Does Surgery Benefit Postmenopausal Overweight Women with Pelvic Floor Dysfunction?
Affiliation(s)
Institute of Physiotherapy and Sport Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary. Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Pécs, Pécs, Hungary. MTA-PTE Human Reproduction Scientific Research Group, Pécs, Hungary. Institute of Pathophysiology and Gerontology, Faculty of Medicine, University of Pécs, Pécs, Hungary.
Institute of Physiotherapy and Sport Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary. Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Pécs, Pécs, Hungary. MTA-PTE Human Reproduction Scientific Research Group, Pécs, Hungary. Institute of Pathophysiology and Gerontology, Faculty of Medicine, University of Pécs, Pécs, Hungary.
ABSTRACT
Introduction: Pelvic floor muscle function of 30 overweight postmenopausal women prior to and after colporrhahpy was monitored in this study. Material and Methods: Patients diagnosed with cystokele or combined cystorectokele was involved. 1 mg oral estriol and local estriol cream were administered for 30 days preoperatively. Pelvic floor muscle function was monitored by surface electromyography 1 month before (1st) 1 day prior to surgery (2nd), and six weeks after the surgery (3rd measurement). Body composition parameters (intra- and extracellular water and body fat) were also measured. Results: The ability to relax significantly improved (p = 0.03) in the preoperative period (between 1st and 2nd occasions). Six weeks after surgery a non-significant (p = 0.054) decrease in average muscle activity was detected when compared with values obtained before the surgery. Muscle-activity declined significantly from the first to the last measurements (p = 0.005). Conclusion: Our results confirm that postmenopausal obese women who undergo anterior or posterior colporrhaphy need a follow-up concerning pelvic floor muscle function and suggest that physiotherapy started the earliest possible may aid in preserving postoperative functionality on the long run.
Introduction: Pelvic floor muscle function of 30 overweight postmenopausal women prior to and after colporrhahpy was monitored in this study. Material and Methods: Patients diagnosed with cystokele or combined cystorectokele was involved. 1 mg oral estriol and local estriol cream were administered for 30 days preoperatively. Pelvic floor muscle function was monitored by surface electromyography 1 month before (1st) 1 day prior to surgery (2nd), and six weeks after the surgery (3rd measurement). Body composition parameters (intra- and extracellular water and body fat) were also measured. Results: The ability to relax significantly improved (p = 0.03) in the preoperative period (between 1st and 2nd occasions). Six weeks after surgery a non-significant (p = 0.054) decrease in average muscle activity was detected when compared with values obtained before the surgery. Muscle-activity declined significantly from the first to the last measurements (p = 0.005). Conclusion: Our results confirm that postmenopausal obese women who undergo anterior or posterior colporrhaphy need a follow-up concerning pelvic floor muscle function and suggest that physiotherapy started the earliest possible may aid in preserving postoperative functionality on the long run.
Cite this paper
Hock, M. , Domány, B. , Bódis, J. and Garai, J. (2014) Does Surgery Benefit Postmenopausal Overweight Women with Pelvic Floor Dysfunction?. Open Journal of Therapy and Rehabilitation, 2, 114-119. doi: 10.4236/ojtr.2014.23016.
Hock, M. , Domány, B. , Bódis, J. and Garai, J. (2014) Does Surgery Benefit Postmenopausal Overweight Women with Pelvic Floor Dysfunction?. Open Journal of Therapy and Rehabilitation, 2, 114-119. doi: 10.4236/ojtr.2014.23016.
References
[1] Wei, J. and De Lancey, J.O.L. (2004) Functional Anatomy of the Pelvic Floor and Lower Urinary Tract. Clinical Obstetrics and Gynecology, 47, 3-17. http://dx.doi.org/10.1097/00003081-200403000-00004 [2] Brown, J., Grady, D., Ouslander, J., et al. (1999) Prevalence of Urinary Incontinence and Associated Risk Factors in Postmenopausal Women: Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. Obstetrics Gynecology, 94, 66-70.
