Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial

Abstract

Introduction and hypothesis

We evaluated the effect of adding pelvic floor muscle training (PFMT) to a structured lifestyle advice program.

Methods

This was a single-blinded randomized trial of women with symptomatic pelvic organ prolapse (POP) stage ≥ II. Participants were randomized to a structured lifestyle advice program with or without PFMT. Both groups received similar lifestyle advice in six separate group sessions. The combined group performed group PFMT after an individual assessment. Primary outcome was a global improvement scale at six-month follow-up. Secondary outcomes were the global scale and objective POP at three-month follow-up, symptoms and quality of life including sexuality, at three and six-month follow-up. A clinically relevant change of symptoms was defined as ≥15 %.

Results

We included 109 women. Eighty-nine women (82 %) completed three months follow-up; 85 (78 %) completed six-month follow-up. At both follow-ups, significantly more women in the combined group reported improvement in the global scale. At the three-month follow-up, the combined group only had significant improvement of POP symptoms while only the lifestyle advice group had significant improvement of quality of life. Change in objective POP and sexuality was nonsignificant. The symptom score improved 17 % in the combined group and 14 % in the lifestyle advice group (P = 0.57). Significantly more women in the lifestyle advice group had sought further treatment at the six-month follow-up.

Conclusion

Adding PFMT to a structured lifestyle advice program gave superior results in a global scale and for POP symptoms. Overall effect of either intervention barely reached clinical relevance.

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Fig. 1

Abbreviations

POP:

Pelvic organ prolapse

HRQoL:

Health-related quality of life

POP-Q:

Pelvic Organ Prolapse Quantification system

PFDI-20:

Pelvic Floor Distress Inventory Short Form 20

POPDI-6:

Pelvic Organ Prolapse Distress Inventory-6

CRADI-8:

Colorectal–Anal Distress Inventory-8

UDI-6:

Urinary Distress Inventory-6

PFIQ-7:

Pelvic Floor Impact Questionnaire Short Form-7

UIQ-7:

Urinary Impact Questionnaire-7

CRAIQ-7:

Colorectal–Anal Impact Questionnaire-7

POPIQ-7:

Pelvic Organ Prolapse Impact Questionnaire-7

PISQ-12:

Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12

PGI-I:

Patient Global Index of Improvement Scale

NRS:

Numeric Rating Scale

PFMT:

Pelvic floor muscle training

LG:

Lifestyle advice group

TLG:

Combined pelvic floor muscle training and lifestyle advice group

ITT:

Intention-to-treat analysis

RR:

Relative risk

References

  1. 1.

    Nygaard I et al (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–6

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Slieker-ten Hove MC et al (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):1037–45

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Swift SE, Tate SB, Nicholas J (2003) Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 189(2):372–7, discussion 377–9

    Article  PubMed  Google Scholar 

  4. 4.

    Dietz HP, Mann KP (2014) What is clinically relevant prolapse? An attempt at defining cutoffs for the clinical assessment of pelvic organ descent. Int Urogynecol J 25(4):451–5

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Haylen BT et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29(1):4–20

    PubMed  Google Scholar 

  6. 6.

    Hall AF et al (1996) Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol 175(6):1467–70, discussion 1470–1

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Bradley CS, Nygaard IE (2005) Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol 106(4):759–66

    Article  PubMed  Google Scholar 

  8. 8.

    Mouritsen L, Larsen JP (2003) Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 14(2):122–7

    Article  PubMed  Google Scholar 

  9. 9.

    Wu JM et al (2014) Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 123(6):1201–6

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Miedel A et al (2011) Short-term natural history in women with symptoms indicative of pelvic organ prolapse. Int Urogynecol J 22(4):461–8

    Article  PubMed  Google Scholar 

  11. 11.

