Conservative Prevention and Management of Pelvic Organ Prolapse in Women

Summary

A Cochrane review [Abstract] 1 included 6 studies with a total of 975 subjects. Greater improvement in symptoms was shown in the pelvic floor muscle training (PFMT) group compared to the control group. Pooling data on severity of prolapse from two trials indicated that PFMT increases the chance of an improvement in prolapse stage by 17% compared to no PFMT. The two trials which measured pelvic floor muscle function found better function (or improvement in function) in the PFMT group compared to the control group; measurements were not known to be blinded. Two out of three trials which measured urinary outcomes (urodynamics, frequency and bother of symptoms, or symptom score) reported differences between groups in favour of the PFMT group. The largest most rigorous trial to date suggests that 6 months of supervised PFMT has benefits in terms of anatomical and symptom improvement (if symptomatic) immediately post-intervention. One trial reported bowel outcomes, showing less frequency and bother with symptoms in the PFMT group compared to the control group. When comparing PFMT supplementing surgery vs surgery alone, pelvic floor muscle function findings differed between the trials: one found no difference between trial groups in muscle strength, whilst the other found a benefit for the PFMT group in terms of stronger muscles (2 small trials).

A multicentre, parallel-group, randomised controlled trial 2 in New Zealand and the UK included women (n=414) having stage 1-3 prolapse after childbirth. They received either one-to-one pelvic floor muscle training (5 physiotherapy appointments over 16 weeks, and annual review) plus Pilates-based pelvic floor muscle training classes and a DVD for home use (intervention group), or a prolapse lifestyle advice leaflet (control group). The primary outcome was self-reported prolapse symptoms (Pelvic Organ Prolapse Symptom Score [POP-SS], range 0 to 28) at 2 years. At baseline, 399 (97%) women had prolapse above or at the level of the hymen. The mean POP-SS score at 2 years was 3.2 (SD 3.4) in the intervention group versus 4.2 (SD 4.4) in the control group (adjusted mean difference -1.01, 95% CI -1.70 to -0.33). The mean symptom score stayed similar across time points in the control group, but decreased in the intervention group.

A parallel-group, multicentre, randomised controlled trial 3 (UK, New Zealand, Australia) included 447 women with newly-diagnosed, symptomatic stage I- III prolapse. They received an individualised programme of pelvic floor muscle training (intervention) or a prolapse lifestyle advice leaflet and no muscle training (control). Women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the POP-SS) at 12 months than those in the control group (mean reduction in POP-SS from baseline 3.77 [SD 5.62] vs 2.09 [5.39]; adjusted difference 1.52, 95% CI 0.46-2.59; p=0.0053).

A meta-analysis 4 included 13 studies with a total of 2 340 patients. Women receiving PFMT gained a greater improvement than controls in prolapse symptom score (mean difference -3.07, 95 % CI -3.91 to -2.23) and POP stages (RR 1.70, 95 % CI 1.19 to 2.44). Meanwhile, women after PFMT had greater improvement in muscle strength and endurance but did not show a significant difference for further treatment needs.