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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 STRATEGY

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.

Authors+Show Affiliations

Glasgow Caledonian University, Nursing, Midwifery & Allied Health Professions Research Unit, Glasgow, UK. s.hagen@gcal.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

17054190

Citation

Hagen, S, et al. "Conservative Management of Pelvic Organ Prolapse in Women." The Cochrane Database of Systematic Reviews, 2006, p. CD003882.
Hagen S, Stark D, Maher C, et al. Conservative management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2006.
Hagen, S., Stark, D., Maher, C., & Adams, E. (2006). Conservative management of pelvic organ prolapse in women. The Cochrane Database of Systematic Reviews, (4), CD003882.
Hagen S, et al. Conservative Management of Pelvic Organ Prolapse in Women. Cochrane Database Syst Rev. 2006 Oct 18;(4)CD003882. PubMed PMID: 17054190.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conservative management of pelvic organ prolapse in women. AU - Hagen,S, AU - Stark,D, AU - Maher,C, AU - Adams,E, Y1 - 2006/10/18/ PY - 2006/10/21/pubmed PY - 2007/1/20/medline PY - 2006/10/21/entrez SP - CD003882 EP - CD003882 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - 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 STRATEGY: 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. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/17054190/Conservative_management_of_pelvic_organ_prolapse_in_women_ L2 - https://doi.org/10.1002/14651858.CD003882.pub3 DB - PRIME DP - Unbound Medicine ER -