbison P, Wilson D, Toozs-Hobson P, Hemming C, Hay-Smith J, Collins M, Dickson S, Logan J. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. Lancet 2017; 389:393-402. [PMID: 28010994 DOI: 10.1016/s0140-6736(16)32109-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/05/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pelvic floor muscle training can reduce prolapse severity and symptoms in women seeking treatment. We aimed to assess whether this intervention could also be effective in secondary prevention of prolapse and the need for future treatment. METHODS We did this multicentre, parallel-group, randomised controlled trial at three centres in New Zealand and the UK. Women from a longitudinal study of pelvic floor function after childbirth were potentially eligible for inclusion. Women of any age who had stage 1-3 prolapse, but had not sought treatment, were randomly assigned (1:1), via remote computer allocation, to receive either one-to-one pelvic floor muscle training (five physiotherapy appointments over 16 weeks, and annual review) plus Pilates-based pelvic floor muscle training classes and a DVD for home use (intervention group), or a prolapse lifestyle advice leaflet (control group). Randomisation was minimised by centre, parity (three or less vs more than three deliveries), prolapse stage (above the hymen vs at or beyond the hymen), and delivery method (any vaginal vs all caesarean sections). Women and intervention physiotherapists could not be masked to group allocation, but allocation was masked from data entry researchers and from the trial statistician until after database lock. The primary outcome was self-reported prolapse symptoms (Pelvic Organ Prolapse Symptom Score [POP-SS]) at 2 years. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01171846. FINDINGS Between Dec 21, 2008, and Feb 24, 2010, in New Zealand, and Oct 27, 2010, and Sept 5, 2011, in the UK, we randomly assigned 414 women to the intervention group (n=207) or the control group (n=207). One participant in each group was excluded after randomisation, leaving 412 women for analysis. At baseline, 399 (97%) women had prolapse above or at the level of the hymen. The mean POP-SS score at 2 years was 3·2 (SD 3·4) in the intervention group versus 4·2 (SD 4·4) in the control group (adjusted mean difference -1·01, 95% CI -1·70 to -0·33; p=0·004). The mean symptom score stayed similar across time points in the control group, but decreased in the intervention group. Three adverse events were reported, all of which were in the intervention group (one women had a fall, one woman had a pain in her tail bone, and one woman had chest pain and shortness of breath). INTERPRETATION Our study shows that pelvic floor muscle training leads to a small, but probably important, reduction in prolapse symptoms. This finding will be important for women and caregivers considering preventive strategies. FUNDING Wellbeing of Women charity, the New Zealand Continence Association, and the Dean's Bequest Fund of Dunedin School of Medicine.
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
| | - Cathryn Glazener
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christine Macarthur
- Department of Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Peter Herbison
- Preventive and Social Medicine, Dunedin School of Medicine, Dunedin, New Zealand
| | - Don Wilson
- Department of Women's and Children's Health, Dunedin School of Medicine, Dunedin, New Zealand
| | | | - Christine Hemming
- Aberdeen Royal Infirmary, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Marissa Collins
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Sylvia Dickson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Janet Logan
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Özengin N, Kaya S, Orhan C, Bakar Y, Duran B, Ankaralı H, Akbayrak T. Turkish adaptation of the Pelvic Organ Prolapse Symptom Score and its validity and reliability. Int Urogynecol J 2017; 28:1217-1222. [PMID: 28062904 DOI: 10.1007/s00192-016-3251-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to adapt the Pelvic Organ Prolapse Symptom Score (POP-SS) into Turkish and evaluate its reliability and validity. METHODS The POP-SS was adapted into Turkish by following the steps of the intercultural adaptation process. One hundred and three women with symptomatic or asymptomatic pelvic organ prolapse (POP) completed the Turkish POP-SS and other valid and reliable Turkish tools for POP: Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal-Anal Distress Inventory 8 (CRADI-8), Urinary Distress Inventory 6 (UDI-6), Pelvic Floor Distress Inventory 20 (PFDI-20), and Pelvic Organ Prolapse Impact Questionnaire 7 (POPIQ-7). Pelvic Organ Prolapse Quantification (POP-Q) system was also used to assess pelvic support, and patients were divided into three groups based on POP-Q scores. Cronbach's alpha was used to determine internal consistency, and intraclass correlation coefficient (ICC) was estimated for test-retest reliability. POP-SS validity was assessed by using the Spearman rank correlation and Kruskal-Wallis analyses. The underlying scale structure was determined by exploratory factor analysis. RESULTS The POP-SS scale had high internal consistency (Cronbach's alpha = 0.705) and test-retest reliability (ICC = 0.981; p < 0.001). Among groups, there was statistically significant differences in POP-SS scores. POP-SS scores were also significantly correlated with POPDI-6 (r = 0.830), CRADI-8 (r = 0.525), UDI-6 (r = 0.385), PFDI-20 (r = 0.752), and POPIQ-7 (r = 0.690) (p < 0.001). Two factors were identified by exploratory factor analysis. CONCLUSIONS The Turkish version of POP-SS is a valid and reliable tool for Turkish women with POP.
