The comparative effectiveness of pelvic floor muscle training and hypopressive breathing techniques for pelvic organ prolapse: A systematic review and pooled analysis of randomized controlled trials - 27/11/24

Doi : 10.1016/j.amjsurg.2024.116111

Jessica R. Mitchell ^a,^b,^⁎ , Hanna E. Brancaccio ^a,^b , Morgan Blusewicz Spt ^c , David F. Lo ^a,^b,^d,^e , Brandon Goodwin ^b,^f , Danielle Carey ^a
^a Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
^b Futures Forward Research Institute, Toms River, NJ, USA
^c Marist University, College of Physical Therapy, Poughkeepsie, NY, USA
^d American Preventive Screening & Education Association (APSEA), Stratford, NJ, USA
^e Department of Biology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
^f Ocean University Medical Center, Hackensack Meridian Health, Brick Township, NJ, USA

^⁎Corresponding author. Department of Medicine, Rowan School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, 08084, USA.Department of MedicineRowan School of Osteopathic Medicine1 Medical Center DrStratfordNJ08084USA

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Abstract

Background

Pelvic floor (PF) disorder affects 25 % of females, often progressing to Pelvic Organ Prolapse (POP). PF muscle training (PFMT) and hypopressive breathing (HB) are conservative techniques used to repair pelvic muscles. This study analyzes the comparative efficacy of PFMT and HB for POP.

Methods

A systematic review was conducted and seven records were included in the pooled analysis, which compared PF outcomes between HB and PFMT.

Results

PFMT (d = 2.14 and d = 1.07) demonstrated a larger effect size compared to HB (d = 1.24 and d = 0.78) for sEMG contractility and the Modified Oxford Scale, respectively. The Pelvic Floor Disability Index (PFDI-20) found a lower effect size of PFMT (d = 0.558) compared to HB (d = 0.961).

Conclusions

PFMT was found to improve PF strength (Oxford) more than HB, while HB had a greater effect on quality of life (PFDI-20). Results were insignificant for contractility.

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Highlights

•	Causes of Pelvic Organ Prolapse is multifactorial, commonly in multiparous women.
•	Pelvic Floor Muscle Training and Hypopressive Breathing strengthen the pelvic floor.
•	Pelvic Floor Muscle Training most improves pelvic floor strength.
•	Hypopressive Breathing most improves quality of life outcomes.
•	These rehabilitative methods may adjunct or replace pelvic floor surgery.