Physical activity and pelvic floor muscle training in patients with pelvic organ prolapse: a pilot study

Introduction and hypothesis

The details of the physical activity in patients with mild to moderate pelvic organ prolapse (Pmoderate pelvic organ prolapse (POP) remain under-studied. The purpose of the present study was to investigate objective physical activity levels and the changes in pelvic floor muscle(PFM) strength, symptoms and quality of life (QOL) between before and after PFM training (PFMT) in patients with POP.

Methods

In a prospective pilot study, 29 patients with stage II or III POP completed approximately 16 weeks of PFMT. A reliable activity monitor was used to measure physical activity parameters including step counts, activity and total calories expended, and duration at each intensity level. Maximum vaginal squeeze pressure, POP symptoms and QOL were assessed. Changes in these outcome measures were compared before and after PFMT.

Results

The step counts per day (mean ± SD) of women with POP was 7,272.9 ± 3,091.7 before PFMT and 7,553.4 ± 2,831.0 after PFMT. There was no significant change between before and PFMT. PFM strength was significantly increased after PFMT. POP-related symptoms including stress urinary incontinence, frequency, postmicturition dribble and interference with emptying the bowels were significantly improved. The QOL scores for general health, physical limitations, emotion, and severity measures were significantly improved after PFMT.

Conclusions

Although PFMT changed PFM strength symptoms, and QOL, there were no changes for any physical activity parameters before and after PFMT. This is probably because the physical activity levels in patients with mild to moderate POP were almost same as in age-matched healthy women.

     

The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis

Introduction and hypothesis

Our objective was to assess the effectiveness of pelvic floor muscle training (PFMT) as a treatment for women with pelvic organ prolapse (POP) or as an adjunct to prolapse surgery.

Methods

Relevant literature sources were searched using databases including PubMed, Ovid, Web of Science, Scopus, ClinicalTrials.gov, EBSCO, CINAHL, the Cochrane Central Register of Controlled Trials, CNKI, VIP, Wanfang, and CBM until 5 July 2015. Eligible studies were restricted to randomized controlled trials (RCT). The available data were pooled using Review Manager version 5.2. For data deemed not appropriate for synthesis, a narrative overview was conducted.

Results

In total, 13 studies with 2,340 patients were included. Our results indicated women receiving PFMT gained a greater improvement than controls in prolapse symptom score [mean difference (MD) ?3.07, 95 % confidence interval (CI) ?3.91 to ?2.23] and POP stages [risk ratio (RR) 1.70, 95 % CI 1.19–2.44]. The number of women who said their prolapse was getting better was higher (RR 5.48, 95 % CI 2.19–13.72) and other discomfort syndromes, such as vaginal, bladder, and rectum, were lower in the PFMT groups than in controls. Meanwhile, women after PFMT had greater improvement in muscle strength and endurance but did not show a significant difference for further treatment needs. In addition, the results evaluating PFMT as an adjunct to prolapse surgery were inconclusive because of the variability in methods of measuring outcome.

Conclusions

Our meta-analysis demonstrated women who received PFMT showed a greater subjective improvement in prolapse symptoms and an objective improvement in POP severity.

     

Age at hysterectomy as a predictor for subsequent pelvic organ prolapse repair

Introduction and hypothesis

The aim of this study was to investigate the association between patient age at the time of hysterectomy and subsequent pelvic organ prolapse (POP) surgery.

Methods

We gathered data on all benign hysterectomies and POP surgeries performed in Denmark on Danish women from 1977 to 2009 from the Danish National Patient Registry. The cohort consisted of 154,882 hysterectomized women, who were followed up for up to 32 years. Survival analysis for each age group at hysterectomy was performed using Kaplan–Meier product limit methods.

