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International Urogynecology Journal

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21-03-2022 | Review Article

The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis

Authors: Ting Wang, Zhengfang Wen, Meng Li

Published in: International Urogynecology Journal | Issue 7/2022

Abstract

Introduction and hypothesis

This study was aimed at evaluating the effect of pelvic floor muscle training (PFMT) as a conservative treatment for patients with pelvic organ prolapse (POP).

Methods

A comprehensive search to identify eligible randomized controlled trial (RCT) studies was conducted using electronic databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase up to 10 June 2021. Results were presented as risk ratio (RR), the weighted mean difference (WMD), with 95% confidence interval (95% CI) using the random effects model. Outcome variables were pooled using Review Manager version 5.3.

Results

Thirteen studies were included. Our results demonstrated that women who received PFMT intervention had a greater improvement than controls in prolapse symptom score (POP-SS; mean difference [MD] −1.66, 95% CI −2.36 to −0.97, p < 0.00001] and POP stages (risk ration [RR] 1.51, 95% CI 1.14–2.01, p = 0.004). The number of participants who felt better after PFMT was higher (RR 1.98, 95% CI 1.21–3.24, p = 0.006). Subgroup analysis showed that the symptoms of prolapse and the degree of prolapse were improved significantly in the short term, but there was no significant difference in the long-term effect. In addition, there was no significant difference in the impact of PFMT on the elderly and the quality of life. More RCTs are needed to evaluate the effect of PFMT on the elderly and whether the quality of life can be improved.

Conclusions

We found that PFMT can improve subjective symptoms and objective POP severity. More research is needed on the long-term effect.

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ACOG technical bulletin. Pelvic organ prolapse. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1996;52(2):197–205.CrossRef

Bump RC, Mattiasson A, Bø 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. https://doi.org/10.1016/s0002-9378(96)70243-0.CrossRefPubMed

Ghetti C, Gregory WT, Edwards SR, Otto LN, Clark AL. Pelvic organ descent and symptoms of pelvic floor disorders. Am J Obstet Gynecol. 2005;193(1):53–7. https://doi.org/10.1016/j.ajog.2004.12.004.CrossRefPubMed

Pelvic Organ Prolapse. ACOG Practice Bulletin, Number 214. Obstet Gynecol. 2019;134(5):e126–42. https://doi.org/10.1097/aog.0000000000003519.CrossRef

Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6. https://doi.org/10.1001/jama.300.11.1311.CrossRefPubMedPubMedCentral

Altman D, Forsman M, Falconer C, Lichtenstein P. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol. 2008;54(4):918–22. https://doi.org/10.1016/j.eururo.2007.12.004.CrossRefPubMed

Mouritsen L, Larsen JP. Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(2):122–7. https://doi.org/10.1007/s00192-002-1024-1.CrossRefPubMed

Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8. https://doi.org/10.1097/aog.0000000000000057.CrossRefPubMedPubMedCentral

Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6. https://doi.org/10.1097/aog.0000000000000286.CrossRefPubMedPubMedCentral

10.

Yimphong T, Temtanakitpaisan T, Buppasiri P, Chongsomchai C, Kanchaiyaphum S. Discontinuation rate and adverse events after 1 year of vaginal pessary use in women with pelvic organ prolapse. Int Urogynecol J. 2018;29(8):1123–8. https://doi.org/10.1007/s00192-017-3445-x.CrossRefPubMed

11.

Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):CD005654. https://doi.org/10.1002/14651858.CD005654.pub4.CrossRefPubMed

12.

Stüpp L, Resende AP, Oliveira E, Castro RA, Girão MJ, Sartori MG. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J. 2011;22(10):1233–9. https://doi.org/10.1007/s00192-011-1428-x.CrossRefPubMed

13.

Alves FK, Riccetto C, Adami DB, et al. A pelvic floor muscle training program in postmenopausal women: A randomized controlled trial. Maturitas. 2015;81(2):300–5. https://doi.org/10.1016/j.maturitas.2015.03.006.CrossRefPubMed

14.

Ouchi M, Kato K, Gotoh M, Suzuki S. Physical activity and pelvic floor muscle training in patients with pelvic organ prolapse: a pilot study. Int Urogynecol J. 2017;28(12):1807–15. https://doi.org/10.1007/s00192-017-3356-x.CrossRefPubMed

15.

Liu YJ, Ting SW, Hsiao SM, Huang CM, Wu WY. Efficacy of bio-assisted pelvic floor muscle training in women with pelvic floor dysfunction. Eur J Obstet Gynecol Reprod Biol. 2020;251:206–11. https://doi.org/10.1016/j.ejogrb.2020.04.050.CrossRefPubMed

16.

Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(2):76–84. https://doi.org/10.1007/s00192-004-1125-0.CrossRefPubMed

17.

Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;12:CD003882. https://doi.org/10.1002/14651858.CD003882.pub4.CrossRef

18.

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. https://doi.org/10.1007/s00192-015-2846-y.CrossRefPubMed

19.