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Affiliation(s)
- Nuriye Özengin
- School of Physical Therapy and Rehabilitation, Abant İzzet Baysal University, 14280, Bolu, Turkey
| | - Serap Kaya
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ceren Orhan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yeşim Bakar
- School of Physical Therapy and Rehabilitation, Abant İzzet Baysal University, 14280, Bolu, Turkey.
| | | | - Handan Ankaralı
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Düzce University, Düzce, Turkey
| | - Türkan Akbayrak
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care. Menopause 2016; 23:1307-1318. [DOI: 10.1097/gme.0000000000000706] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baeßler K, Aigmüller T, Albrich S, Anthuber C, Finas D, Fink T, Fünfgeld C, Gabriel B, Henscher U, Hetzer FH, Hübner M, Junginger B, Jundt K, Kropshofer S, Kuhn A, Logé L, Nauman G, Peschers U, Pfiffer T, Schwandner O, Strauss A, Tunn R, Viereck V. Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd 2016; 76:1287-1301. [PMID: 28042167 PMCID: PMC5193153 DOI: 10.1055/s-0042-119648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
Aims: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). This is a guideline published and coordinated by the DGGG. The aim is to provide evidence-based recommendations obtained by evaluating the relevant literature for the diagnostic, conservative and surgical treatment of women with female pelvic organ prolapse with or without stress incontinence. Methods: We conducted a systematic review together with a synthesis of data and meta-analyses, where feasible. MEDLINE, Embase, Cinahl, Pedro and the Cochrane Register were searched for relevant articles. Reference lists were hand-searched, as were the abstracts of the Annual Meetings of the International Continence Society and the International Urogynecological Association. We included only abstracts of randomized controlled trials that were presented and discussed in podium sessions. We assessed original data on surgical procedures published since 2008 with a minimum follow-up time of at least 12 months. If the studies included descriptions of perioperative complications, this minimum follow-up period did not apply. Recommendations: The guideline encompasses recommendations for the diagnosis and treatment of female pelvic organ prolapse. Recommendations for anterior, posterior and apical pelvic organ prolapse with or without concomitant stress urinary incontinence, uterine preservation options, and the pros and cons of mesh placements during surgery for pelvic organ prolapse are presented. The recommendations are based on an extensive and systematic review and evaluation of the current literature and include the experiences and specific conditions in Germany, Austria and Switzerland.
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Affiliation(s)
- K. Baeßler
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - T. Aigmüller
- Universitätsklinik für Gynäkologie und Geburtshilfe, Med Uni Graz, Austria
| | - S. Albrich
- Praxis “Frauenärzte Fünf Höfe” München, München, Germany
| | | | - D. Finas
- Evangelisches Krankenhaus Bielefeld EvKB, Bielefeld, Germany
| | - T. Fink
- Sana Klinikum Berlin Lichtenberg, Berlin, Germany
| | | | - B. Gabriel
- St. Josefʼs Hospital Wiesbaden, Wiesbaden, Germany
| | - U. Henscher
- Praxis für Physiotherapie, Hannover, Germany
| | | | - M. Hübner
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - B. Junginger
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - K. Jundt
- Frauenarztpraxis am Pasinger Bahnhof, München, Germany
| | | | - A. Kuhn
- Inselspital Bern, Bern, Switzerland
| | - L. Logé
- Sana Klinikum Hof GmbH, Hof, Germany
| | - G. Nauman
- Helios Klinikum Erfurt, Erfurt, Germany
| | | | - T. Pfiffer
- Asklepios Klinik Hamburg Harburg, Hamburg, Germany
| | | | - A. Strauss
- Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - R. Tunn
- St. Hedwig Krankenhaus, Berlin, Germany
| | - V. Viereck
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Abstract
Pelvic organ prolapse is the descent of one or more of the pelvic organs, (including the bladder, uterus and rectum) from their normal anatomical position into the vaginal canal in women. This is a result of failure of the fascial, muscular and ligamentous supports of the pelvic organs and is a common problem encountered in primary care. Pelvic organ prolapse can have a profound and significant impact on quality of life, and it is important for GPs to understand how to diagnose and manage women with this condition. The majority of women presenting with pelvic organ prolapse are suitable for initial management in a primary care setting.
