Conservative management of pelvic organ prolapse in women
Abstract
Background
Pelvic organ prolapse is common, and some degree of prolapse is seen in 50% of parous women. Women with prolapse can experience a variety of pelvic floor symptoms. Treatments include surgery, mechanical devices and conservative management. Conservative management approaches, such as giving lifestyle advice and delivering pelvic floor muscle training, are often used in cases of mild to moderate prolapse.
Objectives
To determine the effects of conservative management (physical interventions and lifestyle interventions) for women with pelvic organ prolapse in comparison with no treatment or other treatment options (such as mechanical devices or surgery).
Search methods
We searched the Cochrane Incontinence Group Specialised Trials Register (searched on 19 September 2005), MEDLINE (January 1966 to August 2005), MEDLINE In Process & Other Citations (15 September 2005), EMBASE (January 1996 to Week 43 2005), CINAHL (January 1982 to October 2005), PEDro (September 2005), the UK National Research Register (Issue 3, 2005), the US National Institute of Health clinical trial register (5 October 2005), Current Controlled Trials register (5 October 2005), Controlled Clinical Trials (September 2005) and ZETOC (September 2005). We searched the reference lists of relevant articles.
Selection criteria
Randomised and quasi‐randomised trials in women with pelvic organ prolapse that included a physical or lifestyle intervention in at least one arm of the trial.
Data collection and analysis
Two reviewers assessed all trials for inclusion/exclusion and methodological quality. Data were extracted by the lead reviewer onto a standard form and cross checked by another. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions.
Main results
Three trials of relevance to this review were identified. The largest of these, of pelvic floor muscle training in preventing anterior prolapse from worsening, had significant limitations which affect the generalisability and rigor of the findings. A small feasibility study (which is to be followed up with a larger trial) randomised 47 women to pelvic floor muscle training or control and found suggestions of better outcomes (better self‐reported improvement, decreased severity) in the intervention group. The third trial evaluated peri‐operative physiotherapy for women undergoing surgery for prolapse and/or incontinence. The authors report that urinary symptoms, pelvic floor muscle function and quality of life were improved more in the treatment group than the control group, but data were not provided to allow this to be assessed. The trial was small and no prolapse‐specific outcome measures were used. It was not possible to combine data from the three trials.
Authors' conclusions
Despite there now being reports of three eligible trials in this update, the evidence available is not significant to guide practice. There is some encouragement from a feasibility study that pelvic floor muscle training, delivered by a physiotherapist to symptomatic women in an outpatient setting, may reduce severity of prolapse. Further evidence from larger, better quality randomised control trials is however still necessary.
PICOs
Plain language summary
Conservative management of pelvic organ prolapse in women
Pelvic organs, such as the uterus, cervix, bladder or bowel, may protrude into the vagina because of weakness in the tissues that normally support them. The symptoms that they cause vary, depending on the type of prolapse. Conservative treatments, such as physiotherapy or lifestyle change, are commonly recommended for prolapse with less severe symptoms. The review found three randomised trials of conservative management from which to gauge their effects. One relatively large trial was not sufficiently well conducted or reported to provide a reliable basis for assessing an exercise programme for elderly Thai women living in the community. A feasibility study involving 47 women provided some evidence of benefit, which is sufficient to justify the large trial that is planned to follow it. The third trial claimed benefits but was reported in a way that could not be used in the analysis. The evidence considered in this review is not sufficient for judging the value of conservative management of pelvic organ prolapse. Large better quality randomised controlled trials are still needed.
