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International Urogynecology Journal

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01-04-2016 | Original Article

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

Authors: Ulla Due, Søren Brostrøm, Gunnar Lose

Published in: International Urogynecology Journal | Issue 4/2016

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.

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

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):1037–45CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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):451–5CrossRefPubMed

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):4–20PubMed

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 CrossRefPubMed

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

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

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

10.

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

11.

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

12.

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

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):796–806CrossRefPubMed

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):69–73CrossRefPubMed

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):45–51CrossRefPubMed

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.

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):1233–9CrossRefPubMed

18.

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

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):523–8CrossRef

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):103–13CrossRefPubMed

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 CrossRefPubMed

22.

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

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.

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

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):746–53CrossRefPubMed

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):531–44CrossRefPubMed

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:g7378CrossRefPubMedPubMedCentral

28.

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

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):1041–8CrossRefPubMed

Title: Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial
Authors: Ulla Due
Søren Brostrøm
Gunnar Lose
Publication date: 01-04-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 4/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2852-0

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Springer Medicine

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

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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