Systematic Review of Evidence for Conservative Management of Pelvic Organ Prolapse in Younger Women.

INTRODUCTION

Treatment of pelvic organ prolapse (POP) is poorly understood in younger women as the majority of prolapse research is conducted in the older population. There is an urgent need to evaluate conservative POP treatments for management in younger women due to high surgical complications and reoperation rates.

METHODS

Systematic review of the literature following PRISMA guidelines and registered in PROSPERO. Included studies were of conservative treatments in women younger than 51 years old.

RESULTS

From 416 retrieved studies, nine were included in the analysis. Two of three studies found pelvic floor muscle training (PFMT) significantly benefited patient reported outcome measures (PROM) compared to educational material. One of three studies found significant improvement in PROM using biofeedback in addition to PFMT versus PFMT alone. Electrical stimulation with PFMT versus PFMT alone (one study) showed significant additional benefit of the combined treatment. Biofeedback and electrical stimulation in combination with PFMT versus PFMT alone (one study) was found to provide significant additional benefits. One compared pessary use to no intervention but stopped early due to slow recruitment.

CONCLUSION

PFMT improves patient reported outcomes in younger women with POP. Electrical stimulation and biofeedback are useful adjuncts to PFMT. The gap in research investigating the effect of pessaries in younger women warrants further study.