Immediate Effects of Exercise and Behavioral Interventions for Pelvic Floor Dysfunction and Lumbopelvic Pain

Abstract

Background: Over the next 30 years chronic health problems associated with pelvic floor dysfunction are projected to increase by 50%. Objective: To determine the efficacy of a noninvasive, pain-free procedure of behavioral modifications and a specialized exercise program to improve pain levels and quality of life. Study Design: A quantitative, longitudinal study was conducted. Methods: Forty-one women aged 43.2 ± 9.5 years (mean ± SD) with symptoms of pelvic floor dysfunction and pelvic organ prolapse were introduced to a protocol that included eight 45-minute live group sessions and a home exercise program to be performed at least 3 times per week. The participants were reassessed after completion of the protocol intervention. IBM SPSS Version 24 statistical programming was used, and Wilcoxon nonparametric analyses were applied to compare the preand INTRODUCTION Low back pain (LBP) is a condition of localized pain to the lumbar spine whose etiology is commonly unknown.1 Pelvic floor disorders (PFDs) occur when the muscles that comprise the pelvic floor fail to properly contract. This can cause urinary incontinence, pelvic organ prolapse, fecal incontinence, or other sensory and emptying abnormalities of the lower urinary and gastrointestinal tracts.2 Current evidence shows that individuals with LBP have a significant decrease in pelvic floor function compared with individuals without LBP.3 Over 25% of all women and more than a third older than 65 years experience PFD. Even though it is a physiological problem, the psychosocial impact of PFD can be much more detrimental to the patient’s quality of life. Over the next 30 years chronic health problems associated with PFD are projected to increase by 50% due to the increasing numbers of women reaching the age of 65.4 PFD does not typically have one specific cause. Pregnancy/childbirth, age, hormonal changes, obesity, lower urinary tract infection, and pelvic surgery are Human Performance and Health Promotion Program, University of New Orleans, Louisiana. Bonis is a faculty member at University of New Orleans. Lormand and Walsh are self-employed clinicians who participate in the University of New Orleans-Human Performance and Health Promotion Program mentorinternship program. The research clinicians who administered the entire procedure to all of the participants are a licensed physical therapist (C.W.) and a clinical exercise physiologist (J.L.). The 2 clinicians collaborated and developed the procedure. The third member of the research group (M.B.) is an experienced researcher and an exercise science faculty member at the University of New Orleans who participated as the primary investigator, designed the study, and performed all of the statistical analyses. The authors declare no conflicts of interest. Corresponding Author: Marc Bonis, PhD, Human Performance and Health Promotion Program, University of New Orleans, 2000 Lakeshore Dr, ELCF Dept ED 348K, New Orleans, LA 70148 (mbonis@uno.edu). DOI: 10.1097/JWH.0000000000000165 Research Report Immediate Effects of Exercise and Behavioral Interventions for Pelvic Floor Dysfunction and Lumbopelvic Pain Marc Bonis, PhD Jennifer Lormand, BS Christina Walsh, PT VOLUME 44 • NUMBER 2 • April/June 2020 poststudy data to determine whether significant relief from pain and/or dysfunction occurred. Results: The procedure significantly improved lower back pain (Oswestry, z(41) = −4.068, P < .05), quality of life as related to pelvic floor disorder symptoms (Pelvic Floor Distress Inventory Questionnaire—Short Form 20, z(41) = −5.317, P < .05), life impact of pelvic floor disorder symptoms (Pelvic Floor Impact Questionnaire—Short Form-7, z(41) = −3.825, P < .05), diastasis recti separation (z(41) = −4.806, P < .05), pelvic floor muscle activation (z(41) = −5.583, P < .05), and pelvic alignment (z(41) = −3.207, P < .05). Conclusion: The noninvasive, pain-free procedure provided significant relief from symptoms of pelvic floor dysfunction and lower back pain.