Conservative treatment of pelvic organ prolapses in primiparous and/or multiparous women: A systematic review of randomized controlled trials
DOI:
https://doi.org/10.47197/retos.v66.113839Keywords:
Exercise therapy; health; physical therapy modalities; sexual function.Abstract
Introduction: This systematic review was conducted in response to the high incidence of pelvic organ prolapse among primiparous and multiparous women. The review evaluated the effectiveness of conservative treatments for prolapse in postpartum women, focusing on pelvic floor muscle training and complementary therapies such as electrical and vibratory stimulation.
Objective: Compare the efficacy of conservative treatments for any type of POP in primiparous and/or multiparous women.
Methods: Following PRISMA guidelines and registered with PROSPERO, a comprehensive search was carried out in seven databases (including PubMed, PEDro, Cochrane Library, and ClinicalTrials.gov) using terms related to prolapse, therapeutics, and women’s health. Randomized controlled trials published from 2013 onwards were selected. Two independent reviewers assessed Methodological quality using the PEDro scale and the RoB 2 tool.
Results: Five studies (n = 1305 women) were included. The methodological quality was good (mean PEDro score of seven). The trials demonstrated significant short-term improvements in pelvic floor muscle strength with pelvic floor muscle training, alone or combined with electrical or vibratory stimulation. Only one study specifically addressed pain and sexual function, reporting reduced pain and enhanced sexual function with vibratory devices. Effects on prolapse severity and quality of life were variable and inconclusive.
Conclusion: Conservative treatments, particularly pelvic floor muscle training alone or in combination, offer short-term benefits in muscle strength and symptom relief, though further research is needed on long-term outcomes and quality of life.
References
Amaro, J. L., Gameiro, M. O., Kawano, P. R., & Padovani, C. R. (2006). Intravaginal electrical stimulation: A randomized, double-blind study on the treatment of mixed urinary incontinence. Acta Obstetricia et Gynecologica Scandinavica, 85(5), 619-622. https://doi.org/10.1080/00016340500495058
Antônio, F. I., Bø, K., Pena, C. C., Bueno, S. M., Mateus-Vasconcelos, E. C. L., Fernandes, A. C. N. L., & Ferreira, C. H. J. (2022). Intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor mus-cles: A randomised trial. Journal of Physiotherapy, 68(1), 37-42. https://doi.org/10.1016/j.jphys.2021.12.004
Artymuk, N. V., & Khapacheva, S. Y. (2022). Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery. The Journal of Ma-ternal-Fetal & Neonatal Medicine, 35(3), 481-485. https://doi.org/10.1080/14767058.2020.1723541
Billups, K. L., Berman, L., Berman, J., Metz, M. E., Glennon, M. E., & Goldstein, I. (2001). A new non-pharmacological vacuum therapy for female sexual dysfunction. Journal of Sex & Marital Ther-apy, 27(5), 435-441. https://doi.org/10.1080/713846826
Bø, K. (2012). Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World Journal of Urology, 30, 437-443. https://doi.org/10.1007/s00345-011-0779-8
Bø, K., Hilde, G., Stær-Jensen, J., Siafarikas, F., Tennfjord, M. K., & Engh, M. E. (2015). Postpartum pelvic floor muscle training and pelvic organ prolapse-A randomized trial of primiparous women. American Journal of Obstetrics and Gynecology, 212(1), 38-e1. https://doi.org/10.1016/j.ajog.2014.06.049
Bugge, C., Adams, E. J., Gopinath, D., Stewart, F., Dembinsky, M., Sobiesuo, P., & Kearney, R. (2020). Pes-saries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 11. https://doi.org/10.1002/14651858.CD004010.pub4