http://dx.doi.org/10.1016/S0029-7844(99)00263-X [3] Lambert, D.M., Marceau, S. and Forse, R.A. (2005) Intraabdominal Pressure in the Morbidly Obese. Obesity Surgery, 15, 1225-1232. http://dx.doi.org/10.1381/096089205774512546 [4] Song, Y., Ye, P., Hong, X., et al. (2009) Changes in Levatorani Muscle after Vaginal Hysterectomy and Prolapse Repair Using the Total Prolift Procedure. International Journal of Gynecology and Obstetrics, 106, 53-56. http://dx.doi.org/10.1016/j.ijgo.2009.03.007 [5] Chen, L., Ashton-Miller, J.A., Hsu, Y., et al. (2006) Interaction among Apical Support, Levatorani Impairment, and Anterior Vaginal Wall Prolapse. Obstetrics Gynecology, 108, 324-332.
http://dx.doi.org/10.1097/01.AOG.0000227786.69257.a8 [6] Grody, M.H. (2003) Posterior Compartment Defects. In: Rock, J.A. and Jones, H.W., Eds., Telinde’s Operative Gynecology, Lippincott Williams &Wilkins, Philadelphia, 966-985. [7] Richardson, A.C. (1993) Therectovaginal Septum Revisited: Its Relationship and Its Importance in Rectocoele Repair. Clinical Obstetrics and Gynecology, 36, 976-983.
http://dx.doi.org/10.1097/00003081-199312000-00022 [8] Olsen, A.L., Smith, V.J., Bergstrom, J.O., et al. (1997) Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence. Obstetrics Gynecology, 89, 501-506.
http://dx.doi.org/10.1016/S0029-7844(97)00058-6 [9] Vakili, B., Zehg, Y.T., Loesch, H., et al. (2005) Levator Contraction Strength and Genital Hiatus as Risk Factors for Recurrent Pelvic Organ Prolapse. American Journal of Obstetrics Gynecology, 192, 1592-1598. http://dx.doi.org/10.1016/j.ajog.2004.11.022 [10] Schneider, H.P.G., Heinemann, L.A.J., Rosemeier, H.P., Potthoff, P. and Behre, H.M. (2000) The Menopause Rating Scale (MRS): Reliability of Scores of Menopausal Complaints. Climacteric, 3, 59-64.
http://dx.doi.org/10.3109/13697130009167600 [11] Wasserberg, N., Petrone, P., Haney, M., et al. (2009) Effect of Surgically Induced Weight Loss on Pelvic Floor Disorders in Morbidly Obese Women. Annals of Surgery, 249, 72-76.
http://dx.doi.org/10.1097/SLA.0b013e31818c7082 [12] Starczewski, A., Brodowska, A. and Brodowski, J. (2008) Epidemiology and Treatment for Urinary Incontinence and Pelvic Organ Prolapse in Women. Polski Merkuriusz Lekarski, 25, 74-76. [13] Wagg, A., Potter, J., Peel, P., et al. (2008) National Audit of Continence Care for Older People: Management of Urinary Incontinence. Age and Ageing, 37, 39-44.
http://dx.doi.org/10.1093/ageing/afm163 [14] Subak, L.L., Waetjen, L.E., van den Eeden, S., et al. (2001) Cost of Pelvic Organ Prolapse Surgery in the United States. Obstetrics Gynecology, 98, 646-651.
http://dx.doi.org/10.1016/S0029-7844(01)01472-7 [15] Hollabaugh Jr., R.S., Dmochowski, R.R., Kneib, T.G., et al. (1998) Preservation of Putative Continence Nerves during Radical Retropubic Prostatectomy Leads to More Rapid Return of Urinary Continence. Urology, 51, 960-967. http://dx.doi.org/10.1016/S0090-4295(98)00128-9 [16] Guri, R., Jeanette, S.B., David, H.T., et al. (2007) Symptomatic Pelvic Organ Prolapse: Prevalence and Risk Factors in a Population-Based, Racially Diverse Cohort. Obstetrics Gynecology, 109, 1396-1403.
http://dx.doi.org/10.1097/01.AOG.0000263469.68106.90 [17] Moalli, P.A., Jones, I.S., Meyn, L.A., et al. (2003) Risk Factors Associated with Pelvic Floor Disorders in Women Undergoing Surgical Repair. Obstetrics Gynecology, 101, 869-874.
