Abstract
A recently published randomized controlled trial that investigated physiotherapy as an adjunct to prolapse surgery or hysterectomy did not show a benefit in the group receiving perioperative pelvic floor muscle training, lifestyle modification, and bladder and bowel advice. This article explores the rationale for why physiotherapy is hypothesized to be beneficial and the evidence for physiotherapy in surgical populations. It also provides an in-depth analysis of why that recent study may not have shown a benefit in the group receiving this intervention. In addition, suggestions for the design and direction of future studies are made within the context of these results.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Olsen AL, Smith VJ, Bergstrom JO, et al.: Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997, 89:501–506.
DeLancey JO: The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 2005, 192:1488–1495.
Fialkow MF, Newton KM, Weiss NS: Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:1483–1487.
Clark AL, Gregory T, Smith VJ, Edwards R: Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2003, 189:1261–1267.
Subak LL, Waetjen LE, van den Eeden S, et al.: Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 2001, 98:646–651.
Jarvis SK, Hallam TK, Lujic S, et al.: Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: results of a randomised controlled trial. Aust N Z J Obstet Gynaecol 2005, 45:300–303.
• Frawley HC, Galea MP, Phillips BA, Bo K: Physiotherapy as an adjunct to prolapse surgery: an assessor-blinded randomized controlled trial. Neurourol Urodyn 2009 Oct 8 (Epub ahead of print). This article is the second RCT published on the effectiveness of physiotherapy as an adjunct to prolapse surgery and hysterectomy. The intervention did not show a benefit to the treatment group in this small study.
Frawley HC, Galea MP, Phillips BA: Survey of clinical practice: pre- and postoperative physiotherapy for pelvic surgery. Acta Obstet Gynecol Scand 2005, 84:412–418.
Cook T: Gynaecological surgery. In Physiotherapy in Obstetrics and Gynaecology, edn 2. Edited by Mantle J, Haslam J, Barton S. London: Butterworth-Heinemann; 2004:309–333.
Haslett S, Jennings M, Walsgrove H, Weatheritt W: Hysterectomy, Vaginal Repair and Surgery for Stress Incontinence, edn 5. Amersham, United Kingdom: Beaconsfield Publishers; 2003.
Sharpe R: Physiotherapy and gynaecological surgery. In Women’s Health: A Textbook for Physiotherapists. Edited by Sapsford R, Bullock-Saxton J, Markwell S. London: W. B. Saunders; 1998:466–473.
Vella M, Bidmead J: Peri- and postoperative care. In Textbook of Female Urology and Urogynaecology, edn 2. Edited by Cardozo L, Staskin D. London: Informa Healthcare; 2006:825–834.
Ottesen M, Moller C, Kehlet H, Ottesen B: Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. A nationwide questionnaire study. Acta Obstet Gynecol Scand 2001, 80:1062–1068.
Hay-Smith J, Berghmans B, Burgio K, et al.: Adult conservative management. In International Consultation on Incontinence, edn 4. Edited by Abrams P, Cardozo L, Khoury S, Wein A. Plymouth, United Kingdom: Health Publications Ltd.; 2009:1025–1120.
Onwude J: Genital prolapse in women. Clin Evid (Online) 2007 Mar 7 (Epub ahead of print).
Vakili B, Zheng YT, Loesch H, et al.: Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. Am J Obstet Gynecol 2005, 192:1592–1598.
Borello-France DF, Handa VL, Brown MB, et al.: Pelvic-floor muscle function in women with pelvic organ prolapse. Phys Ther 2007, 87:399–407.
Roovers JP, van der Bom JG, Huub van der Vaart C, et al.: Does mode of hysterectomy influence micturition and defecation? Acta Obstet Gynecol Scand 2001, 80:945–951.
Weber AM, Walters MD, Piedmonte MR, Ballard LA: Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 2001, 185:1299–1306.
Digesu GA, Salvatore S, Chaliha C, et al.: Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse? Int Urogynecol J Pelvic Floor Dysfunct 2007, 18:1439–1443.
Mahajan ST, Elkadry EA, Kenton KS, et al.: Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol 2006, 194:722–728.
• Barber MD, Brubaker L, Menefee S, et al.: Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial: design and methods. Contemp Clin Trials 2009, 30:178–189. This article describes a large RCT in progress that will investigate the role of PFMT and behavioral techniques as an adjunct to prolapse surgery. It will be an important study to follow.
Brubaker L, Shott S, Tomezsko J, Goldberg RR: Pelvic floor fitness using lay instructors. Obstet Gynecol 2008, 111:1298–1304.
Miskry T, Magos A: Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse. Acta Obstet Gynecol Scand 2003, 82:351–358.
Kovac SR, Barhan S, Lister M, et al.: Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Am J Obstet Gynecol 2002, 187:1521–1527.
Shumaker SA, Wyman JF, Uebersax JS, et al.: Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res 1994, 3:291–306.
Uebersax JS, Wyman JF, Shumaker SA, et al.: Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 1995, 14:131–139.
Wyman JF, Choi SC, Harkins SW, et al.: The urinary diary in evaluation of incontinent women: a test-retest analysis. Obstet Gynecol 1988, 71:812–817.
Versi E, Orrego G, Hardy E, et al.: Evaluation of the home pad test in the investigation of female urinary incontinence. BJOG 1996, 103:162–167.
Vaizey CJ, Carapeti E, Cahill JA, Kamm MA: Prospective comparison of faecal incontinence grading systems. Gut 1999, 44:77–80.
Agachan F, Chen T, Pfeifer J, et al.: A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996, 39:681–685.
Hawthorne G, Richardson J, Osborne R: The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 1999, 8:209–224.
Borg GA: Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics; 1998.
Bo K, Finckenhagen HB: Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 2001, 80:883–887.
Laycock J: Clinical evaluation of the pelvic floor. In Pelvic Floor Re-education. Edited by Schussler B, Laycock J, Norton P, Stanton S. London: Springer-Verlag; 1994:42–48.
Frawley HC, Galea MP, Phillips BA, et al.: Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn 2006, 25:236–242.
Disclosure
No potential conflict of interest relevant to this article was reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Frawley, H.C. Perioperative Physiotherapy as an Adjunct to Prolapse Surgery: An In-Depth Analysis of a Study With a Negative Result. Curr Bladder Dysfunct Rep 5, 48–55 (2010). https://doi.org/10.1007/s11884-010-0039-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-010-0039-6