Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common problems that significantly affect women’s lives. Pathophysiology of these conditions is usually multifactorial and pelvic floor muscles (PFMs) dysfunction is one of the main contributing factors [1]. There is a limited body of evidence regarding PFMs characteristics in women qualified for surgical treatment of SUI and POP. Therefore the aim of this study was to assess PFMs function in women qualified for surgical treatment of POP and SUI and to evaluate the relationship between the pre-operative PFMs function and quality of life.

166 women mean age 56.6±12.1 (range 30 – 84), qualified for surgical treatment of POP (n=106) and SUI (n=60) were included in this study. PFMs function was evaluated with the use of palpation examination (quality and correctness of contraction) and manometry (vaginal resting pressure, vaginal squeeze pressure, endurance). Quality of life was assessed using the Pelvic Floor Distress Inventory (PFDI-20) which comprised the Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), the Colorectal-Anal Distress Inventory 8 (CRADI-8), and the Urinary Distress Inventory 6 (UDI-6). All measurements were performed during the hospital admission, before undergoing surgical treatment. Due to non-normal data distribution, the differences between variables were assessed with the Mann-Whitney test. The correlation between variables was assessed using the Spearman correlation coefficient. Differences in qualitative variables distributions were assessed using the Chi-squared test. Values of p<0.05 were considered statistically significant.

Of the examined women, 89.2% (n=148) were able to voluntarily contract PFMs, but only 34.5% (n=51) did it correctly (in isolation and without breath-holding). The median vaginal resting pressure was significantly higher in women qualified for SUI surgery (32.20 cm H2O) than those awaiting POP intervention (24.25 cm H2O, p<0.01). There were no significant differences in other PFMs measurements between the groups. Vaginal resting pressure was negatively correlated with POPDI-6 (rs=-0.224, p=0.01) and CRADI-8 (rs=-0.213, p=0.01), and positively correlated UDI-6 score (rs=0.172, p=0.04).

Most of the women were able to activate PFMs, but the ability to do it correctly (in an isolated manner and without breath-holding) was generally poor. Vaginal resting pressure was lower in women qualified for POP surgery when compared to those awaiting SUI surgical treatment which may suggest lower PFMs tone in this group of patients. Higher values of vaginal resting pressure were correlated with better quality of life regarding prolapse and anorectal symptoms. However, higher values of vaginal resting pressure were also correlated with a worse quality of life referring to urinary symptoms. This may suggest that changes in pelvic floor muscle tone play a divergent role in the quality of life of women suffering primarily from POP or SUI symptoms.

Women qualified for pelvic floor surgery seem to have low conscious control over their PFMs therefore, future research should investigate whether this could impact surgical treatment success. Further reflections on differences in muscle tone between women undergoing SUI and POP surgery, and whether PFM muscle tone should be addressed in pre-operative rehabilitation are warranted.

1.	Hallock JL, Handa VL. The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstet Gynecol Clin North Am. 2016 Mar;43(1):1-13