Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders
- 592 Downloads
Purpose of Review
The purpose of the study was to catalog the most recent available literature regarding the use of conservative measures in treatment of pelvic floor disorders.
Pelvic floor disorders encompass abnormalities of urination, defecation, sexual function, pelvic organ prolapse, and chronic pain, and can have significant quality of life implications for patients. Current guidelines recommend behavioral modifications and conservative treatments as first-line therapy for pelvic floor disorders. We have reviewed the literature for articles published on physical, complementary, and alternative treatments for pelvic floor disorders over the past 5 years. Review of pelvic floor muscle physiotherapy (PFMT) and biofeedback (BF) shows a benefit for patients suffering from bladder dysfunction (incontinence, overactive bladder), bowel dysfunction (constipation, fecal incontinence), pelvic organ prolapse, and sexual dysfunction (pelvic pain). Combination of PFMT and BF has shown improved results compared to PFMT alone, and some studies find that electrical stimulation can augment the benefit of BF and PFMT. Additionally, acupuncture and cognitive behavioral therapy has shown to be an effective treatment for pelvic floor disorders, particularly with respect to pelvic pain.
This update highlights beneficial conservative treatments available for pelvic floor dysfunction, and supplements the current literature on treatment options for patients suffering from these disorders.
KeywordsBiofeedback Pelvic floor dysfunction Incontinence Pelvic floor muscle therapy Pelvic pain Acupuncture
Compliance with Ethical Standards
Conflict of Interest
Alex Arnouk, Elise De, Alexandra Rehfuss, Carin Cappadocia, Samantha Dickson, and Fei Lian each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.•• Dumoulin C, Hunter KF, Moore K, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: summary of the 5th International Consultation on Incontinence. Neurourol Urodyn. 2016;35(1):15–20. A Summary of the 5th ICI, reviewing and summarizing new evidence of conservative management of UI and POP. CrossRefPubMedGoogle Scholar
- 6.• Griffiths D, Clarkson B, Tadic SD, Resnick NM. Brain mechanisms underlying urge incontinence and its response to pelvic floor muscle training. J Urol. 2015;194(3):708–15. An interesting investigation of cerebral mechanisms underlying brain-bladder control. CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Mclean L, Varette K, Gentilcore-saulnier E, Harvey MA, Baker K, Sauerbrei E. Pelvic floor muscle training in women with stress urinary incontinence causes hypertrophy of the urethral sphincters and reduces bladder neck mobility during coughing. Neurourol Urodyn. 2013;32(8):1096–102.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.• Zoorob D, South M, Karram M, et al. A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain. Int Urogynecol J. 2015;26(6):845–52. A randomized trial comparing effects of PFMT versus levator-directed injections on sexual function and pelvic pain. CrossRefPubMedGoogle Scholar
- 20.•• Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-spadt S. Vulvodynia: assessment and treatment. J Sex Med. 2016;13(4):572–90. Detail recommendations by an expert committee on the 4th International Consultation of Sexual Medicine on the assessment and treatment of women’s genital pain. CrossRefPubMedGoogle Scholar
- 22.Abrams P, Andersson KE, Birder L, et al. Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213–40.CrossRefPubMedGoogle Scholar
- 23.• 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. 2016;27(7):981–92. A systematic review and meta-analysis implicating improvement in POP severity and prolapse symptoms with PFMT. CrossRefPubMedGoogle Scholar
- 27.• Bø K, Hilde G, Stær-jensen J, Siafarikas F, Tennfjord MK, Engh ME. Postpartum pelvic floor muscle training and pelvic organ prolapse—a randomized trial of primiparous women. Am J Obstet Gynecol. 2015;212(1):38.e1–7. A randomized trial demonstrating no effect of post-partum PFMT on POP in primiparous women. CrossRefGoogle Scholar
- 33.• Dumoulin C, Hay-smith J, Frawley H, et al. 2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar. Neurourol Urodyn. 2015;34(7):600–5. A consensus statement on improving adherence to PFMT. CrossRefPubMedGoogle Scholar
- 34.Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int. 2015;116(6):955–64.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.• Burgio KL, Newman DK, Rosenberg MT, Sampselle C. Impact of behaviour and lifestyle on bladder health. Int J Clin Pract. 2013;67(6):495–504. Summarizes behavioral and lifestyle factors influential to bladder health, including a table of bladder and prostate-friendly foods. CrossRefPubMedGoogle Scholar
- 41.Lee HE, Cho SY, Lee S, Kim M, Oh SJ. Short-term effects of a systematized bladder training program for idiopathic overactive bladder: a prospective study. Int Neurourol J 2013;17(1):11–7.Google Scholar
- 42.Imamura M, Williams K, Wells M, Mcgrother C. Lifestyle interventions for the treatment of urinary incontinence in adults. Cochrane Database Syst Rev. 2015;12:CD003505.Google Scholar
- 44.Dijkstra-eshuis J, Van den Bos TW, Splinter R, et al. Effect of preoperative pelvic floor muscle therapy with biofeedback versus standard care on stress urinary incontinence and quality of life in men undergoing laparoscopic radical prostatectomy: a randomised control trial. Neurourol Urodyn. 2015;34(2):144–50.CrossRefPubMedGoogle Scholar
- 49.Woodward S, Norton C, Chiarelli P. Biofeedback for treatment of chronic idiopathic constipation in adults. Cochrane Database Syst Rev. 2014;3:CD008486.Google Scholar
- 60.Amin MM, Ait-allah AS, Ali A-S, Salem RA, Ahmed SR, Alsammani MA. Inferior hypogastric plexus blockade versus acupuncture for the management of idiopathic chronic pelvic pain: a randomized clinical trial. Biom J. 2015;38(4):317–22.Google Scholar
- 64.Liu BP, Wang YT, Chen SD. Effect of acupuncture on clinical symptoms and laboratory indicators for chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis. Int Urol Nephrol. 2016.Google Scholar