Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial

Beatriz Navarro-Brazález, Virginia Prieto-Gómez, David Prieto-Merino, Beatriz Sánchez-Sánchez, Linda McLean, María Torres-Lacomba, Beatriz Navarro-Brazález, Virginia Prieto-Gómez, David Prieto-Merino, Beatriz Sánchez-Sánchez, Linda McLean, María Torres-Lacomba

Abstract

Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at follow-up assessments at 3, 6 and 12 months later. The study was a prospective, single-centre, assessor-blinded, randomised controlled trial. Ninety-four women with PFD were assigned to PFMT (n = 32), hypopressive exercises (n = 31) or both (n = 31). All programs included the same educational component, and instruction about lifestyle interventions and the knack manoeuvre. Primary outcomes were the Pelvic Floor Distress Inventory Short Form (PFDI-20); the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7); PFM strength (manometry and dynamometry) and pelvic floor basal tone (dynamometry). There were no statistically significant differences between groups at baseline, nor after the intervention. Overall, women reduced their symptoms (24.41-30.5 on the PFDI-20); improved their quality of life (14.78-21.49 on the PFIQ-7), improved their PFM strength (8.61-9.32 cmH2O on manometry; 106.2-247.7 g on dynamometry), and increased their pelvic floor basal tone (1.8-22.9 g on dynamometry). These data suggest that individual PFMT, hypopressive exercises and a combination of both interventions significantly reduce PFD symptoms, enhance quality of life, and improve PFM strength and basal tone in women with PFD, both in the short and longer term.

Keywords: adherence; hypopressive exercises; pelvic floor dysfunction; pelvic floor exercise; physiotherapy; quality of life.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of participants.
Figure 2
Figure 2
(A): changes in PFDI-20: Pelvic floor Distress Inventory Short Form outcome from baseline; (B): changes in PFIQ-7: Pelvic Floor Impact Questionnaire Short Form outcome from baseline.
Figure 3
Figure 3
(3): changes in pelvic floor muscle strength measured by manometry outcome from baseline; (3): changes in pelvic floor muscle strength measured by dynamometry outcome from baseline; (3): changes in basal tone outcome from baseline.

