The effect of preoperative pelvic floor muscle training on urinary and colorectal-anal distress in women undergoing pelvic organ prolapse surgery-a randomized controlled trial

Seema Mathew, Maria Øyasæter Nyhus, Øyvind Salvesen, Kjell Åsmund Salvesen, Signe Nilssen Stafne, Ingrid Volløyhaug, Seema Mathew, Maria Øyasæter Nyhus, Øyvind Salvesen, Kjell Åsmund Salvesen, Signe Nilssen Stafne, Ingrid Volløyhaug

Abstract

Introduction and hypothesis: Pelvic floor muscle training (PFMT) improves urinary incontinence and mild pelvic organ prolapse (POP). We aimed to investigate the effect of preoperative PFMT on urinary and colorectal-anal distress and related quality of life (QoL) in women with severe POP scheduled for surgery.

Methods: Randomized controlled trial of 159 women scheduled for POP surgery (intervention = 81, controls = 78). Intervention consisted of daily PFMT from inclusion to the day of surgery. Symptoms and QoL were assessed at inclusion, day of surgery and 6 months postoperatively using the Urinary Distress Inventory (UDI-6), Colorectal-Anal Distress Inventory (CRADI-8), Urinary Impact Questionnaire (UIQ) and Colorectal-Anal Impact Questionnaire (CRAIQ) (range 0-100). Mixed model statistical analyses were used.

Results: One hundred fifty-one (95%) women completed the study (intervention = 75, controls = 76). Mean waiting times until surgery and follow-up were 22 and 28 weeks. There was no difference in mean postoperative symptom and QoL scores (95% CI) between the intervention and control group: UDI-6 16 (12-21) vs. 17 (13-22), CRADI-8 15 (11-18) vs. 13 (10-16), UIQ 11 (7-15) vs. 10 (6-13) and CRAIQ 5 (2-7) vs. 6 (4-9), all p > 0.05. Overall mean scores were reduced from baseline to postoperative follow-up: UDI-6 37 (33-41) vs. 17 (14-20), CRADI-8 22 (19-25) vs. 14 (11-16); UIQ 28 (24-32) vs. 10 (7-13) and CRAIQ 16 (12-19) vs. 5 (3-7), all p < 0.01.

Conclusions: We found no added effect of preoperative PFMT on symptoms or QoL related to urinary and colorectal-anal distress in women scheduled for POP surgery. They achieved symptomatic improvement postoperatively regardless of PFMT.

Clinical trial registration: The study was registered in clinicaltrials.gov: NCT 03,064,750.

Keywords: Fecal incontinence; Muscle training; Pelvic floor; Pelvic organ prolapse; Randomized clinical trial; Urinary incontinence.

Conflict of interest statement

None.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of study population. ¶Declined participation (n = 36), missed for recruitment (n = 4), did not meet eligibility criteria (n = 32). *Three women postponed surgery (one because of other medical conditions and two because of symptomatic improvement). Three women declined further participation. §Two women postponed surgery because of improvement of symptoms
Fig. 2
Fig. 2
Figure comparing symptoms and related quality of life in the intervention group (solid line) and the control group (dashed line) from baseline to the day of surgery and the postoperative follow-up, using linear mixed models analysis. Examination time (baseline, day of surgery and postoperative follow-up) on the x-axis and mean score with 95% confidence interval on the y-axis of the a urinary distress inventory (UDI-6), b colorectal-anal distress inventory (CRADI-8), c urinary impact questionnaire (UIQ) and d colorectal-anal impact questionnaire (CRAIQ)

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