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Pelvic floor muscle training in prolapse surgery

...does the addition of perioperative pelvic floor muscle training improve outcomes?

Pelvic organ prolapse (POP) is a major female health problem with a negative impact on quality of life. The most valid symptom of POP is the sensation of a bulge in the vagina.
Therapeutic options for POP include surgery and conservative treatments such as insertion of a pessary or pelvic floor muscle training (PFMT).

Recent systematic reviews have concluded that PFMT reduces POP symptoms and severity stage and PFMT has been shown to:

  • Increase pelvic floor muscle (PFM) strength and endurance;
  • Reduce the levator hiatus area;
  • Lift the bladder and rectal ampulla;
  • Increase PFM volume; and reduce PFM length.

However, the recurrence rate after POP surgery is high, ranging from 10 to 54%. Because of this, it could be assumed that the success rate of POP surgery would increase by combining surgery with PFMT.

In conclusion, although previous trials have had conflicting results, the results of this study support the existing evidence that perioperative PFMT does not add any worthwhile additional short-term benefit to surgery for POP symptoms.

Given the evidence that PFMT is effective in reducing POP symptoms and improves anatomical POP in POP-Q stages I, II and III, it seems essential that women with POP stage I to III are offered an evidence-based PFMT protocol as first-line treatment before surgery is considered.

> From: Duarte et al., J Physiother 66 (2020) 27-32 . All rights reserved to Australian Physiotherapy Association. Click here for the online summary.

Want to read deeper into this topic? Have a look at the free full text version of this article published in Journal of Physiotherapy!

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