Collins, S., & Lewicky-Gaupp, C. (2022). Pelvic organ prolapse. Gastroenterology Clinics, 51(1), 177-193. https://doi.org/10.1016/j.gtc.2021.10.011
Davenport, M. H., McCurdy, A. P., Mottola, M. F., Skow, R. J., Meah, V. L., Poitras, V. J., Garcia, A. J., Gray, C. E., Barrowman, N., & Riske, L. (2018). Impact of prenatal exercise on both prenatal and postna-tal anxiety and depressive symptoms: A systematic review and meta-analysis. British Journal of Sports Medicine, 52(21), 1376-1385. https://doi.org/10.1136/bjsports-2018-099697
de Tayrac, R., & Sentilhes, L. (2013). Complications of pelvic organ prolapse surgery and methods of prevention. International Urogynecology Journal, 24, 1859-1872. https://doi.org/10.1007/s00192-013-2177-9
Deffieux, X., Thubert, T., Demoulin, G., Rivain, A.-L., Faivre, E., & Trichot, C. (2016). Incontinencia urina-ria de la mujer. EMC-Ginecología-Obstetricia, 52(1), 1-16. https://doi.org/10.1016/S1283-081X(15)76283-1
Dumoulin, C., Hunter, K. F., Moore, K., Bradley, C. S., Burgio, K. L., Hagen, S., Imamura, M., Thakar, R., Wi-lliams, K., & Chambers, T. (2016). Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on In-continence. Neurourology and Urodynamics, 35(1), 15-20. https://doi.org/10.1002/nau.22677
Espitia, F. (2018). Evaluación de la calidad de vida en mujeres climatéricas con prolapso genital luego del uso del pesario. Rev. Colomb. Menopaus, 7-18.
Fatton, B., de Tayrac, R., Letouzey, V., & Huberlant, S. (2020). Pelvic organ prolapse and sexual function. Nature Reviews Urology, 17(7), 373-390. https://doi.org/10.1038/s41585-020-0334-8
Ferreira, C., Dwyer, P., Davidson, M., De Souza, A., Ugarte, J., & Frawley, H. (2015). The effect of pelvic floor muscle training on female sexual function: A systematic review. Physiotherapy, 101, e380-e381. https://doi.org/10.1016/j.physio.2015.03.600
Glazener, C. M., MacArthur, C., Hagen, S., Elders, A., Lancashire, R., Herbison, G., Wilson, P., & ProLong Study Group. (2014). Twelve‐year follow‐up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: Randomised controlled trial. BJOG: An Interna-tional Journal of Obstetrics & Gynaecology, 121(1), 112-120. https://doi.org/10.1111/1471-0528.12473
Hadizadeh-Talasaz, Z., Sadeghi, R., & Khadivzadeh, T. (2019). Effect of pelvic floor muscle training on postpartum sexual function and quality of life: A systematic review and meta-analysis of clini-cal trials. Taiwanese Journal of Obstetrics and Gynecology, 58(6), 737-747. https://doi.org/10.1016/j.tjog.2019.09.003
Hage‐Fransen, M. A., Wiezer, M., Otto, A., Wieffer‐Platvoet, M. S., Slotman, M. H., Nijhuis‐van der Sanden, M. W., & Pool‐Goudzwaard, A. L. (2021). Pregnancy‐and obstetric‐related risk factors for uri-nary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis. Acta Obstetricia et Gynecologica Scandinavica, 100(3), 373-382. https://doi.org/10.1111/aogs.14027
Hagen, S., & Stark, D. (2011). Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 12. https://doi.org/10.1002/14651858.CD003882.pub4
Hagen, S., Stark, D., Glazener, C., Sinclair, L., y Ramsay, I. (2009). A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. International Urogynecology Journal, 20, 45-51. https://doi.org/10.1007/s00192-008-0726-4
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savović, J., Schulz, K. F., Weeks, L., y Sterne, J. A. C. (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 343, d5928. https://doi.org/10.1136/bmj.d5928
Jha, S., y Toozs-Hobson, P. (2009). Prolapse and sexual function. Journal of the Association of Chartered Physiotherapists in Obstetrics and Gynaecology, 104, 20.