Results

For all hysterectomized women, we found that low age at hysterectomy yielded a lower risk of subsequent POP surgery than did hysterectomy at an older age. This difference diminished after stratification by indication; all non-POP hysterectomies had a low cumulative incidence at 8–11 % at the end of the follow-up period. For all women hysterectomized, the predominant compartment for POP surgery was the posterior. Women hysterectomized when aged over 66 years had a higher proportion of POP surgery in the apical compartment than in the other age groups (p?=?0.000).

Conclusion

Our findings indicate that age at hysterectomy only marginally influences the risk of subsequent POP surgery for women hysterectomized for indications other than POP. If POP is the indication for hysterectomy, the risk of undergoing subsequent POP surgery increases substantially.

     

The effect of pelvic floor muscle training and intravaginal electrical stimulation on urinary incontinence in women with incomplete spinal cord injury: an investigator-blinded parallel randomized clinical trial

Introduction and hypothesis

Urinary incontinence is a prevalent problem in women with spinal cord injury. The aim of this study was to examine the effect of pelvic floor muscle training (PFMT) alone and combined with intravaginal electrical stimulation (IVES) on urinary incontinence in women with incomplete spinal cord injury.

Methods

In this investigator-blinded randomized clinical trial, we recruited women aged 18–75 with incomplete spinal cord injury and urinary incontinence from a single spinal cord injury clinic in Denmark. Women were randomly assigned to either PFMT or PFMT combined with IVES daily at home for 12 weeks. All women were trained by a physiotherapist using vaginal palpation and electromyography biofeedback. Outcome measures were recorded at baseline (week 0), post-intervention (week 12) and follow-up (week 24) and included change in the total score on the International Consultation on Incontinence Questionnaire urinary incontinence short form (ICIQ-UI-SF) and daily episodes of urinary incontinence.

Results

From 27 April 2015?9 September 2016, we randomly assigned 36 women (17 in the PFMT group and 19 in the PFMT+IVES group); 27 completed the interventions (13 in the PFMT group and 14 in the PFMT+IVES group). The results showed no difference between the groups on ICIQ-UI-SF or episodes of urinary incontinence at 12 and 24 weeks. Only the PFMT group had a significant change from baseline on ICIQ-UI-SF [?2.4 (95% CI -4.3??0.5), p?=?0.018] and daily episodes of urinary incontinence [?0.4 (95% CI -0.8??0.1), p?=?0.026] at 12 weeks.

Conclusions

PFMT+IVES is not superior to PFMT alone in reducing urinary incontinence in women with incomplete spinal cord injury.

     

Adherence to pelvic floor muscle training with or without vaginal spheres in women with urinary incontinence: a secondary analysis from a randomized trial

Introduction and hypothesis

Pelvic floor muscle training (PFMT) is widely recommended as first-line therapy for women with urinary incontinence. However, adherence to PFMT decreases over time, and information regarding barriers to PFMT is scarce. The primary aim of our study was to investigate whether a vaginal spheres device helped improve adherence to PFMT. The secondary aim was to assess determinants of adherence and the association with treatment outcome.

Methods

This was a secondary analysis of a randomized trial with a 6-month follow-up in women with urinary incontinence (UI) in whom we evaluated adherence to PFMT, performed either with (spheres group) or without (control group) vaginal spheres. The Morisky-Green Questionnaire (MGQ) was used to assess adherence, defined as the extent to which participants corresponded to the agreed recommendations; participants were classified as adherent or nonadherent according to their responses. Efficacy of PFMT was assessed using the International Consultation on Incontinence Questionnaire Short Form scale (ICIQ-SF).

Results

Seventy women were enrolled and data from 65 (35 treated and 30 controls) were suitable for analysis. There were no significant differences in adherence to treatment between groups at the end of follow-up (33.3 % in controls and 42.9 % in spheres). The largest group of nonadherent women in both arms were those who mainly forgot to do the exercises. ICIQ-SF results between adherent and nonadherent women did not differ significantly [mean 0.55, 95 % confidence interval (CI) 1.13–2.25]. No significant difference was observed between women who attained greater and lesser improvement in UI after treatment (4.5 %; 95 % CI ?11.7 to 20.6).