References

    1. Haylen B.T., Maher C.F., Barber M.D., Camargo S., Dandolu V., Digesu A., Goldman H.B., Huser M., Milani A.L., Moran P.A., et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic organ prolapse (POP) Neurourol. Urodyn. 2016;35:137–168. doi: 10.1002/nau.22922.
    1. Bartoli D., Aguzzi G., Tarricone R. Impact on quality of life of urinary incontinence and overactive bladder: A systematic literature review. Urology. 2010;75:491–500. doi: 10.1016/j.urology.2009.07.1325.
    1. Nygaard I., Barber M.D. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–1316. doi: 10.1001/jama.300.11.1311.
    1. MacLennan A.H., Taylor A.W., Wilson D.H., Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. Br. J. Obstet. Gynaecol. 2000;107:1460–1470. doi: 10.1111/j.1471-0528.2000.tb11669.x.
    1. Walker G.J.A., Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: Review of prevalence and risk factors. Int. Urogynecol. J. 2011;22:127–135. doi: 10.1007/s00192-010-1215-0.
    1. Dumoulin C., Hay-Smith E.J.C., Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst. Rev. 2014 doi: 10.1002/14651858.CD005654.pub3.
    1. Hagen S., Stark D. Conservative prevention and management of pelvic organ prolapse in women (review) Cochrane Database Syst. Rev. 2011 doi: 10.1002/14651858.CD003882.pub4.
    1. Hay-Smith E.J.C., Herderschee R., Dumoulin C., Herbison G.P. Comparisons of approaches of pelvic floor muscle training for urinary incontinence in women (review) Cochrane Database Syst. Rev. 2011 doi: 10.1002/14651858.CD009508.
    1. Hung H.C., Hsiao S.M., Chih S.Y., Lin H.H., Tsauo J.Y. An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Man. Ther. 2010;15:273–279. doi: 10.1016/j.math.2010.01.008.
    1. Navarro-Brazález B., Sánchez-Sánchez B., Prieto-Gómez V., De la Villa-Polo P., McLean L., Torres-Lacomba M. Pelvic floor and abdominal muscle responses during hypopressive exercises in women with pelvic floor dysfunction. Neurourol. Urodyn. 2020;39:793–803. doi: 10.1002/nau.24284.
    1. Juez L., Núñez-Córdoba J.M., Couso N., Aubá M., Alcázar J.L., Mínguez J.Á. Hypopressive technique versus pelvic floor muscle training for postpartum pelvic floor rehabilitation: A prospective cohort study. Neurourol. Urodyn. 2019;38:1924–1931. doi: 10.1002/nau.24094.
    1. Soriano L., González-Millána C., Álvarez-Sáez M.M., Curbelo R., Carmona L. Effect of an abdominal hypopressive technique programme on pelvic floor muscle tone and urinary incontinence in women: A randomised crossover trial. Physiotherapy. 2020 doi: 10.1016/j.physio.2020.02.004.
    1. Resende A.P.M., Stüpp L., Bernardes B.T., Oliveira E., Castro R.A., Girao M.J.B.C., Sartori M.G.F. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse? Neurourol. Urodyn. 2012;31:121–125. doi: 10.1002/nau.21149.
    1. Bernardes B.T., Resende A.P.M., Stüpp L., Oliveira E., Castro R.A., Bella Z.I.K.J., Girao M.J.B.C., Sartori M.G.F. Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: Randomized controlled trial. Sao Paulo Med. J. 2012;130:5–9. doi: 10.1590/S1516-31802012000100002.
    1. Caufriez M. Gymnastique Abdominale Hypopressive. Bruxelles, French: 1997. [(accessed on 15 April 2020)]. Available online: .
    1. Dumoulin C., Hay-Smith J., Frawley H., McClurg D., Alewijnse D., Bø K., Burgio K., Chen S.Y., Chiarelli P., Dean S., et al. 2014 consensus statement of improving pelvic floor muscle training adherence: International continence society 2011 state-of-the-science seminar. Neurourol. Urodyn. 2015;34:600–605. doi: 10.1002/nau.22796.
    1. Borello-France D.F., Downey P.A., Zyczynski H.M., Rause C.R. Continence and quality-of-life outcomes 6 months following an intensive pelvic-floor muscle exercise program for female stress urinary incontinence: A randomized trial comparing low-and high-frequency maintenance exercise. Phys. Ther. 2008;88:1545–1553. doi: 10.2522/ptj.20070257.
    1. Laycock J., Jerwood D. Pelvic floor muscle assessment: The PERFECT scheme. Physiotherapy. 2001;87:631–642. doi: 10.1016/S0031-9406(05)61108-X.
    1. Castro-Pardiñas M.A., Torres-Lacomba M., Navarro-Brazález B. Pelvic floor muscle function in healthy, postpartum, and pelvic floor dysfunction women. Actas Urol. Esp. 2017;41:249–257. doi: 10.1016/j.acuro.2016.11.007.
    1. Itza F., Zarza D., Serra L., Gómez-Sancha F., Salinas J., Allona-Almagro A. Síndrome de dolor miofascial del suelo pélvico: Una patología urológica muy frecuente. Actas Urol. Esp. 2010;34:318–326. doi: 10.1016/j.acuro.2009.12.013.
    1. Sánchez-Sánchez B., Torres-Lacomba M., Yuste-Sánchez M., Navarro-Brazález B., Pacheco-da-Costa S., Guitérrez-Ortega C., Zapico-Goñi Á. Cultural adaptation and validation of the pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7) Spanish versions. Eur. J. Obstet. Gynecol. Reprod. Biol. 2013;170:281–285. doi: 10.1016/j.ejogrb.2013.07.006.
    1. Navarro-Brazález B., Torres-Lacomba M., De la Villa-Polo P., Sánchez-Sánchez B., Prieto-Gómez V., Asúnsolo-Del Barco Á., McLean L. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study. Neurourol. Urodyn. 2018;37:269–277.
    1. Imamura M., Williams K., Wells M., McGrother C. Lifestyle interventions for the treatment of urinary incontinence in adults (review) Cochrane Database Syst. Rev. 2015 doi: 10.1002/14651858.CD003505.pub5.
    1. Miller J.M., Perucchini D., Carchidi L.T., DeLancey J.O.L., Asthon-Miller J.A. Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet. Gynecol. 2001;97:255–260.
    1. Barber M., Walters M., Bump R. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7) Obstet. Gynecol. 2005;193:103–113. doi: 10.1016/j.ajog.2004.12.025.
    1. Wiegersma M., Panman C.M.C.R., Kollen B.J., Berger M.Y., Lisma-Van Leeuwen Y., Dekker J.H. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: Randomised controlled trial in primary care. BMJ. 2014;349:1–11. doi: 10.1136/bmj.g7378.
    1. McLean L., Varette K., Gentilcore-Saulnier E., Harvey M.A., Baker K., Sauerbrei E. Pelvic floor muscle training in women with stress urinary incontinence causes hypertrophy of the urethral sphincters and reduces bladder neck mobility during coughing. Neurourol. Urodyn. 2013;32:1096–1102. doi: 10.1002/nau.22343.
    1. Bø K., Talseth T., Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318:487–493. doi: 10.1136/bmj.318.7182.487.
    1. Ruiz de Viñaspe-Hernández R. Eficacia de la gimnasia abdominal hipopresiva en la rehabilitación del suelo pélvico de las mujeres: Revisión Sistemática. Actas Urol. Esp. 2018;42:557–566. doi: 10.1016/j.acuro.2017.10.004.
    1. Madill S.J., McLean L. Quantification of abdominal and pelvic floor muscle synergies in response to voluntary pelvic floor muscle contractions. J. Electromyogr. Kines. 2008;18:955–964. doi: 10.1016/j.jelekin.2007.05.001.
    1. Bø K., Sherburn M., Allen T. Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction. Neurourol. Urodyn. 2003;22:582–588. doi: 10.1002/nau.10139.
    1. Navarro-Brazález B., Torres-Lacomba M., Arranz-Martín B., Sánchez-Méndez Ó. Muscle response during a hypopressive exercise after pelvic floor physiotherapy: Assessment with transabdominal ultrasound. Fisioterapia. 2017;39:187–194.
    1. Vermandel A., De Wachter S., Beyltjens T., D’Hondt D., Jacquemyn Y., Wyndaele J.J. Pelvic floor awareness and the positive effect of verbal instructions in 958 women early postdelivery. Int. Urogynecol. J. 2015;26:223–228. doi: 10.1007/s00192-014-2483-x.
    1. Bø K., Haakstad L.A. Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial. Physiotherapy. 2011;97:190–195.
    1. Bø K., Talseth T. Long-term effect of pelvic floor muscle exercise 5 years after cessation of organized training. Obstet. Gynecol. 1996;87:261–265. doi: 10.1016/0029-7844(95)60375-1.
    1. Bø K., Kvarstein B., Nygaard I. Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Obstet. Gynecol. 2005;105:999–1005. doi: 10.1097/01.AOG.0000157207.95680.6d.
    1. Beyar N., Groutz A. Pelvic floor muscle trainning for female stress urinary incontinence: Five years outcomes. Neurourol. Urodyn. 2017;36:132–135. doi: 10.1002/nau.22888.

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