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Panman C, Wiegersma M, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Vermeulen KM, Dekker JH. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care. BJOG 2016; 124:511-520. [PMID: 26996291 DOI: 10.1111/1471-0528.13992] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare effects and cost-effectiveness of pelvic floor muscle training (PFMT) and watchful waiting in women with pelvic organ prolapse. DESIGN Randomised controlled trial. SETTING Dutch general practice. POPULATION Women (≥55 years) with symptomatic mild prolapse, identified by screening. METHODS Linear multilevel analysis. MAIN OUTCOME MEASURES Primary outcome was change of pelvic floor symptoms (Pelvic-Floor-Distress-Inventory-20 [PFDI-20]) during 24 months. Secondary outcomes were condition-specific and general quality of life, costs, sexual functioning, prolapse stage, pelvic floor muscle function and women's perceived improvement of symptoms. RESULTS PFMT (n = 145) resulted in a 12.2-point (95% CI 7.2-17.2, P < 0.001) greater improvement in PFDI-20 score during 24 months compared with watchful waiting (n = 142). Participants randomised to PFMT more often reported improved symptoms (43% versus 14% for watchful waiting). Direct medical costs per person were €330 for PFMT and €91 for watchful waiting but costs for absorbent pads were lower in the PFMT group (€40 versus €77). Other secondary outcomes did not differ between groups. Post-hoc subgroup analysis demonstrated that PFMT was more effective in women experiencing higher pelvic floor symptom distress at baseline. CONCLUSION PFMT resulted in greater pelvic floor symptom improvement compared with watchful waiting. The difference was statistically significant, but below the presumed level of clinical relevance (15 points). PFMT more often led to women's perceived improvement of symptoms, lower absorbent pads costs, and was more effective in women experiencing higher pelvic floor symptom distress. Therefore, PFMT could be advised in women with bothersome symptoms of mild prolapse. TWEETABLE ABSTRACT Pelvic floor muscle training can be effective in women with bothersome symptoms of mild prolapse.
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Affiliation(s)
- Cmcr Panman
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M Wiegersma
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B J Kollen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M Y Berger
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Y Lisman-Van Leeuwen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J H Dekker
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Due U, Brostrøm S, Lose G. The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse. Acta Obstet Gynecol Scand 2016; 95:811-9. [PMID: 26910261 DOI: 10.1111/aogs.12884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/11/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We evaluated the 12-month effects of adding pelvic floor muscle training to a lifestyle advice program in women with symptomatic pelvic organ prolapse stage II-III and the number of women who had sought further treatment. MATERIAL AND METHODS This study was a 12-month follow up of a randomized controlled trial comparing a structured lifestyle advice program alone (lifestyle group) or in combination with pelvic floor muscle training (training and lifestyle group). Both programs consisted of six separate group sessions within 12 weeks. RESULTS Data were available from 83 (76%) of the 109 originally included women. At the 12-month follow up, 34/83 (41%) had not sought further treatment, 13/43 (30%) in the lifestyle group and 21/40 (52%) in the training and lifestyle group, and these could be included for analysis. The lifestyle group had significantly improved bladder symptoms compared with baseline on single-item analysis (p = 0.01). The training and lifestyle group had significantly improved pelvic organ prolapse symptoms on single-item analysis (p = 0.02) and of bowel-related quality of life (p = 0.04). No significant between-group differences were found in the symptom and quality of life scores. All together 49 women (59%) had sought further treatment, 70% in the lifestyle group, and 48% in the training and lifestyle group (p = 0.05). Twenty-six in the lifestyle group, and 15 in the training and lifestyle group had sought conservative treatment. Four women in each group had received surgery. More severe anterior prolapse and more bladder symptoms at the 3-month follow up were significantly associated with having sought further treatment in both groups. CONCLUSIONS At 12-month follow up, the effects of adding pelvic floor muscle training to a structured lifestyle advice program were limited.
