Synergistic non-surgical management of pelvic floor dysfunction: second report

The normal pelvic floor functions as a balanced synergistic system composed of muscle, connective tissue (CT), and nerve components, with CT being the most vulnerable. The aim was to address a wide range of pelvic floor dysfunctions by strengthening all possible components of the system with minimal time loss, weaving every element of treatment seamlessly into a daily routine. The study group consisted of patients from a tertiary referral pelvic floor clinic who, after testing, opted for nonsurgical treatment of their problem. There were no exclusion criteria. The patients had presented with symptoms which included stress, urge, frequency, nocturia, abnormal emptying and pelvic pain, and the fate of these was tracked prospectively. The regime comprised four visits in 3 months. An anatomical classification guided diagnosis of anatomical defects in the anterior, middle and posterior compartments of the vagina. HRT was administered to all patients, electrotherapy 20 min per day for 4 weeks, squeezing 3 x 12 per day, reverse pushdowns 3 x 12 per day and squatting or equivalent up to 20 min per day. Of 147 patients (mean age 52.5 years), 53% completed the programme. Median QOL improvement reported was 66%, mean cough stress test urine loss reduced from 2.2 g (range 0-20.3 g) to 0.2 g (range 0-1.4 g), p =<0.005, and 24-h pad loss from a mean of 3.7 g (range 0-21.8 g) to a mean of 0.76 g (range 0-9.3 m), p =<0.005. Frequency, nocturia and pelvic pain were significantly improved ( p=<0.005). Residual urine reduced from mean 202 ml to mean 71 ml ( p=<0.005). This method extends indications for nonsurgical therapy beyond stress incontinence, and the results appear to encourage this approach. Confirmation by other investigators is required.