Effectiveness of hypopressive exercises in women with pelvic floor dysfunction: a single-blinded randomized clinical

B Navarro Brazález, M Torres Lacomba, V Prieto Gómez, B Sánchez Sánchez, Ó Sánchez Méndez, F Vergara Pérez.

Grupo de Investigación Fisioterapia en los Procesos de Salud de la Mujer. Unidad Docente, Asistencial y de Investigación en Fisioterapia. Universidad de Alcalá.

Key Words: Hypopressive exercises. Pelvic floor. Physiotherapy. Pelvic floor dysfunction. Therapeutic exercise.

Palabras clave: Ejercicios hipopresivos. Suelo Pélvico. Fisioterapia. Disfunciones del suelo pélvico. Ejercicio terapéutico.

ABSTRACT

Objective

The goal of this study was to compare three pelvic-perineal physiotherapy treatment approaches, based on pelvic floor muscle training (PFMT) vs hypopressive exercises vs a combination of both.

Study design, materials, and methods

This was a single-centre, randomized, simple-blinded, 3-armed parallel group clinical trial. Ninety-four women with pelvic floor dysfunction were randomly assigned to 8 weeks of either direct PFMT, hypopressive exercises or both. All interventions were carried out by the same physiotherapist, were individually, and face-to-face in each group. In the direct PFMT, pelvic floor muscles exercises were performed and guided throw vaginal palpation and intravaginal biofeedback. In the hypopressive exercises group women were instructed in the thirty-three hypopressive exercises described by Dr. Caufriez. In the third group, participants received a direct PFMT and were trained in 10 to 15 hypopressive exercises. The three groups received the same educational strategy and were instructed in the knack maneuver.

Results

The women in the three intervention groups improved their symptoms descending 24.41-41.70 points according to PFDI-20, their quality of life in 12.21-26.69 points based on PFIQ-7 punctuation and increased their PFM strength in 7.10-10.12 cmH2O. Moreover, improvements were maintained after 3, 6 and 12 months after intervention.

Discussion

We have tested the efficacy of a physical therapy treatment based on hypopressive alone, or joined with PFMT, to know the real efficacy of these popular exercises in the treatment of women with pelvic floor dysfunction. Although the results have been positive for the hypopressive intervention, cautions must be taken. Firstly, the three groups have received the same lifestyle advice, which has defined by itself helpful in the symptoms control. Second, all women were instructed in the knack maneuver during perceived intra-abdominal pressures increase, which have also been reported as an effective trick to minimize urinary leakage. Thus, the hypopressive exercises could provide sense of pelvic floor muscles elevation, but without giving a real awareness of pelvic floor muscle contraction, which would be required for example to perform the knack maneuver correctly. This fact could suppose hypopressive exercises as an insufficient treatment for women who are unable to produce a conscious movement of pelvic floor muscles.

Conclusion

Individual physiotherapy treatment based on PFMT or on hypopressive exercises is effective in the symptoms management and in the improvement of pelvic floor muscles strength in women with different combinations of mild pelvic floor dysfunction. Combining both treatments does not seem to improve results.