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Affiliation(s)
- Ulla Due
- Department of Obstetrics and Gynecology, Herlev Hospital, Copenhagen, Denmark.,Department of Occupational and Physical Therapy, Herlev Hospital, Copenhagen, Denmark
| | - Søren Brostrøm
- Division of Hospital Services and Emergency Management, Danish Health and Medicines Authority, Copenhagen, Denmark
| | - Gunnar Lose
- Department of Obstetrics and Gynecology, Herlev Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hagen S, Stark D, Dougall I. A survey of prolapse practice in UK women's health physiotherapists: what has changed in the last decade? Int Urogynecol J 2015; 27:579-85. [PMID: 26476818 PMCID: PMC4819739 DOI: 10.1007/s00192-015-2864-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/28/2015] [Indexed: 12/03/2022]
Abstract
Introduction and hypothesis Prolapse is a common female problem, and conservative treatments such as pelvic floor muscle training (PFMT) are important options for women. Evidence supporting the effectiveness of PFMT for prolapse has grown over the last decade, and it was hypothesised that practice and practice guidelines would have developed in line with the evidence. To assess this, up-to-date information about the practice of physiotherapists working in women’s health regarding their treatment of prolapse was required. Methods An online survey sent to members of the Association of Chartered Physiotherapists in Women’s Health and the Chartered Physiotherapists Promoting Continence. Results were compared with those of an earlier survey undertaken in 2002. Results A 49 % response rate was achieved. The majority of respondents were senior physiotherapists (55 %) and had worked in women’s health for more than 10 years. Respondents were treating significantly more women with prolapse than a decade before: 36 % vs 14 % treated more than 50 women per year in 2002 and 2013 respectively (p < 0.001). Individualised PFMT (93 %), lifestyle advice (92 %) and biofeedback-assisted PFMT (83 %) were the most common treatment elements, with four being the average number of appointments. Forty-eight percent had changed their practice as a result of recent research; however, scepticism amongst medics, the referral of women directly for surgery, and constraints on resources were thought to be barriers to wider implementation of the evidence of PFMT for prolapse. Conclusions There has been uptake of evidence-based prolapse practice by UK specialist physiotherapists in the last decade. Further research targeting the implementation of this evidence would be valuable in addressing potential barriers, and in supporting the need for physiotherapy in the treatment of prolapse.
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Affiliation(s)
- Suzanne Hagen
- Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
| | - Diane Stark
- Functional Bowel Service, Glenfield Hospital, University Hospitals Leicester, Leicester, UK
| | - Isla Dougall
- Department of Psychology, University of Glasgow, Glasgow, UK
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Due U, Brostrøm S, Lose G. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial. Int Urogynecol J 2015; 27:555-63. [DOI: 10.1007/s00192-015-2852-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/14/2015] [Indexed: 11/25/2022]
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Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J 2015; 27:981-92. [PMID: 26407564 DOI: 10.1007/s00192-015-2846-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/09/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our objective was to assess the effectiveness of pelvic floor muscle training (PFMT) as a treatment for women with pelvic organ prolapse (POP) or as an adjunct to prolapse surgery. METHODS Relevant literature sources were searched using databases including PubMed, Ovid, Web of Science, Scopus, ClinicalTrials.gov, EBSCO, CINAHL, the Cochrane Central Register of Controlled Trials, CNKI, VIP, Wanfang, and CBM until 5 July 2015. Eligible studies were restricted to randomized controlled trials (RCT). The available data were pooled using Review Manager version 5.2. For data deemed not appropriate for synthesis, a narrative overview was conducted. RESULTS In total, 13 studies with 2,340 patients were included. Our results indicated women receiving PFMT gained a greater improvement than controls in prolapse symptom score [mean difference (MD) -3.07, 95 % confidence interval (CI) -3.91 to -2.23] and POP stages [risk ratio (RR) 1.70, 95 % CI 1.19-2.44]. The number of women who said their prolapse was getting better was higher (RR 5.48, 95 % CI 2.19-13.72) and other discomfort syndromes, such as vaginal, bladder, and rectum, were lower in the PFMT groups than in controls. Meanwhile, women after PFMT had greater improvement in muscle strength and endurance but did not show a significant difference for further treatment needs. In addition, the results evaluating PFMT as an adjunct to prolapse surgery were inconclusive because of the variability in methods of measuring outcome. CONCLUSIONS Our meta-analysis demonstrated women who received PFMT showed a greater subjective improvement in prolapse symptoms and an objective improvement in POP severity.
