Abstract
Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at follow-up assessments at 3, 6 and 12 months later. The study was a prospective, single-centre, assessor-blinded, randomised controlled trial. Ninety-four women with PFD were assigned to PFMT (n = 32), hypopressive exercises (n = 31) or both (n = 31). All programs included the same educational component, and instruction about lifestyle interventions and the knack manoeuvre. Primary outcomes were the Pelvic Floor Distress Inventory Short Form (PFDI-20); the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7); PFM strength (manometry and dynamometry) and pelvic floor basal tone (dynamometry). There were no statistically significant differences between groups at baseline, nor after the intervention. Overall, women reduced their symptoms (24.41–30.5 on the PFDI-20); improved their quality of life (14.78–21.49 on the PFIQ-7), improved their PFM strength (8.61–9.32 cmH2O on manometry; 106.2–247.7 g on dynamometry), and increased their pelvic floor basal tone (1.8–22.9 g on dynamometry). These data suggest that individual PFMT, hypopressive exercises and a combination of both interventions significantly reduce PFD symptoms, enhance quality of life, and improve PFM strength and basal tone in women with PFD, both in the short and longer term.
Highlights
Pelvic floor dysfunction (PFD) is associated with urinary incontinence (UI), pelvic organ prolapse (POP), anal incontinence (AI), and sexual dysfunction [1]
Some reduction in the performance of the knack was observed at A4 (68.8%, 83.9%, and 80.6% in pelvic floor muscle training (PFMT)-G, hypopressive exercises (HEs)-G and PFMT+Hypopressive Exercise Group (HE-G) respectively), again with no significant differences between groups. This is the first study to test the efficacy of HEs alone, or in combination with PFMT, against PFMT in order to determine the efficacy of these exercises, in relation to the gold standard for conservative intervention
The findings from this study suggest that, when delivered in conjunction with education and advice to perform the knack manoeuvre, a physiotherapy treatment focused on PFMT, HEs or a combination of PFMT+HEs all reduce PFD symptoms, improve condition specific quality of life, and achieve an enhancement in pelvic floor muscle (PFM) function
Summary
Pelvic floor dysfunction (PFD) is associated with urinary incontinence (UI), pelvic organ prolapse (POP), anal incontinence (AI), and sexual dysfunction [1]. Many physical therapists integrate other training approaches in the management of women with PFD, including abdominal muscle training and postural education, in the belief that such training will mitigate repetitive and/or chronic loading on the pelvic floor [9]. In this context, hypopressive exercises (HEs) have emerged as a treatment option for PFD; currently HEs are widely prescribed for women with PFD in hospitals and in private practice settings in France, Belgium, Spain and Latin American countries [10,11,12,13,14]. The theoretical aim of HEs is to lower intra-abdominal pressure, while concurrently increasing the basal tone of the pelvic floor muscles (PFMs) and deep abdominal muscles without voluntary activation [15]
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