Jundt, K., Peschers, U., y Kentenich, H. (2015). The investigation and treatment of female pelvic floor dysfunction. Deutsches Ärzteblatt International, 112(33-34), 564. https://doi.org/10.3238/arztebl.2015.0564
Li, C., Gong, Y., y Wang, B. (2016). The efficacy of pelvic floor muscle training for pelvic organ prolapse: A systematic review and meta-analysis. International Urogynecology Journal, 27, 981-992. https://doi.org/10.1007/s00192-015-2846-y
Limbutara, W., Bunyavejchevin, S., Ruanphoo, P., y Chiengthong, K. (2023). Patient-reported goal achievements after pelvic floor muscle training versus pessary in women with pelvic organ prolapse. A randomised controlled trial. Journal of Obstetrics and Gynaecology, 43(1), 2181061. https://doi.org/10.1080/01443615.2023.2181061
Lowenstein, L., Gruenwald, I., Gartman, I., y Vardi, Y. (2010). Can stronger pelvic muscle floor improve sexual function? International Urogynecology Journal, 21, 553-556. https://doi.org/10.1007/s00192-009-1077-5
Luchristt, D., Zemtsov, G., y Jelovsek, J. E. (2022). Changes in performance of apical suspension at the time of surgery for prolapse: Assessment of the influence of the American Urogynecologic Soci-ety and American College of Obstetricians and Gynecologists practice bulletin. Urogynecology, 28(6), 367-371. https://doi.org/10.1097/SPV.0000000000001136
Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., y Elkins, M. (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy, 83(8), 713-721. https://doi.org/10.1093/ptj/83.8.713
Mazur-Bialy, A. I., Kołomańska-Bogucka, D., Nowakowski, C., y Tim, S. (2020). Urinary incontinence in women: Modern methods of physiotherapy as a support for surgical treatment or independent therapy. Journal of Clinical Medicine, 9(4), 1211. https://doi.org/10.3390/jcm9041211
Munno, G. M., La Verde, M., Lettieri, D., Nicoletti, R., Nunziata, M., Fasulo, D. D., Vastarella, M. G., Pennac-chio, M., Scalzone, G., y Pieretti, G. (2023). Pelvic organ prolapse syndrome and lower urinary tract symptom update: What's new? 11(10), 1513. https://doi.org/10.3390/healthcare11101513
Obsa, M. S., Worji, T. A., Kedir, N. A., y Kute, N. G. (2022). Risk factors of pelvic organ prolapse at Asella Teaching and Referral Hospital: Unmatched case control study. Frontiers in Global Women's Health, 3, 833823. https://doi.org/10.3389/fgwh.2022.833823
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetz-laff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., y Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Panman, C. M., Wiegersma, M., Kollen, B. J., Berger, M. Y., Lisman-van Leeuwen, Y., Vermeulen, K. M., y Dekker, J. H. (2016). Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care. Menopause, 23(12), 1307-1318. https://doi.org/10.1097/GME.0000000000000706
Peinado Molina, R. A., Hernández Martínez, A., Martínez Vázquez, S., y Martínez Galiano, J. M. (2023). Influence of pelvic floor disorders on quality of life in women. Frontiers in Public Health, 11, 1180907. https://doi.org/10.3389/fpubh.2023.1180907
Pizzoferrato, A.-C., Thuillier, C., Vénara, A., Bornsztein, N., Bouquet, S., Cayrac, M., Cornillet-Bernard, M., Cotelle, O., Cour, F., y Cretinon, S. (2023). Management of female pelvic organ prolapse-Summary of the 2021 HAS guidelines. Journal of Gynecology Obstetrics and Human Reproduc-tion, 52(3), 102535. https://doi.org/10.1016/j.jogoh.2023.102535
Quero Córdoba, M. G. de. (2022). Influencia de los pesarios en la micción de las mujeres con prolapso de órganos pélvicos. https://doi.org/10.1016/j.rmclc.2022.03.020