Conclusions

In patients with UI, vaginal spheres as an adjunct to PFMT did not increase adherence to pelvic muscle exercises. Lack of persistence appeared to be due to forgetfulness and did not seem to be influenced by the efficacy of PFMT.

     

Influence of voluntary pelvic floor muscle contraction and pelvic floor muscle training on urethral closure pressures: a systematic literature review

Introduction and hypothesis

Stress urinary incontinence (SUI) is managed with pelvic floor muscle training (PFMT), but the mechanism of treatment action is unclear. Resting maximal urethral closure pressure (MUCP) is lower in women with SUI, but it is unknown whether PFMT can alter resting MUCP. This systematic review evaluated whether voluntary pelvic floor muscle (PFM) contraction increases MUCP above its resting value (augmented MUCP) and the effect of PFMT on resting and augmented MUCP.

Methods

Experimental and effect studies were identified using PubMed and PEDro. The PEDro scale was used to assess internal validity of interventional studies.

Results

We identified 21 studies investigating the influence of voluntary PFM contraction in women. Comparison was hindered by varying demographics, antecedent history, reporting of confirmed correct PFM contraction, and urethral pressure profilometry (UPP) techniques. Mean incremental increase in MUCP during PFM contraction in healthy women was 8–47.3 cm H₂O; in women with urinary incontinence (UI), it was 6–24 cm H₂O. Nine trials reporting MUCP as an outcome of PFMT were found. Wide variation in PFMT regimes affected the findings. Two studies found significant improvement in MUCP of 5–18 cm H₂0. Seven studies assessed augmentation of MUCP with PFM contraction; mean increase was ?0.1 to 25 cm H₂0.

Conclusions

There is no definitive evidence that PFMT increases resting MUCP as its mechanism of action in managing SUI. The degree to which a voluntary PFM contraction augments MUCP varies widely. There was evidence to suggest PFMT increases augmented MUCP. Drawing firm conclusions was hampered by study methodologies.

     

A survey of prolapse practice in UK women’s health physiotherapists: what has changed in the last decade?

Introduction and hypothesis

Prolapse is a common female problem, and conservative treatments such as pelvic floor muscle training (PFMT) are important options for women. Evidence supporting the effectiveness of PFMT for prolapse has grown over the last decade, and it was hypothesised that practice and practice guidelines would have developed in line with the evidence. To assess this, up-to-date information about the practice of physiotherapists working in women’s health regarding their treatment of prolapse was required.

Methods

An online survey sent to members of the Association of Chartered Physiotherapists in Women’s Health and the Chartered Physiotherapists Promoting Continence. Results were compared with those of an earlier survey undertaken in 2002.

Results

A 49 % response rate was achieved. The majority of respondents were senior physiotherapists (55 %) and had worked in women’s health for more than 10 years. Respondents were treating significantly more women with prolapse than a decade before: 36 % vs 14 % treated more than 50 women per year in 2002 and 2013 respectively (p?<?0.001). Individualised PFMT (93 %), lifestyle advice (92 %) and biofeedback-assisted PFMT (83 %) were the most common treatment elements, with four being the average number of appointments. Forty-eight percent had changed their practice as a result of recent research; however, scepticism amongst medics, the referral of women directly for surgery, and constraints on resources were thought to be barriers to wider implementation of the evidence of PFMT for prolapse.

Conclusions

There has been uptake of evidence-based prolapse practice by UK specialist physiotherapists in the last decade. Further research targeting the implementation of this evidence would be valuable in addressing potential barriers, and in supporting the need for physiotherapy in the treatment of prolapse.

