Abstract
Introduction and hypothesis
To provide a clinical opinion based on current literature reporting on the effects of peri-operative pelvic floor muscle training (PFMT) on postoperative pelvic floor symptoms, recurrent treatment after pelvic organ prolapse (POP) surgery and current clinical practice in the Netherlands.
Methods
The PubMed database was searched, with dates from 1966 to May 2012, for all types of studies reporting on the effects of peri-operative PFMT on recurrent treatment and/or pelvic floor symptoms after POP surgery. Also, current clinical practice in the Netherlands was evaluated.
Results
Two small randomised controlled trials (RCTs), with differences in the population included, were identified. The first RCT concluded that peri-operative PFMT reduced the risk of pelvic floor symptoms 12 weeks after surgery and improved the quality of life. The second trial concluded that there is no significant beneficial effect 12 months after surgery. However, when looking at the reported outcomes in this trial micturition symptoms and quality of life improved more in the treatment group too. Studies evaluating whether peri-operative PFMT reduced the rate of recurrent treatment for POP-related symptoms, were not identified. This lack of evidence reflects the current clinical practice, as most gynaecologists do not offer peri-operative PFMT to their patients.
Conclusions
Peri-operative PFMT may reduce the risk of pelvic floor symptoms and improve the quality of life after POP surgery, although evidence is insufficient to implement this in current clinical practice. Since the results of the two RCTs on this topic are promising, there is an urgent need for robust, well-designed trials to evaluate the efficacy and (cost-)effectiveness of peri-operative PFMT.
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References
Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME (2009) The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1037–1045
Bump RC, Norton PA (1998) Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 25(4):723–746
Fialkow MF, Newton KM, Weiss NS (2008) Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct 19(11):1483–1487
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506
Smith FJ, Holman CD, Moorin RE, Tsokos N (2010) Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 116(5):1096–1100
Drutz HP, Alarab M (2006) Pelvic organ prolapse: demographics and future growth prospects. Int Urogynecol J Pelvic Floor Dysfunct 17 [Suppl 1]:S6–S9
Miedel A, Tegerstedt G, Morlin B, Hammarstrom M (2008) A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1593–1601
Weber AM, Abrams P, Brubaker L et al (2001) The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 12(3):178–186
Jarvis SK, Hallam TK, Lujic S, Abbott JA, Vancaillie TG (2005) Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: results of a randomised controlled trial. Aust N Z J Obstet Gynaecol 45(4):300–303
Roovers JP, van der Vaart CH, van der Bom JG, van Leeuwen JH, Scholten PC, Heintz AP (2004) A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. BJOG 111(1):50–56
Diez-Itza I, Aizpitarte I, Becerro A (2007) Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J Pelvic Floor Dysfunct 18(11):1317–1324
Whiteside JL, Weber AM, Meyn LA, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 191(5):1533–1538
Denman MA, Gregory WT, Boyles SH, Smith V, Edwards SR, Clark AL (2008) Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 198(5):555
Vakili B, Zheng YT, Loesch H, Echols KT, Franco N, Chesson RR (2005) Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. Am J Obstet Gynecol 192(5):1592–1598
Braekken IH, Majida M, Engh ME, Bo K (2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol 203(2):170–177
Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I (2009) A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 20(1):45–51
Piya-Anant M, Therasakvichya S, Leelaphatanadit C, Techatrisak K (2003) Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assoc Thai 86(6):509–515
Stupp L, Resende AP, Oliveira E, Castro RA, Girao MJ, Sartori MG (2011) Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct Oct 22(10):1233–1239
Hagen S, Stark D (2011) Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 7(12):CD003882, Review
Berghmans LC, Hendriks HJ, de Bie RA, van Waalwijk van Doorn ES, Bo K, van Kerrebroeck PE (2000) Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int 85(3):254–263
Kairaluoma M, Raivio P, Kupila J, Aarnio M, Kellokumpu I (2004) The role of biofeedback therapy in functional proctologic disorders. Scand J Surg 93(3):184–190
Bo K (2004) Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct 15(2):76–84
Weber AM, Richter HE (2005) Pelvic organ prolapse. Obstet Gynecol 106(3):615–634
Frawley HC, Phillips BA, Bo K, Galea MP (2010) Physiotherapy as an adjunct to prolapse surgery: an assessor-blinded randomized controlled trial. Neurourol Urodyn 29(5):719–725
Frawley HC (2010) Perioperative physiotherapy as an adjunct to prolapse surgery: an in-depth analysis of a study with a negative result. Current Bladder Dysfunction Reports 5:48–55
Barber MD, Brubaker L, Menefee S et al (2009) Operations and pelvic muscle training in the management of apical support loss (OPTIMAL) trial: design and methods. Contemp Clin Trials 30(2):178–189
Conflicts of interest
J.P.W.R. Roovers: investigator initiated studies with AMS and Pohl Boskamp.
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Lakeman, M.M.E., Koops, S.E.S., Berghmans, B.C. et al. Peri-operative physiotherapy to prevent recurrent symptoms and treatment following prolapse surgery: supported by evidence or not?. Int Urogynecol J 24, 371–375 (2013). https://doi.org/10.1007/s00192-012-1973-y
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DOI: https://doi.org/10.1007/s00192-012-1973-y