Examining the impact of weight loss and exercise on pelvic organ prolapse (POP) management
DOI:
https://doi.org/10.12775/QS.2024.19.54098Keywords
pelvic floor muscle training (PFMT), pelvic organ prolapse, weight loss, bariatric surgery, biofeedbackAbstract
Introduction: Pelvic organ prolapse is a descent of pelvic organs such as the bladder, cervix, apex of the vagina, and rectum which create herniation and slide into the direction of the vagina entrance. Pelvic prolapse is caused by ligament and muscle weakness, and its risk increases with age, parity, and obesity. Proper exercise and weight loss can be a key component of pelvic prolapse management, especially in the I-III stages. Those interventions may decrease the need for pelvic surgery and the risk of complications that can arise from it.
Purpose of the study: This study aimed to explore the effectiveness of weight loss and exercise on pelvic organ prolapse (POP) symptoms and staging.
Materials and methods: A comprehensive analysis of research papers available on PubMed, and Google Scholar was undertaken using the keywords: ‘weight loss pelvic prolapse’, ‘exercise in pelvic prolapse’, ‘pelvic floor dysfunction’, ‘pelvic floor muscle training’, ‘hypopressive exercises’, ‘biofeedback prolapse’
Results: Conventional weight loss does not reduce the intensity of the pelvic prolapse symptoms. However, weight loss that is achieved via bariatric surgery is effective in reducing symptoms arising from pelvic organ prolapse. Furthermore, the bigger the amount of weight loss the greater improvement in symptoms. Pelvic floor muscle training showed improvement in symptoms and in the staging of pelvic organ prolapse. Hypopressive exercises are not as effective as pelvic floor muscle training. Biofeedback and supervised exercises are helpful in proper exercise execution, and thus may improve the strength of the pelvic floor muscles.
References
Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health. 2023 Oct 14;23(1):2005.
Al-Badr A, Saleem Z, Kaddour O, Almosaieed B, Dawood A, Al-Tannir M, et al. Prevalence of pelvic floor dysfunction: a Saudi national survey. BMC Womens Health. 2022 Feb 4;22(1):27.
Aboseif C, Liu P. Pelvic Organ Prolapse. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK563229/
Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2020;46(1):5–14.
Alcalay M, Stav K, Eisenberg VH. Family history associated with pelvic organ prolapse in young women. Int Urogynecol J. 2015 Dec;26(12):1773–6.
Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002 Jun;186(6):1160–6.
Myers DL, Sung VW, Richter HE, Creasman J, Subak LL. Prolapse symptoms in overweight and obese women before and after weight loss. Female Pelvic Med Reconstr Surg. 2012;18(1):55–9.
Abdool Z, Dietz HP, Lindeque BG. Prolapse symptoms are associated with abnormal functional anatomy of the pelvic floor. Int Urogynecol J. 2017 Sep;28(9):1387–91.
Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014 Jan;123(1):141–8.
Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016 Feb;27(2):165–94.
Wilkinson KH, Thomas A, Theobald J. Pelvic organ prolapse: An unusual cause of small bowel obstruction. Am J Emerg Med. 2019 Sep;37(9):1809.e5-1809.e6.
Siddique M, Ingraham C, Kudish B, Iglesia CB, Polland A. Hydronephrosis Associated With Pelvic Organ Prolapse: A Systematic Review. Female Pelvic Med Reconstr Surg. 2020 Mar;26(3):212–8.
Serin AN, Birge Ö. A serious consequence of pelvic organ prolapse: Hydroureteronephrosis. Int Urogynecol J. 2023 Sep;34(9):2147–54.
Kapoor DS, Thakar R, Sultan AH, Oliver R. Conservative versus surgical management of prolapse: what dictates patient choice? Int Urogynecol J Pelvic Floor Dysfunct. 2009 Oct;20(10):1157–61.
Ganj FA, Ibeanu OA, Bedestani A, Nolan TE, Chesson RR. Complications of transvaginal monofilament polypropylene mesh in pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Aug;20(8):919–25.
Bordoni B, Sugumar K, Leslie SW. Anatomy, Abdomen and Pelvis, Pelvic Floor. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK482200/
Cho ST, Kim KH. Pelvic floor muscle exercise and training for coping with urinary incontinence. J Exerc Rehabil. 2021 Dec;17(6):379–87.
Sammarco AG, Nandikanti L, Kobernik EK, Xie B, Jankowski A, Swenson CW, et al. Interactions among pelvic organ protrusion, levator ani descent, and hiatal enlargement in women with and without prolapse. Am J Obstet Gynecol. 2017 Nov;217(5):614.e1-614.e7.