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Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 536 Changle Road, Shanghai, 200040, China.
| | - Yuping Gong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bei Wang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
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Wiegersma M, Panman CMCR, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Dekker JH. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care. BMJ 2014; 349:g7378. [PMID: 25533442 PMCID: PMC4273538 DOI: 10.1136/bmj.g7378] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. DESIGN Randomised controlled trial. SETTING Dutch primary care. PARTICIPANTS Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. INTERVENTIONS Pelvic floor muscle training versus watchful waiting. MAIN OUTCOME MEASURES The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients' perceived change in symptoms. RESULTS Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. CONCLUSIONS Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points). Nevertheless, 57% of the participants in the intervention group reported an improvement of overall symptoms. More studies are needed to identify factors related to success of pelvic floor muscle training and to investigate long term effects.Trial registration Dutch Trial Register (www.trialregister.nl) identifier: NTR2047.
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Affiliation(s)
- Marian Wiegersma
- University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands
| | - Chantal M C R Panman
- University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands
| | - Boudewijn J Kollen
- University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands
| | - Marjolein Y Berger
- University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands
| | - Yvonne Lisman-Van Leeuwen
- University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands
| | - Janny H Dekker
- University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands
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Giarenis I, Robinson D. Prevention and management of pelvic organ prolapse. F1000PRIME REPORTS 2014; 6:77. [PMID: 25343034 PMCID: PMC4166938 DOI: 10.12703/p6-77] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery.
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Kotarinos RK, Kotarinos E. The Past, Present and Future of POP and Physical Therapy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0088-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hagen S, Stark D, Glazener C, Dickson S, Barry S, Elders A, Frawley H, Galea MP, Logan J, McDonald A, McPherson G, Moore KH, Norrie J, Walker A, Wilson D. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet 2014; 383:796-806. [PMID: 24290404 DOI: 10.1016/s0140-6736(13)61977-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pelvic organ prolapse is common and is strongly associated with childbirth and increasing age. Women with prolapse are often advised to do pelvic floor muscle exercises, but evidence supporting the benefits of such exercises is scarce. We aimed to establish the effectiveness of one-to-one individualised pelvic floor muscle training for reducing prolapse symptoms. METHODS We did a parallel-group, multicentre, randomised controlled trial at 23 centres in the UK, one in New Zealand, and one in Australia, between June 22, 2007, and April 9, 2010. Female outpatients with newly-diagnosed, symptomatic stage I, II, or III prolapse were randomly assigned (1:1), by remote computer allocation with minimsation, to receive an individualised programme of pelvic floor muscle training or a prolapse lifestyle advice leaflet and no muscle training (control group). Outcome assessors, and investigators who were gynaecologists at trial sites, were masked to group allocation; the statistician was masked until after data analysis. Our primary endpoint was participants' self-report of prolapse symptoms at 12 months. Analysis was by intention-to-treat analysis. This trial is registered, number ISRCTN35911035. FINDINGS 447 eligible patients were randomised to the intervention group (n=225) or the control group (n=222). 377 (84%) participants completed follow-up for questionnaires at 6 months and 295 (66%) for questionnaires at 12 months. Women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the pelvic organ prolapse symptom score [POP-SS]) at 12 months than those in the control group (mean reduction in POP-SS from baseline 3.77 [SD 5.62] vs 2.09 [5.39]; adjusted difference 1.52, 95% CI 0.46-2.59; p=0.0053). Findings were robust to missing data. Eight adverse events (six vaginal symptoms, one case of back pain, and one case of abdominal pain) and one unexpected serious adverse event, all in women from the intervention group, were regarded as unrelated to the intervention or to participation in the study. INTERPRETATION One-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms. Long-term benefits should be investigated, as should the effects in specific subgroups. FUNDING Chief Scientist Office of the Scottish Government Health and Social Care Directorates, New Zealand Lottery Board, and National Health and Medical Research Council (Australia).
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
| | - Diane Stark
- Clinic 2, Balmoral Building, Leicester Royal Infirmary, Leicester, UK
| | - Cathryn Glazener
- Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Sylvia Dickson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Sarah Barry
- Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow, UK
| | - Andrew Elders
- Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Helena Frawley
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia
| | - Mary P Galea
- Department of Medicine-Royal Melbourne Hospital, University of Melbourne, VIC, Australia
| | - Janet Logan
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials, Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Gladys McPherson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Kate H Moore
- Pelvic Floor and Bladder Unit, Department of Urogynaecology, St George Hospital, NSW, Australia
| | - John Norrie
- Centre for Healthcare Randomised Trials, Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Andrew Walker
- Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow, UK
| | - Don Wilson
- Department of Obstetrics and Gynaecology, Dunedin School of Medicine, Dunedin, New Zealand
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Affiliation(s)
- Kathryn L Burgio
- University of Alabama at Birmingham and the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL 35244, USA.
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