     

Impact of pelvic floor muscle training in the postpartum period

Introduction and hypothesis

Our study piloted a novel, two-tiered approach to delivering pelvic floor muscle training (PFMT) to postpartum women involving a standardized group workshop followed by the opportunity to self-select for individual PFMT sessions. The aim of the study was to evaluate the outcomes in women who self-selected for individual PFMT using validated quality of life (QoL) questionnaires, the Pelvic Floor Distress Inventory-20 (PFDI-20), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12), as well as the Modified Oxford Scale (MOS) for strength. Women’s satisfaction with the program was also assessed.

Methods

This was a single-center prospective cohort study conducted between December 2013 and September 2014. Changes from baseline to postintervention QoL and MOS scores were tested using the Wilcoxon signed-rank test.

Results

Two hundred and eighteen women attended the workshop, 54 enrolled in PFMT sessions, and 50 completed follow-up. Significant improvements were seen in the PFDI-20 (mean change ?41.8, p?<?0.001) and PFIQ-7 (mean change ?23.0, p?<?0.001) questionnaires. Results for the PISQ-12 could not be tabulated, as there were too many missing responses. The MOS score was significantly improved from baseline (4; range {0–5} compared with 3; range {0–4}; p?<?0.001). Forty-nine of 50 women’s expectations for the program were met [9 of 10; standard deviation (SD) 1.4].

Conclusion

Results suggest that a two-tiered, self-selection approach to administering PFMT in the postpartum period contributes to significant improvements in pelvic floor function, QoL, MOS strength, and to high satisfaction rates.

     

Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: a systematic review

Introduction and hypothesis

Our objective was to evaluate the effectiveness of pelvic floor muscle training (PFMT) in reducing overactive bladder (OAB) symptoms in women.

Methods

Searches were performed at MEDLINE, PubMed, Physiotherapy Evidence Database (PEDro), Scielo, and Central Cochrane Library PubMed until January 2017. Controlled trials were researched by two independent reviewers. Eligible studies were restricted to random and controlled clinical trials that investigated the effectiveness of PFMT in decreasing OAB symptoms. Qualitative methodology was evaluated using the PEDro scale. Data was analyzed and interpreted qualitatively.

Results

The final search retrieved eight studies (n =?1161 women with urgency symptoms), which were published between 2002 and 2016. The methodological scores varied between 4 and 7 in the PEDro scale. PFMT, with the objective of controlling urgent micturition, demonstrated improvements in quality of life in women with OAB. Most data in this revision came from small- to moderate-sized trials, with different and inconsistent outcome measures, which could have impacted the end results.

Conclusions

The literature regarding the effectiveness of PFMT in OAB remains heterogeneous and inconclusive.

     

Primary treatment of pelvic organ prolapse: pessary use versus prolapse surgery

Introduction and hypothesis

The objective of this study was to compare the functional outcomes after pessary treatment and after prolapse surgery as primary treatments for pelvic organ prolapse (POP).

Methods

This was a prospective cohort study performed in a Dutch teaching hospital in women with symptomatic POP of stage II or higher requiring treatment. Patients were treated according to their preference with a pessary or prolapse surgery. The primary endpoint was disease-specific quality of life at 12 months follow-up according to the prolapse domain of the Urogenital Distress Inventory (UDI) questionnaire. Secondary outcomes included adverse events and additional interventions. To show a difference of ten points in the primary outcome, we needed to randomize 80 women (power 80%, α 0.05, taking 10% attrition into account).

Results

We included 113 women (74 in the pessary group, 39 in the surgery group). After 12 months, the median prolapse domain score was 0 (10th to 90th percentile 0–33) in the pessary group and 0 (10th to 90th percentile 0–0) in the surgery group (p < 0.01). Differences in other domain scores were not statistically significant. In the pessary group, 28% (21/74) of the women had a surgical intervention versus 3% (1/39) reoperations in the surgery group (p = 0.01).

Conclusions

In women with POP of stage II or higher undergoing surgery, prolapse symptoms were less severe than in those who were treated with a pessary, but 72% of women who were treated with a pessary did not opt for surgery. Trial registration number: Dutch trial register NTR2856.

