The lifetime risk for a woman to undergo surgery for either vaginal prolapse or urinary incontinence is high. There are many different surgical techniques for treatment of prolapse, but there is a lack of knowledge about factors that contribute to objective result and patient satisfaction after surgery. The aim of the study is to investigate factors that could be related to patient satisfaction and objective result such as pelvic floor muscle contractility/strength and muscle injury, objective measures of prolapse and women's symptoms. This study will investigate whether systematic pelvic floor exercise and life style advise before surgery can improve outcomes after surgery for either vaginal prolapse. Another aim is to determine an ultrasound scale for measure of pelvic floor muscle contraction.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
151
In preparation for surgery, patients receive individual information by a physiotherapist on pelvic floor anatomy and correct pelvic floor contraction. Patients are told to do the following pelvic floor exercises 3 times a day: 8-12 maximal contractions, hold contractions during 10 seconds, and 3 fast contractions after each long contraction. In addition exercise in groups with skilled physical therapists once a week during 12 weeks.
patients wait as usual until surgery without special treatment.
St Olavs Hospital
Trondheim, Norway
Pelvic floor muscle strength assessed by palpation
Muscle strength is evaluated using 6 point modified Oxford Scale (MOS) range 0-5.
Time frame: 9 months
Pelvic floor muscle strength assessed by ultrasound
Changes in pelvic floor muscle at rest and during pelvic floor contraction, measured in mm and calculated proportional change
Time frame: 9 months
Symptoms of pelvic floor disorders
Symptoms of pelvic floor disorders assessed by validated questionnaire (PDFI-20)
Time frame: 9 months
Pelvic floor muscle strength assessed by perineometry
measuring the pressure with vaginal manometry in cm H2O during pelvic floor contraction
Time frame: 9 months
Pelvic floor muscle strength assessed by electromyography
Assessed by vaginal surface electrode during pelvic floor contraction, measured in mV
Time frame: 9 months
Proportion of anatomical pelvic organ prolapse
Assessment with the Pelvic Organ Prolapse Quantification (POP-Q) System
Time frame: 9 months
Proportion of anatomical sphincter ani defect
Anatomical sphincter ani defect assessed by transperineal ultrasound
Time frame: 9 months
Proportion of levator ani muscle trauma
Assessed by transperineal ultrasound on contraction and Valsalva
Time frame: 9 months
Assessment of pelvic organ mobility as a measure of pelvic organ function/dysfunction
Movement of the pelvic organs during Valsalva and contraction
Time frame: 9 months
Imaging of synthetic implants assessed by ultrasound
Registration of implants after pelvic floor surgery and their relations to anatomical structures in mm.
Time frame: 9 months
Symptoms of pelvic floor disorders
Symptoms of pelvic floor disorders assessed by validated questionnaire (PFIQ-7)
Time frame: 9 months
Symptoms of pelvic floor disorders
Symptoms of pelvic floor disorders assessed by visual analogue scale (VAS 1-10)
Time frame: 9 months
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