http://dx.doi.org/10.1016/S0029-7844(03)00078-4 [18] Brown, J., Grady, D., Ouslander, J., et al. (1999) Prevalence of Urinary Incontinence and Associated Risk Factors in Postmenopausal Women: Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. Obstetrics Gynecology, 94, 66-70.
http://dx.doi.org/10.1016/S0029-7844(99)00263-X [19] Perucchini, D., De Lancey, J.O.L. and Blaivas, M. (1997) Evidence of Major Myopathic Changes in the Striated Urethral Sphincter Muscle in the Female. Neurourology and Urodynamics, 15, 394-395. [20] Rett, M.T., Simoes, J.A., Herrmann, V., et al. (2007) Management of Stress Urinary Incontinence with Surface Electromyography-Assisted Biofeedback in Women of Reproductive Age. Physical Therapy, 87, 136-142. http://dx.doi.org/10.2522/ptj.20050318 [21] Dannecker, C., Wolf, V., Raab, R., et al. (2005) EMG-Biofeedback Assisted Pelvic Floor Muscle Training Is an Effective Therapy of Stress Urinary or Mixed Incontinence: A 7-Year Experience with 390 Patients. Archives of Gynecology and Obstetrics, 273, 93-97.
http://dx.doi.org/10.1007/s00404-005-0011-4 [22] Madill, S.J., Harvey, M.A. and McLean, L. (2009) Women with SUI Demonstrate Motor Control Differences during Voluntary Pelvic Floor Muscle Contractions. International Urogynecology Journal, 20, 447-459. [23] Mokrzycki, M.L., Mittal, K., Smilen, S.W., et al. (1997) Estrogen and Progesterone Receptors in the Uterosacral Ligament. Obstetrics Gynecology, 90, 402-404.
http://dx.doi.org/10.1016/S0029-7844(97)00285-8 [24] Hodgins, M.B., Spike, R.C., Mackie, R.M., et al. (1998) An Immunohistochemical Study of Androgen, Oestrogen and Progesterone Receptors in the Vulva and Vagina. British Journal of Obstetrics and Gynaecology, 105, 216-222. http://dx.doi.org/10.1111/j.1471-0528.1998.tb10056.x [25] Smith, P., Heimer, G., Norgren, A., et al. (1993) Localization of Steroid Hormone Receptors in the Pelvic Muscles. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 50, 83-85.
http://dx.doi.org/10.1016/0028-2243(93)90169-D [26] Chen, G.D., Oliver, R.H., Leung, B.S., et al. (1999) Estrogen Receptor Alpha and Beta Expression in the Vaginal Walls and Uterosacral Ligaments of Premenopausal and Postmenopausal Women. Fertility and Sterility, 71, 1099-1102. http://dx.doi.org/10.1016/S0015-0282(99)00113-2 [27] Moalli, P.A., Klingensmith, W.L., Meyn, L.A., et al. (2002) Regulation of Matrix Metalloproteinase Expression by Estrogen in Fibroblasts That Are Derived from the Pelvic Floor. American Journal of Obstetrics Gynecology, 187, 72-79. http://dx.doi.org/10.1067/mob.2002.124845 [28] Gebhart, J.B., Rickard, D.J., Barrett, T., et al. (2001) Expression of Estrogen Receptor Isoforms α and β Messenger RNA in Vaginal Tissue of Premenopausal and Postmenopausal Women. American Journal of Obstetrics Gynecology, 185, 1325-1331. http://dx.doi.org/10.1067/mob.2001.119627 [29] Jarvis, S.K., Hallam, T.K., Lujicm, S., et al. (2005) Peri-Operative Physiotherapy Improves Outcomes for Women Undergoing Incontinence and or Prolapse Surgery: Results of a Randomised Controlled Trial. Australian and New Zealand Journal of Obstetrics and Gynaecology, 45, 300-303.
http://dx.doi.org/10.1111/j.1479-828X.2005.00415.x
[1] Wei, J. and De Lancey, J.O.L. (2004) Functional Anatomy of the Pelvic Floor and Lower Urinary Tract. Clinical Obstetrics and Gynecology, 47, 3-17. http://dx.doi.org/10.1097/00003081-200403000-00004 [2] Brown, J., Grady, D., Ouslander, J., et al. (1999) Prevalence of Urinary Incontinence and Associated Risk Factors in Postmenopausal Women: Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. Obstetrics Gynecology, 94, 66-70.
