Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy

Daniëlle A van Reijn-Baggen; Ingrid J M Han-Geurts; Petra J Voorham-van der Zalm; Rob C M Pelger; Caroline H A C Hagenaars-van Miert; Ellen T M Laan

doi:10.1016/j.sxmr.2021.03.002

Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy

Sex Med Rev. 2022 Apr;10(2):209-230. doi: 10.1016/j.sxmr.2021.03.002. Epub 2021 Jun 12.

Authors

Daniëlle A van Reijn-Baggen¹, Ingrid J M Han-Geurts², Petra J Voorham-van der Zalm³, Rob C M Pelger³, Caroline H A C Hagenaars-van Miert⁴, Ellen T M Laan⁵

Affiliations

¹ Proctos Clinic, Department of Surgery, Utrecht, The Netherlands; Leiden University Medical Centre, Department of Urology, Leiden, The Netherlands. Electronic address: davr@me.com.
² Proctos Clinic, Department of Surgery, Utrecht, The Netherlands.
³ Leiden University Medical Centre, Department of Urology, Leiden, The Netherlands.
⁴ Avans+, University of Applied Sciences, Master Pelvic Physical Therapy, Breda, The Netherlands.
⁵ Amsterdam University Medical Centers, University of Amsterdam, Department of Sexology and Psychosomatic Gynaecology, The Netherlands.

PMID: 34127429
DOI: 10.1016/j.sxmr.2021.03.002

Abstract

Introduction: Hypertonicity of the pelvic floor (PFH) is a disabling condition with urological, gynecological and gastrointestinal symptoms, sexual problems and chronic pelvic pain, impacting quality of life. Pelvic floor physical therapy (PFPT) is a first-line intervention, yet no systematic review on the efficacy of PFPT for the treatment of PFH has been conducted.

Objectives: To systematically appraise the current literature on efficacy of PFPT modalities related to PFH.

Methods: PubMed, Embase, Emcare, Web of Science, and Cochrane databases were searched from inception until February 2020. A manual search from reference lists of included articles was performed. Ongoing trials were reviewed using clinicaltrial.gov. Randomized controlled trials (RCTs), prospective - and retrospective cohorts and case-study analyses were included. Outcome measures were pelvic floor muscle tone and function, pain reports, sexual function, pelvic floor symptom scores, quality of life and patients' perceived effect.

Results: The literature search resulted in 10 eligible studies including 4 RCTs, 5 prospective studies, and 1 case study published between 2000 and 2019. Most studies had a high risk of bias associated with the lack of a comparison group, insufficient sample sizes and non-standardized interventions. Six studies were of low and 4 of medium quality. All studies were narratively reviewed. Three of 4 RCTs found positive effects of PFPT compared to controls on five out of 6 outcome measures. The prospective studies found significant improvements in all outcome measures that were assessed. PFPT seems to be efficacious in patients with chronic prostatitis, chronic pelvic pain syndrome, vulvodynia, and dyspareunia. Smallest effects were seen in patients with interstitial cystitis and painful bladder syndrome.

Conclusion: The findings of this systematic review suggest that PFPT can be beneficial in patients with PFH. Further high-quality RCTs should be performed to confirm the effectiveness of PFPT in the treatment of PFH. van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, et al. Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sex Med Rev 2022;10:209-230.

Keywords: Hypertonicity; Overactivity; Pelvic Floor; Pelvic Floor Physical Therapy; Physiotherapy.

Publication types

Review
Systematic Review

MeSH terms

Female
Humans
Male
Pelvic Floor Disorders* / therapy
Pelvic Floor* / physiology
Pelvic Pain / therapy
Physical Therapy Modalities
Treatment Outcome