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

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 measuresThe 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. ResultsOf 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.

Managing mild, symptomatic pelvic organ prolapse

“…1 Fifty seven per cent of women in the intervention group reported an overall improvement in prolapse related symptoms over three months, compared with 13% of controls managed with watchful waiting (P<0.001).…”

Pelvic organ prolapse

“…There is currently no consensus regarding which surgical approach is superior, and each has its own risk-benefit profile, although transvaginal mesh augmented repairs have come under scrutiny by national regulatory agencies and professional medical societies in recent years because of an increased risk of adverse events relative to other approaches. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Apical pelvic organ prolapse…”

Prolaps

“…Daarnaast geeft meer dan een derde van de seksueel actieve vrouwen met een gevorderde prolaps aan dat hun seksualiteit door de prolapsklachten negatief wordt beïnvloed [15]. Niet zozeer door de lichamelijke veranderingen, als wel door de psychische last die het hebben van een prolaps voor veel vrouwen betekent [16,17].Vrouwen die last hebben van urine-of fecale incontinentie tijdens seksuele activiteit, vermijden seksuele activiteit vaak, vanwege de angst of de schaamte die dit met zich meebrengt. Behandeling van de klachten kan leiden tot een positiever zelfbeeld, minder schaamtegevoel en daarmee ook een verbetering van het seksueel functioneren [18].…”

“…Hieruit blijkt dat bekkenfysiotherapie bij deze vrouwen een positief effect heeft op de prolapsklachten [16,20,21]. Er is één studie in de huisartsenpraktijk gedaan, waarin bekkenfysiotherapie vergeleken werd met afwachten bij vrouwen met een prolaps in stadium 1 of 2 [17]. Hieruit bleek dat vrouwen in de bekkenfysiotherapiegroep minder prolapsklachten hadden en 57 % van deze vrouwen vond de klachten na drie maanden verbeterd.…”