Pelvic floor rehabilitation in women undergoing pelvic floor reconstructive surgery

[摘要] INTRODUCTION: Pelvic organ prolapse (POP) has a mean prevalence of 455 to681 per 1000 women (aged 50 to 60 years). Approximately 11% may need surgery,of which 30% may need follow-up surgery. The effect that comprehensive muscletraining can have on prevention and treatment of POP in conjunction with surgery, isstill under-investigated and controversial.AIMS: To describe the symptoms, signs, quality of life (QOL) and muscle function inwomen scheduled for pelvic floor reconstructive surgery; and to determine/comparethe outcomes of a pelvic floor muscle training (PFMT) programme, and a coretraining programme in this population.METHODOLOGY: Eighty one women scheduled for PF reconstructive surgery wererandomly assigned to three groups in this randomised, controlled, double blind trial.Group 1 received a PFMT programme, group 2 a core stability programme, whilegroup 3 was the control group. Participants received intervention for six months frompre- to post-operative. The P-QOL, SF-36, two-dimensional ultrasound, POP-Qstaging, the PERFECT scale, EMG, Sahrmann scale and PBU was used to measureQOL, POP, PFM and abdominal muscle function respectively. Additional outcomemeasures included exercise compliance and the Visual Faces Scale for painassessment. Descriptive statistics and 95% CI`s were used to determine statisticalsignificance. Spearman, Pearson CC`s, and effect sizes were used to correlatemuscle variables at baseline.RESULTS: Women (mean age 59 years) with predominantly stage III POP (n=100)showed affected prolapse impact (66.7%), social (median 33.3%), emotional(median 44.4%0) and severity measures (median 25%) according to the P-QOL atbaseline. Women were physically inactive (80-85%) and showed a tendency towards hypertension (47%), depression (12%), and hypothyroidism (18%). Only15% had previously been introduced to PFM exercises, and 7% to core training. Alloutcomes for the PFM and abdominal muscle function were not within normalreported ranges pre-operatively. Statistical significant correlations were foundbetween different components of PFM function, and between PFM and abdominalmuscle function (p<0.05) at baseline. PFMT yielded the most significant changesregarding PFM function during the first three months (endurance, thickness ofperineal body, length of levator hiatus), while only group 2 showed significantchanges in abdominal muscle function (Sahrmann and PBU levels, 95% CIs [1;3]and [1;9]) in addition to the latter up to six months. Both intervention groups hadsome statistically significant muscle changes when compared to the control group.Only group 2 yielded a statistical significant improvement in the total P-QOL score(95% CI [1.5;28.4]).DISCUSSION/CONCLUSION: It seems that both PFMT and core muscle trainingare important to address different, but specific biomechanics and muscle function forthe prevention and treatment of POP. Co-morbidities, symptoms and signs, and theeffect they may have on motor control and QOL, motivates for a comprehensive,lifestyle orientated, and biopsychosocial rehabilitation model for patients scheduledfor pelvic floor reconstructive surgery.

[发布机构] University of the Free State