    Basu M, Wise B, Duckett J (2011) A qualitative study of women’s preferences for treatment of pelvic floor disorders. BJOG 118(3):338–44

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Kapoor DS et al (2009) Conservative versus surgical management of prolapse: what dictates patient choice? Int Urogynecol J Pelvic Floor Dysfunct 20(10):1157–61

    Article  PubMed  Google Scholar 

  13. 13.

    Hagen S et al (2014) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet 383(9919):796–806

    Article  PubMed  Google Scholar 

  14. 14.

    Kashyap R, Jain V, Singh A (2013) Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapse. Int J Gynaecol Obstet 121(1):69–73

    Article  PubMed  Google Scholar 

  15. 15.

    Hagen S et al (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

    Article  PubMed  Google Scholar 

  16. 16.

    Braekken IH et al (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 e1-7

  17. 17.

    Stupp L et al (2011) Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J 22(10):1233–9

    Article  PubMed  Google Scholar 

  18. 18.

    Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189(1):98–101

    Article  PubMed  Google Scholar 

  19. 19.

    Srikrishna S, Robinson D, Cardozo L (2010) Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 21(5):523–8

    Article  Google Scholar 

  20. 20.

    Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–13

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Rogers RG et al (2003) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14(3):164–8, discussion 168

    Article  PubMed  Google Scholar 

  22. 22.

    Jelovsek JE, Maher C, Barber MD (2007) Pelvic organ prolapse. Lancet 369(9566):1027–38

    Article  PubMed  Google Scholar 

  23. 23.

    Miller JM (1998) The impact of specimen management in microbiology. MLO Med Lab Obs 30(5):28–30, 32, 34; quiz 35–6

  24. 24.

    Bo K (2006) Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstet Gynecol Scand 85(3):263–8

    Article  PubMed  Google Scholar 

  25. 25.

    Dumoulin C, Glazener C, Jenkinson D (2011) Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol Urodyn 30(5):746–53

    Article  PubMed  Google Scholar 

  26. 26.

    Utomo E et al (2014) Validation of the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) in a Dutch population. Int Urogynecol J 25(4):531–44

    Article  PubMed  Google Scholar 

  27. 27.

    Wiegersma M et al (2014) 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 349:g7378

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Terwee CB et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60(1):34–42

    Article  PubMed  Google Scholar 

  29. 29.

    Due U, Brostrom S, Lose G (2013) Validation of the Pelvic Floor Distress Inventory-20 and the Pelvic Floor Impact Questionnaire-7 in Danish women with pelvic organ prolapse. Acta Obstet Gynecol Scand 92(9):1041–8

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank physical therapists Dorthe Svarre Petersen, Katrin Jacobæus, Therese Simonsen, Annette Sørensen, and Marie Thorsager for their help with the two interventions; Tobias Wirenfeldt Clausen, statistician at the Department of Hematology, Herlev Hospital for help with statistical analyses; research nurse Berit Sejersen Larsen, Department of Gynecology and Obstetrics, Herlev Hospital, for her tremendous work with the randomization and follow-up of participants; the Department of Physical therapy, Herlev Hospital, for allowing us to use all their facilities.

Conflicts of interest

Ulla Due has been paid as a consultant for Astellas Pharma, Coloplast, and SCA and was partly funded with a research grant from the Association of Danish Physiotherapists; the funding source had no involvement in the study

Søren Brostrøm has no financial disclosures

Gunnar Lose has received grants from Astellas Pharma and Coloplast, and has been paid as consultant for Contura

Preliminary data from this paper was presented at the 29th Biannual Meeting of the Nordic Urogynaecological Association (NUGA) in Stockholm, Sweden, 29–31 January 2015 Ulla Due

The study was approved by the Danish Scientific Ethical Committee (H-4-2011-072) 24 August 2011

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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 27, 555–563 (2016). https://doi.org/10.1007/s00192-015-2852-0

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Keywords

  • Conservative treatment
  • Lifestyle advice
  • Pelvic floor muscle training
  • Pelvic organ prolapse