The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis

Li, Chunbo; Gong, Yuping; Wang, Bei

doi:10.1007/s00192-015-2846-y

Cited by 115 publications

(73 citation statements)

References 36 publications

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“…9 Many of the studies demonstrating the positive effects of PFM exercise on POP required the participants to have multiple follow-up sessions with a health professional, which may not be feasible for many women who have accessibility issues. 5,10 In remote regions of Nepal, health education is delivered predominantly through radio programs or female community health volunteers (FCHV). 11 The FCHVs have basic health training and facilitate mother's groups using verbal instruction to deliver information on various maternal and child health topics.…”

Section: ≥11mentioning

confidence: 99%

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Caagbay

Black

Dangal

et al. 2017

J Nepal Health Res Council

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INTRODUCTIONPelvic organ prolapse (POP) is a common condition for women globally and is one of the most widespread reproductive health problems in Nepal.1,2 POP occurs when the pelvic floor muscles (PFM) and supporting tissues are stretched, weakened or damaged allowing the bladder, uterus or bowel to descend into the vagina. 3Women who have weak or damaged PFMs have 4-11 times the risk of developing a POP when compared to women with good PFM function. 4 Strengthening the PFMs is the first line conservative treatment option for POP and can improve symptoms, quality of life (QOL) and severity.5 However, teaching women to correctly exercise their PFMs is challenging and up to 50% may still do it incorrectly even after verbal instruction. 6 The aim of this pilot study was to investigate whether brief verbal instruction in conjunction with an illustrated leaflet resulted in Nepali women being able to correctly contract their PFMs. METHODSIn February 2016, a pilot study of parous women aged 18 years and above was conducted. The women were attending two gynecology outpatient clinics run by the Public Health Concern Trust: Kathmandu Model Hospital and Kirtipur Hospital, Nepal.Women attending the hospital outpatient clinics were invited to participate in the study by their doctor. Initially, the doctor performed the Pelvic Organ Prolapse Quantification scale (POP-Q) to assess for POP. Following their clinical examination, a demographic questionnaire containing questions about their age, educational Background: Pelvic organ prolapse is a common disorder for women in Nepal causing symptoms and reduced quality of life. Pelvic floor muscle exercise is a conservative treatment option for pelvic organ prolapse but the effective way to teach women in Nepal is not known. The objective of this pilot study was to determine if an illustrative leaflet with brief verbal instruction could teach Nepali women to correctly contract their pelvic floor muscles. Methods:Fifteen parous women attending two outpatient gynecology clinics in Kathmandu Valley were interviewed to assess their knowledge of pelvic organ prolapse and pelvic floor muscles exercise. Following verbal instruction and an illustrative leaflet on how to contract their pelvic floor muscles, the transabdominal real time ultrasound was applied to assess the muscle contraction. Results:The median age of 15 participants was 45 years (range 18-75 years) and 10 women had pelvic organ prolapse. Some of the participants (9/15) knew about pelvic organ prolapse but none were aware of the pelvic floor muscles. After being taught how to contract their pelvic floor muscle, only 4 of 14 correctly contracted the pelvic floor muscle. Conclusions:This study highlighted the low knowledge of the pelvic floor muscle, and brief verbal instruction with an illustrative leaflet is also not sufficient in teaching Nepali women how to correctly contract their pelvic floor muscle. Further research is needed to determine how to teach a correct pelvic floor muscle contraction for women with low...

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Section: ≥11mentioning

confidence: 99%

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Caagbay

Black

Dangal

et al. 2017

J Nepal Health Res Council

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show abstract

“…PFMT is recommended as Grade A for pelvic floor symptoms on POP . Additionally, a meta‐analysis concluded that PFMT is effective for increasing PFM strength and improving POP symptoms and stage, compared with controls . The significant increase in ΔAPD can be interpreted to represent increased PFM function and by extension the potential to improve some POP‐related symptoms.…”

Section: Discussionmentioning

confidence: 99%

Evaluating pelvic floor muscle contractility using two‐dimensional transperineal ultrasonography in patients with pelvic organ prolapse

