The Effect of Pelvic Floor Exercises
In her doctoral research Ingeborg Hoff Brækken has shown that controlled pelvic floor exercises in women can reduce the level of prolapse, reduce symptoms and encourage change in the pelvic floor.
Karen Christensen | 04.03.2010 
Background and aim of the thesis
The overall high prevalence of pelvic organ prolapse (POP) and related problems indicates a need for identification of risk factors, prevention and treatment strategies.
Today there is a lack of evidence for the effect of PFMT in reducing and preventing POP, and there is scant knowledge of possible changes in morphology and function of the pelvic floor muscles (PFM) following PFM training. Use of responsive, reliable and valid outcome measures is mandatory for evaluation of the proposed effects.
Illustration of pelvic floor exercise
Ultrasound
To evaluate test- retest and intra-observer repeatability of 2D, 3D and 4D perineal ultrasound assessments of PFM morphology and function, 17 participants were examined twice. Results showed that perineal ultrasound was a reliable method for measuring most of the tested parameters of morphology and may be used in clinical trials evaluating changes in anatomical parameters after PFMT.
Risk factors for POP
49 women with POP and 49 controls participated in the study. Univariate analyses showed no significant differences between groups in postmenopausal status, current smoking, current low intensity exercise, type of birth (cesarean, forceps, vacuum), birth weight, and presence of striae, diastasis recti abdominis and joint hypermobility.
Women with POP had lower PFM strength, PFM endurance and vaginal resting pressure than controls. Body mass index (BMI), socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP. BMI and PFM function may be of particular clinical significance in prevention of POP, since these factors can be altered by the women themselves.
PFM training in prevention and treatment of POP
109 women with POP were randomly allocated to training group (n=59) and control (n=50). Both the training and control group received written information about POP and were advised to contract their PFM prior and during increases in abdominal pressure (coughing, sneezing, heavy lifting) and they were advised not to bear down (e.g. during defecation).
Women in the training group were advised to do 3 sets of 8-12 close to maximum PFM contractions per day for six months. In addition they were individually supervised by a physical therapist.
Results: 19% of the women in the training group versus 8% of controls improved one stage of prolapse. Women in the training group reduced the frequency and bother of POP, bladder and bowel symptoms, improved PFM strength and endurance, increased muscle thickness, elevated position of bladder and bowel, decreased hiatus area and shortened muscle length compared to controls.
Conclusion: The randomised controlled trial demonstrated that supervised strength training of the PFM can reverse POP, reduce symptoms and create morphological and functional changes of the pelvic floor.
 |
Ingeborg Hoff Brækken (15.10.1971) is born in Akershus, Norway. She obtained her basic course, bachelor in “sports biology and movement science” and master degree in “physical activity and health” from NSSS. She was educated physiotherapist and manual therapist at the College of physical therapy in Oslo and university of Bergen, respectively. Ingeborg started her PhD in 2005, and has been supervised by Professor Kari Bø. |
Interview with Research Fellow Ingeborg Hoff Brækken from The Norwegian School of Sports Sciences on Vimeo. The interview is in Norwegian.
Ingeborg Hoff Brækken’s examination lecture in conncetion with the presentation of her thesis: “An account of incontinence, ethology, symptoms and methods of treatment.” The lecture is in Norwegian.