THE EFFECT OF A PHYSIOTHERAPY EXERCISE PROGRAM ON BLADDER, PROLAPSE AND BOWEL OUTCOMES IN WOMEN UNDERGOING GYNAECOLOGICAL SURGERY: AN

Hypothesis / aims of study Very little is known about the effect of physiotherapy after gynaecological surgery, despite this intervention being a recommended therapy in clinical practice. A previous study in women undergoing pelvic organ prolapse (POP) and/or urinary incontinence (UI) surgery showed a positive effect on bladder function at 3 months post-operatively (1), but the effects on POP and bowel function, and longer term effects were not measured. The aim of this study was to investigate whether physiotherapy, as an adjunct to surgery, would demonstrate significant improvement in bladder, POP and bowel symptoms compared to a control group at 3, 6, and 12 months post-operatively. Study design, materials and methods This study was an assessor-blinded randomised controlled trial. Included were women of any age undergoing vaginal or laparoscopic-assisted vaginal surgery for either POP repair (primary or recurrent), and/or hysterectomy, at six metropolitan private hospitals. Exclusion criteria were surgery for cancer or surgery for UI. Participants were randomised to receive either physiotherapy-supervised pre- and post-operative pelvic floor exercises, or ‘usual care ’ provided by the surgeon and hospital. The physiotherapy intervention comprised a pelvic floor muscle (PFM) strength training protocol, supplemented by bladder and bowel advice. This was provided over 8 sessions: one pre-operative and seven post-operative sessions; at day 3 post-operatively, week 6, 7, 8, 10 and 12, and a final appointment at 9 months post-operatively. The main outcomes of bladder and POP symptoms wer