Effects of pelvic floor muscle training combined with neuromuscular electrical stimulation in treatment of pelvic organ prolapse

Abstract

Objective To investigate the clinical effect of pelvic floor muscle training (PFMT) combined with neuromuscular electrical stimulation (NMES) on patients with pelvic organ prolapse (POP). Methods A total of 150 patients with POP who were treated in Xuzhou Central Hospital from June 2015 to April 2018, were chosen as research subjects. They were divided into observation group (n=80) and control group (n=70) according to random digits table method. Patients in observation group were treated with PFMT combined with NMES, while patients in control group were only treated with PFMT. Quality of sexual life was evaluated by Pelvic Organ Prolapse /Urinary Incontinence Sexual Questionnaire Short Form (PISQ)-12. Quality of life (QoL) of patients was evaluated by Mos 36-Item Short form Health Survey. The pelvic floor muscle strength of patients was evaluated by neuromuscular stimulation therapy apparatus. The anxiety and depression of patients were evaluated by Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). The degree of POP of patients was evaluated by abdominal ultrasonography. The related indexes above mentioned before treatment and until one year of treatment of POP patients were compared intra-group or inter-group by t test or chi-square test. The study was carried out with the approval of Ethics Committee of Xuzhou Central Hospital (Approval No. 20150056). All patients had informed consent to the study. Results ① Comparison of quality of sexual life: PISQ-12 score of POP patients who had sexual life after treatment in observation group until one year of treatment was (24.5±8.0) scores, which was higher than that of (19.7±8.2) sores before treatment in observation group who had sexual life after treatment, also higher than that of (20.6±7.1) sores of POP patients in control group until one year of treatment, and the difference was statistically significant (t=8.326, P=0.037; t=7.422, P=0.042). ② Comparison of QoL: the score of physiological function (PF), role physiological (RP), bodily pain (BP), general health (GH), physical component summary (PCS), vitality (VT), social functioning (SF), role emotional (RE), mental health (MH) and mental component summary (MCS) of POP patients in observation group until one year of treatment were (88.0±13.4) scores, (91.9±22.6) scores, (98.4±22.6) scores, (88.1±9.5) scores, (90.8±21.7) scores, (92.1±19.6) scores, (91.6±18.5) scores, (92.1±21.6) scores, (91.2±27.4) scores and (91.9±14.5) scores, which were higher than those of (71.6±8.5) scores, (76.9±9.5) scores, (73.8±12.1) scores, (69.4±8.6) scores, (79.1±10.3) scores, (76.8±10.4) scores, (75.5±11.7) scores, (78.6±9.5) scores, (75.2±11.6) scores and (80.1±7.3) scores in control group until one year of treatment, and the differences were statistically significant (t=8.805, 9.537, 8.643, 10.335, 8.036, 8.605, 9.060, 8.254, 8.814, 8.541, all P<0.001). ③ Comparison of pelvic floor muscle strength: the proportion of grades of pelvic floor muscle strength of Ⅲ+ Ⅳ+ Ⅴ of POP patients in observation group until one year of treatment was 90.0%, which was higher than that of 44.3% in control group until one year of treatment, and the difference was statistically significant (χ2=12.652, P=0.011). ④ Comparison of anxiety and depression conditions: the score of HAMA and HAMD of POP patients in observation group until one year of treatment were (7.4±2.1) scores, (8.1±3.1) scores, which were lower than those of (10.3±2.3) scores, (10.1±3.1) scores in control group until one year of treatment, and the differences were statistically significant (t=5.170, P=0.041; t=5.352, P=0.039). ⑤ Comparison of degree of POP: the distance from bladder neck to baseline and from cervix to baseline of POP patients in observation group until one year of treatment were (0.71±0.62) cm, (1.5±0.8) cm, which were longer than those of (0.14±0.74) cm, (1.1±0.6) cm in control group until one year of treatment; the hiatus area of levator ani muscle of POP patients in observation group was (18.2±2.8) cm2, which was less than that of (22.5±4.9) cm2 in control group, and all the differences above were statistically significant (t=3.275, P=0.039; t=3.073, P=0.046; t=3.770, P=0.043). Conclusions PFMT combined with NMES for treatment of POP can improve the quality of sexual life, QoL and pelvic floor muscle strength of patients, also reduce the severity degree of POP, and relieve anxiety and depression. Key words: Pelvic organ prolapse; Electric stimulation; Pelvic floor, muscle tissue; Pelvic floor muscle training; Quality of life; Anxiety; Depression; Comparative effectiveness research; Female