Ge J, Wei XJ, Zhang HZ, Fang GY. Pelvic floor muscle training in the treatment of pelvic organ prolapse: a meta-analysis of randomized controlled trials. Actas Urol Esp (Engl Ed). 2021;45(1):73–82. https://doi.org/10.1016/j.acuro.2020.01.012.CrossRef

20.

Hagen S, Glazener C, Sinclair L, Stark D, Bugge C. Psychometric properties of the pelvic organ prolapse symptom score. BJOG. 2009;116(1):25–31. https://doi.org/10.1111/j.1471-0528.2008.01903.x.CrossRefPubMed

21.

Barber MD, Walters MD, Bump RC. 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. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025.CrossRefPubMed

22.

Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.CrossRefPubMedPubMedCentral

23.

Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I. 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. https://doi.org/10.1007/s00192-008-0726-4.CrossRefPubMed

24.

Braekken IH, Majida M, Engh ME, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e1–7. https://doi.org/10.1016/j.ajog.2010.02.037.CrossRef

25.

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 prolapse. Int J Gynaecol Obstet. 2013;121(1):69–73. https://doi.org/10.1016/j.ijgo.2012.11.012.CrossRefPubMed

26.

Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomized controlled trial. Lancet. 2014;383(9919):796–806. https://doi.org/10.1016/S0140-6736%2813%2961977-7.CrossRefPubMed

27.

Due U, Brostrøm S, Lose G. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial. Int Urogynecol J. 2016;27(4):555–63. https://doi.org/10.1007/s00192-015-2852-0.CrossRefPubMed

28.

Panman CM, Wiegersma M, Kollen BJ, et al. Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care. Menopause. 2016;23(12):1307–18. https://doi.org/10.1097/gme.0000000000000706.CrossRefPubMed

29.

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 care. BJOG. 2017;124(3):511–20. https://doi.org/10.1111/1471-0528.13992.CrossRefPubMed

30.

Due U, Brostrøm S, Lose G. The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse. Acta Obstet Gynecol Scand. 2016;95(7):811–9. https://doi.org/10.1111/aogs.12884.CrossRefPubMed

31.

Hagen S, Glazener C, McClurg D, et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. Lancet. 2017;389(10067):393–402. https://doi.org/10.1016/s0140-6736(16)32109-2.CrossRefPubMed

32.

Resende APM, Bernardes BT, Stüpp L, et al. Pelvic floor muscle training is better than hypopressive exercises in pelvic organ prolapse treatment: An assessor-blinded randomized controlled trial. Neurourol Urodyn. 2019;38(1):171–9. https://doi.org/10.1002/nau.23819.CrossRefPubMed

33.

Wiegersma M, Panman CM, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Dekker JH. 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. https://doi.org/10.1136/bmj.g7378.CrossRefPubMedPubMedCentral

34.

Burgio KL, Goode PS, Richter HE, Locher JL, Roth DL. Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings. Neurourol Urodyn. 2006;25(5):411–7. https://doi.org/10.1002/nau.20243.CrossRefPubMed

35.

Basnet R. Impact of pelvic floor muscle training in pelvic organ prolapse. Int Urogynecol J. 2021;32(6):1351–60. https://doi.org/10.1007/s00192-020-04613-w.CrossRefPubMed

36.

Fine P, Burgio K, Borello-France D, et al. Teaching and practicing of pelvic floor muscle exercises in primiparous women during pregnancy and the postpartum period. Am J Obstet Gynecol. 2007;197(1):107.e101–5. https://doi.org/10.1016/j.ajog.2007.02.052.CrossRef

37.

NICE Guidance—Urinary incontinence and pelvic organ prolapse in women: management: © NICE. Urinary incontinence and pelvic organ prolapse in women: management. BJU Int. 2019;123(5):777–803. https://doi.org/10.1111/bju.14763.CrossRef

38.

Wiegersma M, Panman C, Hesselink LC, Malmberg AGA, Berger MY, Kollen BJ, et al. Predictors of success for pelvic floor muscle training in pelvic organ prolapse. Phys Ther. 2019;99(1):109–17. https://doi.org/10.1093/ptj/pzy114.CrossRefPubMed

39.

Jackson SR, Avery NC, Tarlton JF, Eckford SD, Abrams P, Bailey AJ. Changes in metabolism of collagen in genitourinary prolapse. Lancet. 1996;347(9016):1658–61. https://doi.org/10.1016/s0140-6736(96)91489-0.CrossRefPubMed

40.

Tosun Ö, Mutlu EK, Tosun G, et al. Do stages of menopause affect the outcomes of pelvic floor muscle training? Menopause. 2015;22(2):175–84. https://doi.org/10.1097/gme.0000000000000278.CrossRefPubMed

41.

Roovers JP. Female urology: the benefits of pelvic floor muscle training for prolapse. Nat Rev Urol. 2014;11(4):192–3. https://doi.org/10.1038/nrurol.2014.35.CrossRefPubMed

Title: The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis
Authors: Ting Wang
Zhengfang Wen
Meng Li
Publication date: 21-03-2022
Publisher: Springer International Publishing
Published in: International Urogynecology Journal / Issue 7/2022
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-022-05139-z

At a glance: The STEP trials

Springer Medicine

The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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