Radzimińska, A., Strączyńska, A., Weber-Rajek, M., Styczyńska, H., Strojek, K., y Piekorz, Z. (2018). The impact of pelvic floor muscle training on the quality of life of women with urinary inconti-nence: A systematic literature review. Clinical Interventions in Aging, 957-965. https://doi.org/10.2147/CIA.S160057
Raju, R., y Linder, B. J. (2021). Evaluation and management of pelvic organ prolapse. 96(12), 3122-3129. https://doi.org/10.1016/j.mayocp.2021.09.005
Sánchez-Sánchez, B., Yuste-Sánchez, M. J., Arranz-Martín, B., Navarro-Brazález, B., Romay-Barrero, H., y Torres-Lacomba, M. (2020). Quality of life in POP: Validity, reliability and responsiveness of the Prolapse Quality of Life Questionnaire (P-QoL) in Spanish women. International Journal of En-vironmental Research and Public Health, 17(5), 1690. https://doi.org/10.3390/ijerph17051690
Santamaría, F. C. (2008). Evaluación y tratamiento de la anorgasmia femenina. Revista Internacional de Andrología, 6(2), 115-120. https://doi.org/10.1016/S1698-031X(08)75679-6
Santos, P. C., Bernardo, D., Abdalla, P. P., Leirós-Rodríguez, R., da Silva, L. S. L., Mesquita, C., Mota, J., y Machado, D. (2024). Influence of Physical Activity on Self-Esteem and Anxiety during Pregnan-cy: A Longitudinal Prospective Study. Women, 4(4), 340-350. https://doi.org/10.3390/women4040026
Schulten, S. F., Claas-Quax, M. J., Weemhoff, M., van Eijndhoven, H. W., van Leijsen, S. A., Vergeldt, T. F., IntHout, J., y Kluivers, K. B. (2022). Risk factors for primary pelvic organ prolapse and prolapse recurrence: An updated systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 227(2), 192-208. https://doi.org/10.1016/j.ajog.2022.04.046
The American College of Obstetricians and Gynecologists and the American Urogynecologic Socie-ty INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the re-pair of pelvic organ prolapse. Pelvic Organ Prolapse. Female Pelvic Medicine & Reconstructive Surgery 25(6):p 397-408, 11/12 2019. https://doi.org/10.1097/SPV.0000000000000794
Tso, C., Lee, W., Austin-Ketch, T., Winkler, H., y Zitkus, B. (2018). Nonsurgical treatment options for women with pelvic organ prolapse. Nursing for Women's Health, 22(3), 228-239. https://doi.org/10.1016/j.nwh.2018.03.007
Weintraub, A. Y., Glinter, H., y Marcus-Braun, N. (2019). Narrative review of the epidemiology, diagno-sis y pathophysiology of pelvic organ prolapse. International Braz J Urol, 46, 5-14. https://doi.org/10.1590/s1677-5538.ibju.2018.0581
Wu, J. M., Vaughan, C. P., Goode, P. S., Redden, D. T., Burgio, K. L., Richter, H. E., y Markland, A. D. (2014). Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstetrics & Gyne-cology, 123(1), 141-148. https://doi.org/10.1097/AOG.0000000000000057
Yang, S., Sang, W., Feng, J., Zhao, H., Li, X., Li, P., Fan, H., Tang, Z., y Gao, L. (2017). The effect of rehabilita-tion exercises combined with direct vagina low voltage low frequency electric stimulation on pelvic nerve electrophysiology and tissue function in primiparous women: A randomised con-trolled trial. Journal of Clinical Nursing, 26(23-24), 4537-4547. https://doi.org/10.1111/jocn.13790
Yin, P., y Wang, H. (2022). Evaluation of nursing effect of pelvic floor rehabilitation training on pelvic organ prolapse in postpartum pregnant women under ultrasound imaging with artificial intelli-gence algorithm. Computational and Mathematical Methods in Medicine, 2022(1), 1786994. https://doi.org/10.1155/2022/1786994
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