Clinical Question

For women with symptomatic pelvic floor prolapse, are pelvic floor exercises better than lifestyle advice to improve symptoms?

Bottom Line

In women with mild to moderate pelvic floor prolapse, a formal program including physiotherapist-guided pelvic floor exercises only modestly improved symptoms. (Level of Evidence = 1b –)

Synopsis

These researchers randomized women (all of whom had been enrolled in a postpartum follow-up study 12 years earlier) to a pelvic floor exercise program plus Pilates (n = 207) or to a control group (n = 207). The women had anatomic evidence of mild to moderately severe prolapse that had not yet been treated. The women in the exercise program were given five sessions over 16 weeks with a physiotherapist, a prolapse lifestyle advice leaflet that focused on weight loss and avoiding triggers (e.g., heavy lifting, constipation, coughing, high-impact exercise), and tailored lifestyle advice. The women in the control group simply had the lifestyle advice leaflet mailed to them. The main outcome was a change in a validated symptom severity score, with a potential range from 0 to 28 points, one year and two years after enrollment.

At baseline, the women in the intervention group had slightly worse symptom scores and had improvement of 1.2 points after each follow-up period; the women in the control group had no change in symptom scores after the first year and slightly worse scores after two years. On a 28-point scale, a change of approximately three points is clinically important, and these researchers planned their study to have more than 90% power to detect such a difference. Approximately 75% of the women in the intervention group attended at least three exercise sessions, but fewer than 50% attended all of the sessions. Finally, after two years, the researchers found no difference in quality-of-life scores.

Study design: Randomized controlled trial (nonblinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (any)

Reference: Hagen S, Glazener C, McClurg D, et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. Lancet. 2017;389(10067):393-402.