|Physiotherapy and Pelvic Floor Muscle Exercises in Prevention and Treatment of Pregnancy Related Pelvic Floor Disorders: A Systematic Review and Meta-analysis|
|Fahime Khorasani1, Fariba Ghaderi1, Parvin Bastani3, Parvin Sarbakhsh1, Parisa Ahadi1, Elahe Khorasani1, Fereshteh Ansari2, Nafiseh Vahed2|
|1Department of Physiotherapy, Tabriz University of Medical Sciences, Tabriz, Iran
2Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
3Woman’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Keywords : Physiotherapy, Pelvic floor muscle exercise, Urinary incontinence, Pelvic organ prolapse, Fecal incontinence
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Objectives:The present systematic review includes three main pelvic floor dysfunctions (PFDs) including urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) prevention or treatment by physiotherapy and pelvic floor muscle exercises (PFMEs). There is little evidence that is based on the best management, despite the breadth of the problem. The aim of this review was to evaluate the effects of physiotherapy and PFMEs in prevention and treatment of pregnancy related pelvic floor disorders including FI, UI and POP. This review included the studies that compare the physiotherapy and PFMEs to any other treatments.
Materials and Methods: This systematic review and meta-analysis was conducted of randomized and quasi-randomized controlled trials. The databases to be searched include PubMed (Medline), The Cochrane Library, Scopus, Embase, Proquest and Web of Science published without limitation of time and the search was done to December 2017. Meta-analysis was used to data synthesis. Cochran's Q test and I2 index was used to assess heterogeneity.
Results: Finally 26 randomized controlled trials were included in this review. Outcome variables were related to prevalence of UI, FI and POP, severity of UI, FI and POP, PFM strength and endurance. In most articles, the severity or prevalence of UI in the intervention group was significantly improved compared to the control group. The number of studies that examined FI and POP was relatively low. In two of the studies, the severity or prevalence of FI in the intervention group was significantly improved than the control group, and in two of the studies, the prevalence of FI in the intervention group was lower than that of the control group, but there was no significant difference and in two other of the studies, no significant improvement was observed in the intervention group. Three studies did not report an improvement in the POP and a significant difference between the groups and two studies observed a significant improvement in the POP between the groups. According to the results of meta-analysis on the pelvic floor muscle strength variable, Cochran's Q test (p <.001) and I2 index (90.02) indicated heterogeneity between studies, so, random effects meta-analysis was used to estimate the overall effect size. The overall mean differences between the intervention and control groups after the intervention was 6.94, CI 95% (1.36 to 12.52).
Conclusion: Physiotherapy and pelvic floor muscle exercises seem to be effective on the pregnancy-related UI but it do not consistently reduce the severity or prevalence of FI and do not consistently improve the POP.
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