     

Association between pelvic floor muscle trauma and pelvic organ prolapse 20 years after delivery

Introduction and hypothesis

It is known that pelvic floor muscle trauma (PFMT) after vaginal delivery is associated with pelvic organ prolapse (POP) symptoms (sPOP) and signs (POP-Q ≥2) in patient populations. Our aims were to establish the prevalence and investigate a possible association between PFMT and sPOP and POP-Q ≥2 in healthy women 20 years after their first delivery.

Methods

During 2013 and 2014 we conducted a cross-sectional study among 847 women who delivered their first child between 1990 and 1997. Women responded to a postal questionnaire and were offered a clinical examination including prolapse grading and pelvic floor ultrasonography. The main outcome measures were sPOP, POP-Q ≥2 and PFMT, defined by levator avulsion or a levator hiatal area on Valsalva manoeuvre of >40 cm² on ultrasonography.

Results

Of the 847 eligible women, 608 (72 %) were examined. Data on POP symptoms, POP-Q stage, levator avulsion and levator hiatal area were available in 598, 608, 606 and 554 women, respectively, and of these 75 (13 %) had sPOP, 275 (45 %) had POP-Q ≥2, 113 (19 %) had levator avulsion and 164 (30 %) had a levator hiatal area >40 cm². Levator avulsion was associated with POP-Q ≥2 with an odds ratio (OR) of 9.91 and a 95 % confidence interval (CI) of 5.73 – 17.13, and with sPOP (OR 2.28, 95 % CI 1.34 – 3.91). Levator hiatal area >40 cm² was associated with POP-Q ≥2 (OR 6.98, 95 % CI 4.54, – 10.74) and sPOP (OR 3.28, 95 % CI 1.96 – 5.50).

Conclusion

Many healthy women selected from the general population have symptoms and signs of POP 20 years after their first delivery, and PFMT is associated with POP-Q ≥2 and sPOP.

     

Prevalence of obstetric fistula and symptomatic pelvic organ prolapse in rural Ethiopia

Introduction and objective

Little is known about the extent to which women in low- and middle-income countries suffer with urological and urogynaecological complications of childbirth. This study measured the prevalence of obstetric fistula and symptomatic pelvic organ prolapse (POP) in east and north Ethiopia.

Methods

We randomly selected 23,023 women of reproductive age (15–49 years) from 113 villages in East Harraghe, South Gondar and West Gojjam, Ethiopia. Trained local health workers administered a validated face-to-face survey and a team of researchers verified data by readministering a random selection (5 %) of the survey. All suspected fistulae were followed up to confirm a clinical diagnosis.

Results

Mean age was 29.5 [standard deviation (SD) 8.05] years. Only 22 % of women were knowledgeable about the symptoms of fistula. The prevalence of all obstetric fistulae was 6:10,000 reproductive-aged women [95 % confidence interval (CI) 3–8], of untreated fistula 2:10,000 (95 % CI 0–4) and of symptomatic POP 100:10,000 (95 % CI 86–114).

Conclusion

The prevalence of obstetric fistula in these rural zones of Ethiopia is relatively low and reflects a substantial reduction from previous reports. Significant numbers of women suffer with symptomatic POP, for which surgical and nonsurgical treatments would be beneficial.

Brief summary

Obstetric fistula in north and east Ethiopia is relatively low; however, the many women with symptomatic pelvic organ prolapse could benefit from treatment.

     

Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial

Introduction and hypothesis

We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI).

Methods

This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of continent women with symptomatic stage II or greater POP. Women with occult SUI were randomly assigned to vaginal prolapse repair with or without MUS. Women without occult SUI received POP surgery. Main outcomes were the absence of SUI at the 12-month follow-up based on the Urogenital Distress Inventory and the need for additional treatment for SUI.

