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Pelvic Floor Muscle Training and Prolapse: Prevention or Treatment?

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Management of Pelvic Organ Prolapse

Abstract

Pelvic organ prolapse (POP), the descent of the pelvic organs due to deficiencies in the pelvic support system, is a very common problem. Up to 40% of women aged 45–85 years have at least stage II POP according to POP-Q staging [1], even though only 10–20% of them seek medical care [2]. Pelvic floor muscle training has been proposed for its prevention and treatment.

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References

  1. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, et al. 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. 2009;20(9):1037–45.

    Article  Google Scholar 

  2. Rodriguez-Mias N, Martinez-Franco E, Aguado J, et al. Pelvic organ prolapse and stress urinary incontinence, do they share the same risk factors? Eur J Obstet Gynecol Reprod Biol. 2015;190:52–7.

    Article  Google Scholar 

  3. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.

    Article  CAS  Google Scholar 

  4. Zhang FW, Wei F, Wang HL, et al. Does pelvic floor muscle training augment the effect of surgery in women with pelvic organ prolapsed? A systematic review of randomized controlled trials. Neurourol Urodyn. 2016;35(6):666–74.

    Article  CAS  Google Scholar 

  5. Lakeman MM, Koops SE, Berghmans BC, et al. Peri-operative physiotherapy to prevent recurrent symptoms and treatment following prolapsed surgery: supported by evidence or not? Int Urogynecol J. 2013;24(3):371–5.

    Article  Google Scholar 

  6. De Lancey JO, Morgan D, Fenner DE, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapsed. Obstet Gynecol. 2007;109:295–302.

    Article  Google Scholar 

  7. Diez-Itza I, Arrue M, Ibanez L, et al. Postpartum impairment of pelvic floor muscle function: factors involved and association with prolapsed. Int Urogynecol J. 2011;22:1505–11.

    Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

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

    Article  Google Scholar 

  10. Miller JM, Perucchini D, Carchidi LT, et al. Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol. 2001;97(2):255–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Moore K, Domoulin C, Bradley C, et al. Adult conservative management. In: Abrams P, Cardozo L, Khouri AE, Wein A, editors. International consultation on urinary incontinence. 5th ed. Plymbridge: Health Publications Ltd; 2013. p. 1101–95.

    Google Scholar 

  12. Hay-Smith J, Herderschee R, Dumoulin C, et al. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women: an abridged Cochrane systematic review. Eur J Phys Rehabil Med. 2012;48(4):689–705.

    CAS  PubMed  Google Scholar 

  13. Balmforth JR, Mantle J, Bidmead J, et al. A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. BJU Int. 2006;98(4):811–7.

    Article  Google Scholar 

  14. Braekken IH, Majida M, Engh ME, et al. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapsed symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203:170e1–7.

    Article  Google Scholar 

  15. Frawley HC, Phyllips BA, Bo K, et al. Physiotherapy as an adjunct to prolapsed surgery: an assessor-blinded randomized controlled trial. Neurourol Urodyn. 2010;29:719–25.

    Article  Google Scholar 

  16. Calais-Germain B. Le périnée feminine et l’accouchement. Désiris ed. Paris; 2000.

    Google Scholar 

  17. Lind LR, Lucente V, Kohn N. Thoracic kyphosis and the prevalence of advanced uterine prolapse. Obstet Gynecol. 1996;87(4):605–9.

    Article  CAS  Google Scholar 

  18. Nguyen J, Lind R, Choe J, McKindesy F, et al. Lumbosacral spine and pelvic inlet changes associated with pelvic organ prolapsed. Obstet Gynecol. 2000;95:332–6.

    CAS  PubMed  Google Scholar 

  19. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9(1):3–12.

    Article  Google Scholar 

  20. De Gasquet B. Abdominaux: arretez le massacre. Marabout ed. Paris, 2005.

    Google Scholar 

  21. Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  Google Scholar 

  22. Di Gesu GA, Khullar V, Cardozo L, et al. P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):176–81.

    Article  Google Scholar 

  23. Biroli A. Prolasso genitale e riabilitazione: quale rapporto? Ital J Rehab Med MR. 2006;20:269–75.

    Google Scholar 

  24. Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012;30:437–43.

    Article  Google Scholar 

  25. Aponte MM, Rosenblum N. Repair of pelvic organ prolapse: what is the goal? Curr Urol Rep. 2014;15:385.

    Article  Google Scholar 

  26. Samuelsson EC, Victor FT, Tibblin G, et al. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J ObstetGynecol. 1999;180:299–305.

    Article  CAS  Google Scholar 

  27. Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. In: Bo K, Berghmans B, Morkved S, Kampen MV, editors. Evidence-based physical therapy for the pelvic floor. St Louis: Elsevier; 2007. p. 19–33.

