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15.3: Physiotherapy

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  • Pelvic muscle training (Kegel exercises) is a simple, noninvasive intervention that may improve pelvic function. Whether Kegel exercises can resolve prolapse has not been adequately studied in good randomized controlled trials since Kegel’s original articles. While systematic reviews and randomized controlled trials (RCT) have shown a convincing effect of pelvic floor muscle training for stress and mixed urinary incontinence, there seems to be a paucity of data for other conditions associated with pelvic floor dysfunction. It is commonly recommended as adjunct therapy for women with prolapse, often with symptom directed therapy. The POPPY Trial, a multi-centre randomized controlled trial of a pelvic floor muscle training for women with pelvic organ prolapse, which is currently being conducted in Australia, may address this issue.


    Harvey et al in a systematic review on the role of pelvic floor exercises in preventing pelvic floor prolapse, failed to validate its use as a preventative measure. PiyaAnant et al performed a cross sectional study in 682 women and an intervention study of 654 of the same cohort . Seventy percent of the subjects in the cross sectional study had POP. Thirty percent were classified as severe and 40% as mild prolapse. The women were randomly allocated to an intervention or a control group. Women in the intervention group were taught to contract the pelvic floor muscles 30 times after a meal every day. Women not able to contract were asked to return to the clinic once a month until they could perform corrected contractions. They were also advised to eat more vegetables and fruit and to drink at least two liters of water per day to prevent constipation. They were followedup every six months throughout the 2-year intervention period. The results indicated that the intervention was only effective in the group with severe prolapse. The rate of worsening of POP was 72.2 and 27.8% in the control group and in the pelvic floor muscle training group, respectively.

    The two main hypotheses on the mechanism of action of PFMT include morphological changes occurring after strength training and the use of a conscious contraction during an increase in abdominal pressure in daily activities. There is an urgent need for good quality RCT’s, preferably using the POP-Q system and using standardized exercise programmes.

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