Swenson CW, Masteling M, DeLancey JO, Nandikanti L, Schmidt P, Chen L. Aging effects on pelvic floor support: a pilot study comparing young versus older nulliparous women. Int Urogynecol J. 2020 Mar;31(3):535–43.
Handa VL, Roem J, Blomquist JL, Dietz HP, Muñoz A. Pelvic organ prolapse as a function of levator ani avulsion, hiatus size, and strength. Am J Obstet Gynecol. 2019 Jul;221(1):41.e1-41.e7.
Madhu C, Swift S, Moloney-Geany S, Drake MJ. How to use the Pelvic Organ Prolapse Quantification (POP-Q) system? Neurourol Urodyn. 2018 Aug;37(S6):S39–43.
Haya N, Segev E, Younes G, Goldschmidt E, Auslender R, Abramov Y. The effect of bladder fullness on evaluation of pelvic organ prolapse. Int J Gynaecol Obstet. 2012 Jul;118(1):24–6.
Lowder JL, Oliphant SS, Shepherd JP, Ghetti C, Sutkin G. Genital hiatus size is associated with and predictive of apical vaginal support loss. Am J Obstet Gynecol. 2016 Jun;214(6):718.e1-8.
Kinay T, Tapisiz OL, Kiykac Altinbas S, Kayikcioglu F, Karakaya J, Moraloglu Tekin O. The Relationship Between Perineal Body Size, Total Vaginal Length, Apical Prolapse, and Prolapse Symptoms. Urogynecology (Phila). 2022 Sep 1;28(9):602–7.
Gutman RE, Ford DE, Quiroz LH, Shippey SH, Handa VL. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol. 2008 Dec;199(6):683.e1-7.
Pang H, Zhang L, Han S, Li Z, Gong J, Liu Q, et al. A nationwide population-based survey on the prevalence and risk factors of symptomatic pelvic organ prolapse in adult women in China - a pelvic organ prolapse quantification system-based study. BJOG. 2021 Jul;128(8):1313–23.
Spencer JE, Brown HW, Oliphant SS. Health literacy and PFDI-20 and PFIQ-7 completion in urogynecology patients. Int Urogynecol J. 2021 Dec;32(12):3209–15.
Kudish BI, Iglesia CB, Sokol RJ, Cochrane B, Richter HE, Larson J, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009 Jan;113(1):81–8.
Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017 Jul;217(1):11-26.e3.
Gozukara YM, Akalan G, Tok EC, Aytan H, Ertunc D. The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy. Int Urogynecol J. 2014 Sep;25(9):1219–25.
Leshem A, Groutz A, Amir H, Gordon D, Shimonov M. Surgically induced weight loss results in a rapid and consistent improvement of female pelvic floor symptoms. Scand J Urol. 2018 Jun;52(3):219–24.
McDermott CD, Terry CL, Mattar SG, Hale DS. Female pelvic floor symptoms before and after bariatric surgery. Obes Surg. 2012 Aug;22(8):1244–50.
Wasserberg N, Petrone P, Haney M, Crookes PF, Kaufman HS. Effect of surgically induced weight loss on pelvic floor disorders in morbidly obese women. Ann Surg. 2009 Jan;249(1):72–6.
Gabriel I, Tavakkoli A, Minassian VA. Pelvic Organ Prolapse and Urinary Incontinence in Women After Bariatric Surgery: 5-Year Follow-up. Female Pelvic Med Reconstr Surg. 2018;24(2):120–5.
Olivera CK, Herron DM, Kini SU, Vardy MD, Ascher-Walsh CJ, Garely AD, et al. Long-term quality of life and pelvic floor dysfunction after bariatric surgery. Am J Obstet Gynecol. 2012 Nov;207(5):431.e1-4.
Pomian A, Majkusiak W, Lisik W, Tomasik P, Horosz E, Zwierzchowska A, et al. Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders? Obes Surg. 2018 Jun;28(6):1653–8.
Basu M, Wise B, Duckett J. A qualitative study of women’s preferences for treatment of pelvic floor disorders. BJOG. 2011 Feb;118(3):338–44.
Bernardes BT, Resende APM, Stüpp L, Oliveira E, Castro RA, Bella ZIKJ di, et al. Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial. Sao Paulo Med J. 2012;130(1):5–9.