http://dx.doi.org/10.1016/S0029-7844(99)00263-X [3] Lambert, D.M., Marceau, S. and Forse, R.A. (2005) Intraabdominal Pressure in the Morbidly Obese. Obesity Surgery, 15, 1225-1232. http://dx.doi.org/10.1381/096089205774512546 [4] Song, Y., Ye, P., Hong, X., et al. (2009) Changes in Levatorani Muscle after Vaginal Hysterectomy and Prolapse Repair Using the Total Prolift Procedure. International Journal of Gynecology and Obstetrics, 106, 53-56. http://dx.doi.org/10.1016/j.ijgo.2009.03.007 [5] Chen, L., Ashton-Miller, J.A., Hsu, Y., et al. (2006) Interaction among Apical Support, Levatorani Impairment, and Anterior Vaginal Wall Prolapse. Obstetrics Gynecology, 108, 324-332.
http://dx.doi.org/10.1097/01.AOG.0000227786.69257.a8 [6] Grody, M.H. (2003) Posterior Compartment Defects. In: Rock, J.A. and Jones, H.W., Eds., Telinde’s Operative Gynecology, Lippincott Williams &Wilkins, Philadelphia, 966-985. [7] Richardson, A.C. (1993) Therectovaginal Septum Revisited: Its Relationship and Its Importance in Rectocoele Repair. Clinical Obstetrics and Gynecology, 36, 976-983.
http://dx.doi.org/10.1097/00003081-199312000-00022 [8] Olsen, A.L., Smith, V.J., Bergstrom, J.O., et al. (1997) Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence. Obstetrics Gynecology, 89, 501-506.
http://dx.doi.org/10.1016/S0029-7844(97)00058-6 [9] Vakili, B., Zehg, Y.T., Loesch, H., et al. (2005) Levator Contraction Strength and Genital Hiatus as Risk Factors for Recurrent Pelvic Organ Prolapse. American Journal of Obstetrics Gynecology, 192, 1592-1598. http://dx.doi.org/10.1016/j.ajog.2004.11.022 [10] Schneider, H.P.G., Heinemann, L.A.J., Rosemeier, H.P., Potthoff, P. and Behre, H.M. (2000) The Menopause Rating Scale (MRS): Reliability of Scores of Menopausal Complaints. Climacteric, 3, 59-64.
http://dx.doi.org/10.3109/13697130009167600 [11] Wasserberg, N., Petrone, P., Haney, M., et al. (2009) Effect of Surgically Induced Weight Loss on Pelvic Floor Disorders in Morbidly Obese Women. Annals of Surgery, 249, 72-76.
http://dx.doi.org/10.1097/SLA.0b013e31818c7082 [12] Starczewski, A., Brodowska, A. and Brodowski, J. (2008) Epidemiology and Treatment for Urinary Incontinence and Pelvic Organ Prolapse in Women. Polski Merkuriusz Lekarski, 25, 74-76. [13] Wagg, A., Potter, J., Peel, P., et al. (2008) National Audit of Continence Care for Older People: Management of Urinary Incontinence. Age and Ageing, 37, 39-44.
http://dx.doi.org/10.1093/ageing/afm163 [14] Subak, L.L., Waetjen, L.E., van den Eeden, S., et al. (2001) Cost of Pelvic Organ Prolapse Surgery in the United States. Obstetrics Gynecology, 98, 646-651.
http://dx.doi.org/10.1016/S0029-7844(01)01472-7 [15] Hollabaugh Jr., R.S., Dmochowski, R.R., Kneib, T.G., et al. (1998) Preservation of Putative Continence Nerves during Radical Retropubic Prostatectomy Leads to More Rapid Return of Urinary Continence. Urology, 51, 960-967. http://dx.doi.org/10.1016/S0090-4295(98)00128-9 [16] Guri, R., Jeanette, S.B., David, H.T., et al. (2007) Symptomatic Pelvic Organ Prolapse: Prevalence and Risk Factors in a Population-Based, Racially Diverse Cohort. Obstetrics Gynecology, 109, 1396-1403.