Results

We evaluated 231 women, of whom 91 randomized as follows: 43 to POP surgery with and 47 without MUS. A greater number of women in the MUS group reported absence of SUI [86 % vs. 48 %; relative risk (RR) 1.79; 95 % confidence interval (CI) 1.29–2.48]. No women in the MUS group received additional treatment for postoperative SUI; six (13 %) in the control group had a secondary MUS. Women with occult SUI reported more urinary symptoms after POP surgery and more often underwent treatment for postoperative SUI than women without occult SUI.

Conclusions

Women with occult SUI had a higher risk of reporting SUI after POP surgery compared with women without occult SUI. Adding a MUS to POP surgery reduced the risk of postoperative SUI and the need for its treatment in women with occult SUI. Of women with occult SUI undergoing POP-only surgery, 13 % needed additional MUS. We found no differences in global impression of improvement and quality of life.

     

Effect of pessary use on hydronephrosis in women with advanced pelvic organ prolapse: a self-selected interventional trial

Introduction and hypothesis

The purpose of this study was to determine the proportion of women who demonstrate improvement in hydronephrosis after pessary placement for advanced pelvic organ prolapse (POP).

Methods

This was a planned subset analysis of a prospective study on the prevalence of hydronephrosis in women with advanced POP. Women with anterior or apical POP ≥1 cm past the hymenal remnant were enrolled and screened for hydronephrosis. All were offered expectant management, pessary placement or surgery. Participants self-selecting pessary placement were compared with those with expectant management during the study period. A follow-up ultrasound scan was performed after >3 weeks of treatment. The proportions of participants demonstrating cure/improvement were compared using Fisher’s exact test.

Results

Of 180 participants enrolled, 55 had hydronephrosis for a prevalence of 30.6% (95% CI 24.3–37.6%). Of those with hydronephrosis, 39 (70.8%) chose pessary placement while 16 (30.2%) declined. A follow-up ultrasound scan was performed in 89% of participants at a median of 77 days (interquartile range 49–99 days). Intention-to-treat analysis showed no difference in improvement or resolution of hydronephrosis between women who accepted and those who declined pessary placement (p?=?0.43). However, of 22 women successfully using a pessary, 77.3% showed improvement or cure, compared with 29.6% of 27 women not using a pessary (p?=?0.003).

Conclusions

Successful pessary use improved hydronephrosis in over 75% of women with advanced POP. Approximately 39% of women with prolapse did not comply with pessary use and did not demonstrate hydronephrosis improvement.

     

Association between vaginal bulge and anatomical pelvic organ prolapse during pregnancy and postpartum: an observational study

Introduction and hypothesis

Pelvic organ prolapse (POP) is defined as the coexistence of anatomical POP and relevant symptoms. Vaginal bulge is the symptom most closely associated with the anatomical condition in nonpregnant women. Even if childbearing is a major risk factor for the development of POP, there is scant knowledge on the prevalence of specific POP symptoms, and how these symptoms relate to anatomical POP during pregnancy and postpartum. The aim of this study was to explore whether vaginal bulge symptoms were associated with anatomical POP in pregnancy and postpartum, and to present the prevalence of vaginal bulge symptoms throughout this period.

Methods

A prospective observational study was carried out following 300 nulliparous pregnant women with repeat assessments from mid-pregnancy until 1 year postpartum. Symptoms of vaginal bulge defined as the sensation of a vaginal bulge inside and/or outside the vagina were assessed by electronic questionnaires. Anatomical POP defined as pelvic organ prolapse quantification system (POP-Q) stage ≥2 has been presented in a previous publication and showed a range of 1–9%. The association between the symptom vaginal bulge and anatomical POP at the various visits was analyzed using Fisher’s exact test.

Results

Prevalence of vaginal bulge ranged between 16 and 23%. At 6 weeks postpartum the symptom was associated with anatomical POP; otherwise, these two features were unrelated.

