EFFECTIVENESS OF DIFFERENT MODALITIES OF HYPOPRESSIVE EXERCISES IN WOMEN WITH PELVIC FLOOR DYSFUNCTIONS. RANDOMISED SINGLE-BLIND, CONTROLLED TRIAL

M. Torres-Lacomba¹, B. Arranz-Martín², D. Prieto-Merino³, C. Carazo⁴, B. Sánchez-Sánchez¹, B. Navarro-Brazález¹

¹University of Alcalá, FPSM Research Group. Physiotherapy, Alcalá de Henares, Spain, ²Unviersity of Alcalá, FPSM Research Group, Alcalá de Henares, Spain, ³University of Alcalá, Statistics, Alcalá de Henares, Spain, ⁴UCAM, Statistics, Murcia, Spain

Background: Female pelvic floor disorders (PFD) include urinary incontinence (UI), anal incontinence, pelvic organ prolapses (POP), lower urinary tract emptying and perception disturbances, defecatory dysfunctions, sexual disorders, and a variety of chronic pain syndromes of the perineal area. These conditions are chronic and are associated with lower quality of life. Physiotherapy based on pelvic floor muscle training is the first line of treatment for women with UI and early stages of POP. Hypopressive exercises (HEs) have emerged as a treatment option for PFD, and there is evidence that HEs produce the neuromuscular activation of pelvic floor muscles (PFM) and abdominal muscles, leading to a beneficial effect on symptoms in women with PFD. HEs are described in certain postures, and have in common the hypopressive maneuver, which consists of opening the ribs and raising the abdomen during an expiratory apnea, thus hypothesizing the involuntary activation of the pelvic floor muscles. However, there are no studies that justify the condition of not actively contracting the pelvic floor muscles during HEs, nor is it known whether performing the postures described for these exercises determines the effectiveness of the technique.

Purpose: To compare the effectiveness of different HEs modalities and the use of ultrasoundbiofeedback in women with PFD on quality of life (QoL); strength and basal tone of the pelvic floor muscles.

Methods: Single-blind, randomised controlled trial. 80 women with stress UI, and/or mild POP and/or anal incontinence, with Oxford ≥ 3 were randomly allocated to four groups: (i) to a reference group, based on hypopressive maneuver consisting of raising the abdomen during expiratory apnea, without performing the postures proposed by Caufriez, and using transabdominal ultrasound control; (ii) to a second experimental group based on HEs described by Caufriez; (iii) to a third experimental group adding the voluntary contraction of the PFM to the Caufriez HEs; and (iv) to a fourth experimental group performing the hypopressive maneuver adding the voluntary contraction of the PFM under transabdominal ultrasound control. Primary outcome measures were PFDI-20 and PFIQ-7. Assessments were made pre-intervention, post-intervention, and 3- and 6-months post-intervention.

Results: There was a significant change (p<0.001) of all the outcomes (except basal tone) of the reference group (No posture No SP) between the baseline visit and all of the other visits (ES: -44.11 95%CI: -54.12 to -34.10on the PFDI-20;and ES: -53.40 95%CI:-64.88 to -41.92on the PFIQ-7). However adding the posture or SP did not produce a significant increase or decrease of those changes in any outcome or any visit.

Conclusions: Hypopressive maneuver, with or without postures and with or without associated PFM contraction, improve QoL and associated symptoms in women with PFD.

Implications: Hypopressive maneuver improves symptoms and QoL in women with PFDs who know to contract PFM. Even if an active PFM contraction and/or hypopressive postures are added, they do not further improve its effectiveness.

Funding acknowledgements: The authors thank the Professional College of Physiotherapists of the Community of Madrid (CPFCM) for the award.

Keywords:
Hypopressive exercises
Pelvic floor dysfunction
Ultrasonography

Topics:
Pelvic, sexual and reproductive health

Did this work require ethics approval? Yes

Institution: Hospital "Príncipe de Asturias", Madrid, Spain

Committee: Research Ethics Committee of the "Príncipe de Asturias" University Hospital

Ethics number: PI OE23/2018