Resende APM, Bernardes BT, Stüpp L, Oliveira E, Castro RA, Girão MJBC, et al. Pelvic floor muscle training is better than hypopressive exercises in pelvic organ prolapse treatment: An assessor-blinded randomized controlled trial. Neurourol Urodyn. 2019 Jan;38(1):171–9.
Caufriez M. Gymnastique abdominale hypopressive. 1997. 122 p.
Resende APM, Stüpp L, Bernardes BT, Oliveira E, Castro RA, Girão MJBC, et al. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse? Neurourol Urodyn. 2012 Jan;31(1):121–5.
Molina-Torres G, Moreno-Muñoz M, Rebullido TR, Castellote-Caballero Y, Bergamin M, Gobbo S, et al. The effects of an 8-week hypopressive exercise training program on urinary incontinence and pelvic floor muscle activation: A randomized controlled trial. Neurourol Urodyn. 2023 Feb;42(2):500–9.
Huang YC, Chang KV. Kegel Exercises. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK555898/
Due U, Brostrøm S, Lose G. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial. Int Urogynecol J. 2016 Apr;27(4):555–63.
Chiarelli P, Murphy B, Cockburn J. Women’s knowledge, practises, and intentions regarding correct pelvic floor exercises. Neurourol Urodyn. 2003;22(3):246–9.
Zanetti MRD, Castro R de A, Rotta AL, Santos PDD, Sartori M, Girão MJBC. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. Sao Paulo Med J. 2007 Sep 6;125(5):265–9.
Curillo-Aguirre CA, Gea-Izquierdo E. Effectiveness of Pelvic Floor Muscle Training on Quality of Life in Women with Urinary Incontinence: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2023 May 23;59(6):1004.
Alves FK, Riccetto C, Adami DBV, Marques J, Pereira LC, Palma P, et al. A pelvic floor muscle training program in postmenopausal women: A randomized controlled trial. Maturitas. 2015 Jun;81(2):300–5.
Sasotya RMS, Reswari A, Kurniadi A, Permadi W, Achmad ED, Pramatirta AY, et al. Enhancement of Levator Ani Muscle Strength in Postpartum Women: The Impact of Pelvic Floor Muscle Training. Med Sci Monit. 2024 Jan 15;30:e942758.
Panman C, Wiegersma M, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Vermeulen KM, et al. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care. BJOG. 2017 Feb;124(3):511–20.
Stüpp L, Resende APM, Oliveira E, Castro RA, Girão MJBC, Sartori MGF. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J. 2011 Oct;22(10):1233–9.
Kashyap R, Jain V, Singh A. Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapse. Int J Gynaecol Obstet. 2013 Apr;121(1):69–73.
Braekken IH, Majida M, Ellström Engh M, Bø K. Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. J Sex Med. 2015 Feb;12(2):470–80.
Hoff Brækken I, Majida M, Engh ME, Bø K. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial. Obstet Gynecol. 2010 Feb;115(2 Pt 1):317–24.
Gorji Z, Pourmomeny AA, Hajhashemy M. Evaluation of the effect of a new method on the pelvic organ prolapse symptoms. Low Urin Tract Symptoms. 2020 Jan;12(1):20–4.
Chmielewska D, Stania M, Sobota G, Kwaśna K, Błaszczak E, Taradaj J, et al. Impact of different body positions on bioelectrical activity of the pelvic floor muscles in nulliparous continent women. Biomed Res Int. 2015;2015:905897.
Zhong F, Miao W, Yu Z, Hong L, Deng N. Clinical effect of electrical stimulation biofeedback therapy combined with pelvic floor functional exercise on postpartum pelvic organ prolapse. Am J Transl Res. 2021;13(6):6629–37.
Hagen S, Bugge C, Dean SG, Elders A, Hay-Smith J, Kilonzo M, et al. Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT. Health Technol Assess. 2020 Dec;24(70):1–144.
Liu YJ, Ting SWH, Hsiao SM, Huang CM, Wu WY. Efficacy of bio-assisted pelvic floor muscle training in women with pelvic floor dysfunction. Eur J Obstet Gynecol Reprod Biol. 2020 Aug;251:206–11.
Vermandel A, De Wachter S, Beyltjens T, D’Hondt D, Jacquemyn Y, Wyndaele JJ. Pelvic floor awareness and the positive effect of verbal instructions in 958 women early postdelivery. Int Urogynecol J. 2015 Feb;26(2):223–8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Bartosz Moskal, Małgorzata Maria Bednarczyk

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 153
Number of citations: 0