Conclusions

The symptom vaginal bulge was barely associated with anatomical POP, and cannot identify anatomical POP in pregnancy or postpartum.

     

Incidence of pelvic organ prolapse repair subsequent to hysterectomy: a comparison between radical hysterectomy and total abdominal hysterectomy

Introduction and hypothesis

The aim of this study was to compare the incidence of subsequent pelvic organ prolapse (POP) repair in women following radical hysterectomy versus total abdominal hysterectomy.

Methods

From the Danish National Patient Registry, we collected data on all radical hysterectomies, all total abdominal hysterectomies, and all POP operations performed in Denmark from 1 January 1977 to 31 December 2009. We excluded patients with prior POP repair, POP diagnosis, or concomitant POP repair at hysterectomy. We analyzed the incidence of POP surgery using Kaplan–Meier curves and hazard ratio (HR).

Results

In all, 5279 women underwent radical hysterectomy, and 63 of these underwent subsequent POP surgery. In the same period, 149,920 women underwent total abdominal hysterectomy, and 6107 of these had POP surgery subsequent to the hysterectomy. The cumulative incidence of POP surgery was significantly lower for radical hysterectomy than for abdominal hysterectomy—3.4 % and 9.5 %, respectively, at the end of the study period, yielding a crude HR of 0.36 and an adjusted HR of 0.40 in favor of the radical hysterectomy. The distribution of POP operations in the defined compartments was the same for the two types of hysterectomy.

Conclusions

This study found a significantly lower incidence of subsequent POP operations among women who undergo radical hysterectomy than total abdominal hysterectomy.

     

Prevalence of,and risk factors for,symptomatic pelvic organ prolapse in Rural Bangladesh: a cross-sectional survey study

Introduction and hypothesis

The prevalence of symptomatic pelvic organ prolapse (POP), diagnosed by a pre-tested structured questionnaire, is unknown in Bangladesh. We investigated the prevalence of, and risk factors for, symptomatic POP in women in rural Bangladesh, recruited from the community.

Methods

A cross-sectional survey of 787 women aged over 15 years was conducted in four villages in one district in rural Bangladesh. The prevalence of symptomatic POP and the risk factors associated with the condition was investigated, using Chi-squared and multivariate logistic regression.

Results

The prevalence of symptomatic POP was 15.6 %. The mean age of participants was 40.1 (±9.0) years. Women aged 35–44 years (odds ratio [OR] 1.96, 95 % confidence interval [CI] 1.03–3.73) and ≥45 years (OR 2.95, 95 % CI 1.62–5.38) were more likely to have POP compared with women aged ≤35 years. Having POP was positively associated with women having ≥5 children (OR 4.34, 95 % CI 1.39–13.58), having chronic obstructive pulmonary disease (COPD; OR 2.07, 95 % CI 1.02–4.21), and women having constipation (OR 3.54, 95 % CI 1.87–6.72). Women whose husband had >5 years of schooling were less likely to have POP (OR 0.37, 95 % CI 0.19–0.73) compared with women whose husband had no schooling.

Conclusions

Symptomatic POP affects a substantial proportion of women in rural Bangladesh and increases with age. Parity, COPD, constipation and husband’s education are associated with POP, all of which have the potential to be modified. Thus, interventions targeting these risk factors to prevent the condition are urgently needed in Bangladesh.

     

Characteristics associated with pelvic organ prolapse in women with significant levator ani muscle deficiency

Introduction and hypothesis

Age is a factor associated with symptomatic pelvic organ prolapse (POP) among women with significant levator ani deficiency.

Methods

This cross-sectional study included patients who were referred for varied pelvic floor disorders, had 3D endovaginal ultrasound as part of their evaluation, and were diagnosed with significant levator ani muscle deficiency defined as a score of 12 or more on 3D endovaginal ultrasound. Patients were categorized as having no pelvic organ prolapse (stages 0 and 1), or symptomatic prolapse (stages 2–4).