http://dx.doi.org/10.1097/01.AOG.0000263469.68106.90 [17] Moalli, P.A., Jones, I.S., Meyn, L.A., et al. (2003) Risk Factors Associated with Pelvic Floor Disorders in Women Undergoing Surgical Repair. Obstetrics Gynecology, 101, 869-874.
http://dx.doi.org/10.1016/S0029-7844(03)00078-4 [18] Brown, J., Grady, D., Ouslander, J., et al. (1999) Prevalence of Urinary Incontinence and Associated Risk Factors in Postmenopausal Women: Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. Obstetrics Gynecology, 94, 66-70.
http://dx.doi.org/10.1016/S0029-7844(99)00263-X [19] Perucchini, D., De Lancey, J.O.L. and Blaivas, M. (1997) Evidence of Major Myopathic Changes in the Striated Urethral Sphincter Muscle in the Female. Neurourology and Urodynamics, 15, 394-395. [20] Rett, M.T., Simoes, J.A., Herrmann, V., et al. (2007) Management of Stress Urinary Incontinence with Surface Electromyography-Assisted Biofeedback in Women of Reproductive Age. Physical Therapy, 87, 136-142. http://dx.doi.org/10.2522/ptj.20050318 [21] Dannecker, C., Wolf, V., Raab, R., et al. (2005) EMG-Biofeedback Assisted Pelvic Floor Muscle Training Is an Effective Therapy of Stress Urinary or Mixed Incontinence: A 7-Year Experience with 390 Patients. Archives of Gynecology and Obstetrics, 273, 93-97.
http://dx.doi.org/10.1007/s00404-005-0011-4 [22] Madill, S.J., Harvey, M.A. and McLean, L. (2009) Women with SUI Demonstrate Motor Control Differences during Voluntary Pelvic Floor Muscle Contractions. International Urogynecology Journal, 20, 447-459. [23] Mokrzycki, M.L., Mittal, K., Smilen, S.W., et al. (1997) Estrogen and Progesterone Receptors in the Uterosacral Ligament. Obstetrics Gynecology, 90, 402-404.
http://dx.doi.org/10.1016/S0029-7844(97)00285-8 [24] Hodgins, M.B., Spike, R.C., Mackie, R.M., et al. (1998) An Immunohistochemical Study of Androgen, Oestrogen and Progesterone Receptors in the Vulva and Vagina. British Journal of Obstetrics and Gynaecology, 105, 216-222. http://dx.doi.org/10.1111/j.1471-0528.1998.tb10056.x [25] Smith, P., Heimer, G., Norgren, A., et al. (1993) Localization of Steroid Hormone Receptors in the Pelvic Muscles. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 50, 83-85.
http://dx.doi.org/10.1016/0028-2243(93)90169-D [26] Chen, G.D., Oliver, R.H., Leung, B.S., et al. (1999) Estrogen Receptor Alpha and Beta Expression in the Vaginal Walls and Uterosacral Ligaments of Premenopausal and Postmenopausal Women. Fertility and Sterility, 71, 1099-1102. http://dx.doi.org/10.1016/S0015-0282(99)00113-2 [27] Moalli, P.A., Klingensmith, W.L., Meyn, L.A., et al. (2002) Regulation of Matrix Metalloproteinase Expression by Estrogen in Fibroblasts That Are Derived from the Pelvic Floor. American Journal of Obstetrics Gynecology, 187, 72-79. http://dx.doi.org/10.1067/mob.2002.124845 [28] Gebhart, J.B., Rickard, D.J., Barrett, T., et al. (2001) Expression of Estrogen Receptor Isoforms α and β Messenger RNA in Vaginal Tissue of Premenopausal and Postmenopausal Women. American Journal of Obstetrics Gynecology, 185, 1325-1331. http://dx.doi.org/10.1067/mob.2001.119627 [29] Jarvis, S.K., Hallam, T.K., Lujicm, S., et al. (2005) Peri-Operative Physiotherapy Improves Outcomes for Women Undergoing Incontinence and or Prolapse Surgery: Results of a Randomised Controlled Trial. Australian and New Zealand Journal of Obstetrics and Gynaecology, 45, 300-303.
http://dx.doi.org/10.1111/j.1479-828X.2005.00415.x