Pelvic floor rehabilitation in women undergoing pelvic floor reconstructive surgery
INTRODUCTION: Pelvic organ prolapse (POP) has a mean prevalence of 455 to 681 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 muscle training can have on prevention and treatment of POP in conjunction with surgery, is still under-investigated and controversial. AIMS: To describe the symptoms, signs, quality of life (QOL) and muscle function in women scheduled for pelvic floor reconstructive surgery; and to determine/compare the outcomes of a pelvic floor muscle training (PFMT) programme, and a core training programme in this population. METHODOLOGY: Eighty one women scheduled for PF reconstructive surgery were randomly assigned to three groups in this randomised, controlled, double blind trial. Group 1 received a PFMT programme, group 2 a core stability programme, while group 3 was the control group. Participants received intervention for six months from pre- to post-operative. The P-QOL, SF-36, two-dimensional ultrasound, POP-Q staging, the PERFECT scale, EMG, Sahrmann scale and PBU was used to measure QOL, POP, PFM and abdominal muscle function respectively. Additional outcome measures included exercise compliance and the Visual Faces Scale for pain assessment. Descriptive statistics and 95% CI`s were used to determine statistical significance. Spearman, Pearson CC`s, and effect sizes were used to correlate muscle 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 at baseline. Women were physically inactive (80-85%) and showed a tendency towards hypertension (47%), depression (12%), and hypothyroidism (18%). Only 15% had previously been introduced to PFM exercises, and 7% to core training. All outcomes for the PFM and abdominal muscle function were not within normal reported ranges pre-operatively. Statistical significant correlations were found between different components of PFM function, and between PFM and abdominal muscle function (p<0.05) at baseline. PFMT yielded the most significant changes regarding PFM function during the first three months (endurance, thickness of perineal body, length of levator hiatus), while only group 2 showed significant changes 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 had some 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 training are important to address different, but specific biomechanics and muscle function for the prevention and treatment of POP. Co-morbidities, symptoms and signs, and the effect they may have on motor control and QOL, motivates for a comprehensive, lifestyle orientated, and biopsychosocial rehabilitation model for patients scheduled for pelvic floor reconstructive surgery.