Results

Seventy-six women were available for analysis and found to have significant levator ani muscle deficiency, including 51 with symptomatic POP and 25 without POP. Patients with symptomatic POP were older, (mean age 66 (SD?±?11.8) vs 48 (SD?±?17.3) years; p <0.0001), had greater mean minimal levator hiatus (MLH) area (19.7 cm² (SD?±?4.6) vs 17.5 cm² (SD?±?3.5); p?=?0.048), and were more likely to be menopausal (91.3 % vs 54.5 %; p <0.001) compared with those with no POP. In a modified Poisson regression analysis excluding nulliparous women, increasing age (RR?=?2.39, 95 % CI 1.03–5.55) and smoking (RR?=?1.34, 95 % CI 1.08–1.67) remained associated with symptomatic POP after controlling for one another and the MLH area.

Conclusions

Among women with significant levator ani deficiency, older women and smokers had an increased prevalence of symptomatic POP. On average, women without POP, but with significant levator ani deficiency were 18 years younger than women with POP and significant muscle deficiency.

     

Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis

Introduction and hypothesis

Urinary Incontinence (UI) in women is a condition that becomes more common with age. Pelvic floor muscle training (PFMT) is recommended as a first option of treatment for women with symptoms of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and for some with symptoms of urge urinary incontinence (UUI). PFMT can be performed in groups, individually, and at home, and there is no consensus as to which of the approaches is more efficient for the conservative treatment of UI. The objective was to perform a systematic review comparing the effects of group PFMT vs individual or home training in the treatment of women with UI.

Methods

Cochrane’s recommendations for systematic reviews were followed. The inclusion criteria were that the studies had been carried out in adult women who suffered from UI and who underwent PFMT in a group.

Results

Ten studies that fit the criteria previously mentioned were included in this systematic review. The meta-analysis showed that there was no difference when comparing PFMT in groups vs individual PFMT. However, when comparing PFMT in groups vs PFMT at home, the group intervention was more efficient in the treatment of UI.

Conclusion

PFMT is an efficient technique for the improvement of the symptoms of female UI. When PFMT was supervised by a physiotherapist, no significant difference was noted when comparing group with individual approaches.

     

Role of concurrent vaginal hysterectomy in the outcomes of mesh-based vaginal pelvic organ prolapse surgery

Introduction and hypothesis

Hysterectomy is often performed at the time of pelvic organ prolapse (POP) surgery; yet, there is insufficient evidence regarding the specific effect of hysterectomy on outcomes. We sought to determine the outcomes and associated short-term complications of mesh-based POP surgery with and without concurrent hysterectomy.

Methods

We utilized the New York Statewide Planning and Research Cooperation System (SPARCS) database to identify patients under 55 years of age undergoing surgeries for POP with mesh between 2009 and 2014. Patients who had a hysterectomy at the time of mesh-based POP surgery were compared with those who underwent mesh-based POP surgery without hysterectomy. Outcome measures of the patient groups before and after propensity score matching were compared. We assessed the difference Chi-squared tests and log-rank tests in the entire cohort and Mantel–Haenszel stratified Chi-squared tests and Prentice-Wilcoxon tests in the matched cohort.

Results

A total of 1,601 women underwent mesh-based POP surgery. 921 patients underwent concurrent hysterectomy, whereas 680 had mesh-based uterine-preserving POP surgery. After propensity score matching, there was no difference in reintervention rates between groups for up to 3 years. Concurrent hysterectomy with mesh-based POP repair was consistently associated with longer hospitalization (20.0% vs 12.8% stayed longer than 2 days) and higher charges (median charges were $22,689 vs $19,273).

Conclusions

Concurrent hysterectomy during mesh-based POP surgery in patients under 55 years led to more expensive charges and a longer stay compared with uterine-preserving mesh surgery. There was no difference in reintervention rates between groups for up to 3 years.