Ouchi

Kitta

Suzuki³

et al. 2019

Neurourology and Urodynamics

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Aim The hiatal anterior‐posterior distance (APD), as measured by two‐dimensional (2D) transperineal ultrasonography, is an indicator of pelvic floor muscle (PFM) contractility. The function of the pelvic floor is independently related to pelvic organ prolapse (POP) severity. However, little evidence concerning the APD for patients with POP before and after PFM training (PFMT) has been published. Therefore, we analyzed 2D transperineal ultrasonography in women with POP. Methods Twenty‐eight women with POP completed a physiotherapist‐led PFMT regimen that consisted of 4 months of one‐on‐one PFMT and lifestyle advice. The APD was measured using 2D transperineal ultrasonography immediately before and after the PFMT period and used to calculate ΔAPD (APD at rest—APD during contraction). Vaginal squeeze pressure during maximum voluntary contractions was also assessed using a manometer. We then analyzed the reliability and the correlation between ΔAPD as measured using 2D transperineal ultrasonography and vaginal squeeze pressure before and after PFMT. Results The APD at rest and during PFM contractions demonstrated intraclass correlation coefficients (ICCs) of 0.89 and 0.88, respectively. The ICC of maximal vaginal squeeze pressure was 0.97 during PFM contractions. Both ΔAPD (P < 0.01) and PFM strength (P < 0.05) increased significantly after PFMT. PFM strength and ΔAPD were correlated before (R = 0.53) and after (R = 0.68) PFMT (P < 0.01). Conclusions We demonstrated that dynamic 2D transperineal ultrasonography could be used for studying functional changes in patients with POP. The ΔAPD of the levator hiatus has potential as an anatomical surrogate marker for evaluating PFM function in hospitals.

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“…Prolapse symptom scores were used to assess subjective changes in prolapse symptoms, and pelvic floor prolapse stages were used to assess changes in severity of the disorder. The study authors found that women who underwent PFPT reported a greater improvement than women in the control group in prolapse symptom scores (mean difference −3.07; 95% CI, −3.91 to −2.23) and demonstrated an objective improvement in pelvic floor prolapse severity (RR 1.70; 95% CI, 1.19‐2.44) …”

Section: Pelvic Organ Prolapsementioning

confidence: 94%

“…Randomized trials that have evaluated use of PFPT for treating women with pelvic floor prolapse have demonstrated a small but clinically relevant improvement in both pelvic organ prolapse and bowel symptoms when women adhere to PFPT treatment . A meta‐analysis of 13 trials concluded that pelvic floor muscle training was associated with a greater improvement in prolapse symptom scores; therefore, a trial of PFPT is likely appropriate as it may improve symptoms and presents very little risk for harm . Prolapse symptom scores were used to assess subjective changes in prolapse symptoms, and pelvic floor prolapse stages were used to assess changes in severity of the disorder.…”

Section: Pelvic Organ Prolapsementioning

confidence: 99%

Pelvic Floor Physical Therapy and Women's Health Promotion

Lawson¹,

Sacks²

2018

J Midwife Womens Health

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Pelvic floor dysfunction is defined as abnormal function of the pelvic floor and includes conditions that can have significant adverse impacts on a woman's quality of life, including urinary incontinence (stress, urge, and mixed), fecal incontinence, pelvic organ prolapse, sexual dysfunction, diastasis recti abdominis, pelvic girdle pain, and chronic pain syndromes. Women's health care providers can screen for, identify, and treat pelvic floor dysfunction. This article examines the case of a woman with multiple pelvic-floor-related problems and presents the evidence for the use of pelvic floor physical therapy (PFPT) for pregnancy-related pelvic floor dysfunction. PFPT is an evidence-based, low-risk, and minimally invasive intervention, and women's health care providers can counsel women about the role that PFPT may play in the prevention, treatment, and/or management of pelvic floor dysfunction.

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The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis

Abstract: Our meta-analysis demonstrated women who received PFMT showed a greater subjective improvement in prolapse symptoms and an objective improvement in POP severity.

Cited by 115 publications

References 36 publications

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Evaluating pelvic floor muscle contractility using two‐dimensional transperineal ultrasonography in patients with pelvic organ prolapse

Pelvic Floor Physical Therapy and Women's Health Promotion

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