International trial shows pelvic floor exercise benefit for preventing prolapse
Researchers, including several University of Otago academics, have conducted the first trial of pelvic floor muscle training for the prevention of prolapse symptoms in women with early signs of prolapse several years after childbirth, publishing their findings in the world's leading medical journal The Lancet.
Pelvic organ prolapse - when the bladder, womb or bowel moves downward from its normal position - is common and is associated with childbirth and increasing age. The symptoms of prolapse, such as a feeling of something 'coming down', urinary and bowel issues, affect up to 30% of women.
Led by Professor Suzanne Hagen, Programme Director at the Nursing, Midwifery and Allied Health Professions Research Unit at Glasgow Caledonian University (GCU), and funded by Wellbeing of Women - the UK's only charity that funds medical research into women's reproductive and gynaecological health, researchers conducted a trial with 414 women in the UK and New Zealand to identify the effectiveness of pelvic floor muscle training on the development of prolapse symptoms.
The study compared women who were provided with one-to-one pelvic floor muscle training (five physiotherapy appointments over 16 weeks, including tailored lifestyle advice) plus Pilates-based pelvic floor muscle training classes and a DVD for guided home exercise, with the other half of the group, who received only a prolapse lifestyle advice leaflet.
The study found the intervention led to fewer prolapse symptoms. Within two years, a significantly higher proportion (14.4% compared to 6%) of the women who did not have the pelvic floor muscle training reported having had prolapse treatment, which includes surgery, pessaries, physiotherapy or GP consultation.
"Taking part has helped me realise some of the effects childbirth and ageing has had on my body and how I need to look after myself to ensure I keep fit and healthy. I feel more positive about ageing /menopause - it is always good to know that you are not the only one going through something. I have benefited physically and mentally."
"Since taking part in the study and attending both 1:1 physiotherapy sessions and group Pilates there has been a noticeable difference to the incontinence I was experiencing. I am now more confident when going out, no longer need to plan journeys around toilets. This has made so much difference to my quality of life. Talking to friends and work colleagues, it's amazing how many other women are suffering in silence as they are too embarrassed to go to their GP."
The researchers, from GCU, the universities of Aberdeen and Birmingham and the University of Otago, claimed women should be recommended to undertake pelvic floor muscle training even before they have bothersome symptoms.
Professor Hagen said: "Knowing that these exercises and lifestyle advice can help to avoid symptoms in the future will allow women to be proactive about maintaining their pelvic floor health. Wellbeing of Women has provided invaluable support for an important, but often overlooked and difficult to fund area of research, which has undoubtedly helped many women who are at risk of these problems."
Professor Hagen is also author of the Cochrane review of conservative prevention and management of prolapse. The review, first published in 2006, identified no existing prolapse prevention trials, informing her present research.
One of the study's co-authors, Professor Don Wilson of Otago's Department of Women's and Children's Health, said pelvic floor muscle training is a unique form of treatment for pelvic floor dysfunction in women.
"It has clear benefits with very few side effects, which is different from other interventions - surgery and drugs - used in medicine. It has been shown to be an effective treatment for urinary incontinence and some forms of symptomatic prolapse and now we have shown that these exercises can help prevent prolapse symptoms developing in the future.
"I currently recommend all my patients to carry out regular pelvic floor muscle training."
More information: Suzanne Hagen et al, Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial, The Lancet (2016). DOI: 10.1016/S0140-6736(16)32109-2