The effect of a physiotherapy treatment program on pelvic function following gynaecological surgery

Investigators : Ms Helena Frawley, Prof Mary Galea, Dr Bev Phillips, Prof Kari Bø

The aim of this study is to investigate the effect of a physiotherapy treatment program on pelvic function following gynaecological surgery.   The hypotheses to be tested are:

• The physiotherapy intervention will significantly improve pelvic floor muscle strength and bladder / bowel function at 6 months post surgery compared to a control group.
• The physiotherapy intervention will have a significant effect on post-operative abdominal muscle function, general fitness and return to activities of daily living compared to a control group.
• The physiotherapy intervention will prevent the onset of de novo symptoms of bladder and bowel dysfunction following surgery compared to a control group.

The study is a single-blind randomised controlled trial. Fifty subjects will be recruited in collaboration with gynaecologists who perform surgery at several private hospitals in Melbourne. The inclusion criteria are: (i) women of any age, undergoing gynaecological surgery, including simple hysterectomy and/or prolapse repair.   The exclusion criteria are (i) surgery via laparotomy, (ii) surgery for malignancy, (iii) anti-incontinence surgery, (iv) women who have experienced more than mild stress urinary incontinence in the previous 4 weeks (as defined by the International Continence Society).

Subjects will be randomised to treatment or control group. The subjects in the control group will receive the normal post-operative care as provided by their gynaecologist and will also be required to attend for one pre-operative and three post-operative assessments (3, 6 and 12 months post-operative) performed by one of the investigators.    Subjects in the treatment group, in addition to the normal post-operative care provided by their gynaecologist, will receive a physiotherapy treatment program consisting of one pre-operative visit and 6 post-operative visits, as well as the pre- and post-operative assessments performed by the investigator.   The intervention will include pre-operative advice and education, post-operative advice regarding level and intensity of resumption of normal activities, a pelvic floor muscle training program, advice regarding good bladder and bowel habits and prevention of prolapse.

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