Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women
randomized controlled trial
Keywords:
Ultrasonography, Pelvic floor, Exercise, Perineum, HypertrophyAbstract
CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle. CLINICAL TRIAL REGISTRATION NUMBER: NCT01196598
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References
Bernstein IT. The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies. Neurourol Urodyn. 1997;16(4):237-75.
Athanasiou S, Chaliha C, Toozs-Hobson P, et al. Direct imaging of the pelvic floor muscles using two-dimensional ultrasound: a comparison of women with urogenital prolapse versus controls. BJOG. 2007;114(7):882-8.
Dietz HP, Shek KL. Levator defects can be detected by 2D translabial ultrasound. Int Urogynecol. J Pelvic Floor Dysfunct. 2009;20(7):807-11.
Braekken IH, Majida M, Engh ME, Bø K. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial. Obstet Gynecol. 2010;115(2 Pt 1):317-24.
Dietz HP, Schierlitz L. Pelvic floor trauma in childbirth - myth or reality? Aust N Z J Obstet Gynaecol. 2005;45(1):3-11.
Noguti AS, Jarmy-Di Bella ZI, de Oliveira E, et al. Ultrasonographic and doppler velocimetric evaluation of the levator ani muscle according to the hormonal status. Eur J Obstet Gynecol Reprod Biol. 2008;141(2):183-5.
Oliveira E, Castro RA, Takano CC, et al. Ultrasonographic and Doppler velocimetric evaluation of the levator ani muscle in premenopausal women with and without urinary stress incontinence. Eur J Obstet Gynecol Reprod Biol. 2007;133(2):213-7.
Hay-Smith EJ, Bø K, Berghmans LC, et al. WITHDRAWN: Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2007;(1):CD001407.
Bø K. Pelvic floor muscle training for stress urinary incontinence. In: Bø K, Berghmans B, Morkved S, Kampen MV, editors. Evidence- based physical therapy for the pelvic floor. Philadelphia: Churchill Livingstone; 2007. p. 171-86.
Hagen S, Stark D, Maher C, Adams E. Conservative management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2006;(4):CD003882.
Bø K. Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstet Gynecol Scand. 2006;85(3):263-8.
Hoyte L, Schierlitz L, Zou K, Flesh G, Fielding JR. Two- and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am J Obstet Gynecol. 2001;185(1):11-9.
DeLancey JO, Morgan DM, Fenner DE, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2 Pt 1):295-302.
Bump RC, Matiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10-7.
Caufriez M, Ballester SE. Gimnasia abdominal hipopresiva. Bruxelas: Marcel Caufriez; 1997.
Ahtiainen JP, Hoffren M, Hulmi JJ, et al. Panoramic ultrasonography is a valid method to measure changes in skeletal muscle cross-sectional area. Eur J Appl Physiol. 2010;108(2):273-9.
DiNubile NA. Strength training. Clin Sports Med. 1991;10(1):33-62.
Thompson LV. Effects of age and training on skeletal muscle physiology and performance. Phys Ther. 1994;74(1):71-81.
Jármy-Di Bella ZI, Girão MJ, Di Bella V, et al. Hormonal influence on periurethral vessels in postmenopausal incontinent women using Doppler velocimetry analysis. Maturitas. 2007;56(3):297-302.
Hay-Smith EJ, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006;(1):CD005654.
Zanetti MR, Castro Rde A, Rotta AL, et al. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. Sao Paulo Med J. 2007;125(5):265-9.
Fleck SJ, Kraemer WJ. Designing resistance training programs. 3rd ed. Champaign: Human Kinetics; 2004.
Bø K, Aschehoug A. Strength training. In: Bø K, Berghmans B, Morkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor. Philadelphia: Churchill Livingstone; 2007. p. 119-32.