    Chapter  Google Scholar 

  28. Slieker-ten Hove M, Pool-Goudzwaard A, Eijkemans M, et al. Pelvic floor muscle function in a general population of women with and without pelvic organ prolapse. Int Urogynecol J. 2010;21:311–9.

    Article  Google Scholar 

  29. DeLancey JO. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol. 2005;192:1488–95.

    Article  Google Scholar 

  30. Chen L, Ashton-Miller JA, Hsu Y, et al. Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol. 2006;108:324–32.

    Article  Google Scholar 

  31. Alas AN, Anger JT. Management of apical pelvic organ prolapse. Curr Urol Rep. 2015;16:33.

    Article  Google Scholar 

  32. Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012;119:852–60.

    Article  Google Scholar 

  33. Piya-Anant M, Therasakvichya S, Leelaphatanadit C, et al. 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. 2004;85:509–15.

    Google Scholar 

  34. Ghroubi S, Kharrat O, Chaari M, et al. Effect of conservative treatment in the management of low-degree urogenital prolapse. Ann Readapt Med Phys. 2008;51:96–102.

    Article  CAS  Google Scholar 

  35. Hagen S, Stark D, Glazener C, et al. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(1):45–51.

    Article  Google Scholar 

  36. Stüpp L, Resende AP, Oliveira E, et al. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J. 2011;22:1233–9.

    Article  Google Scholar 

  37. Alves FK, Riccetto C, Adami DB, et al. A pelvic floor muscle training program in postmenopausal women: a randomized controlled trial. Maturitas. 2015;81:300–5.

    Article  Google Scholar 

  38. Brækken IH, Majida M, Ellström Engh M, et al. Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. J Sex Med. 2015;12:470–80.

    Article  Google Scholar 

  39. Wiegersma M, Panman CM, Kollen BJ, et al. 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.

    Article  Google Scholar 

  40. Kashyap R, Jain V, Singh A. Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapsed. Int J Gynecol Obstet. 2013;121:69–73.

    Article  Google Scholar 

  41. Miedel A, Tegerstedt G, Maehle-Schmidt M, et al. Non obstetric risk factors for symptomatic pelvic organ prolapse. Obstet Gynecol. 2009;113:1089–97.

    Article  Google Scholar 

  42. Saks EK, Harvie HS, Asfaw TS, et al. Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse. Int J Gynaecol Obstet. 2010;111(3):237–40.

    Article  Google Scholar 

  43. Braekken IH, Majida M, Ellstrom Engh M, et al. Pelvic floor function is independently associated with pelvic organ prolapse. BJOG. 2009;116:1706–14.

    Article  CAS  Google Scholar 

  44. Whitcomb EL, Lukacz ES, Lawrence JM, et al. Prevalence and degree of bother from pelvic floor disorders in obese women. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(3):289–94.

    Article  Google Scholar 

  45. Washington BB, Erekson EA, Kassis NC, et al. The association between obesity and stage II or greater prolapse. Am J Obstet Gynecol. 2010;202:503.

    Article  Google Scholar 

  46. Braekken I, Majida M, Engh ME, et al. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography. Obstet Gynecol. 2010;115:317–24.

    Article  Google Scholar 

  47. Panman C, Wiegersma M, Kollen BJ, et al. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary are. BJOG. 2016. https://doi.org/10.1111/1471-0528.13992.

  48. Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014;383:796–806.

    Article  Google Scholar 

  49. 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.

    Article  Google Scholar 

  50. Bø K, Hilde G, Stær-Jensen J, et al. 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.

    Article  Google Scholar 

  51. Glazener CMA, McArthur C, Hagen S, et al. Twelve-year follow-up of conservative management of postnatal urinary and fecal incontinence and prolapsed outcomes: randomised controlled trial. BJOG. 2014;121:112–20.

    Article  CAS  Google Scholar 

  52. Hullfish KL, Bovbjerg VE, Gurka MJ, et al. Surgical versus nonsurgical treatment of women with pelvic floor dysfunction: patient centered goals at 1 year. J Urol. 2008;179(6):2280–5.

    Article  Google Scholar 

  53. Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311:1023–34.

    Article  CAS  Google Scholar 

  54. Pauls R, Crisp CC, Novicki K, et al. Pelvic floor physical therapy: impact on quality of life 6 months after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg. 2013;1:34–9.

    Google Scholar 

  55. McClurg D, Hilton P, Dolan L, et al. Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study. Int Urogynecol J. 2014;25:883–91.

    Article  Google Scholar 

  56. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;12:CD003882.

    Google Scholar 

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Correspondence to Antonella Biroli .

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Biroli, A., Lamberti, G.F. (2018). Pelvic Floor Muscle Training and Prolapse: Prevention or Treatment?. In: Li Marzi, V., Serati, M. (eds) Management of Pelvic Organ Prolapse. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-59195-7_6

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  • DOI: https://doi.org/10.1007/978-3-319-59195-7_6

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