Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence
Abstract
Introduction and hypothesis Native tissue vaginal repairs are associated with relatively high levels of recurrence. Systematic reviews have noted that preoperative pelvic floor muscle strength was associated with increased risk of recurrence in the short term.Methods This is a retrospective review of patients who underwent a primary reconstructive surgery for anterior compartment vaginal prolapse between 2001 and 2015. Patients were divided into "absent," "weak" and "good" preoperative PFM strength (aPFM, wPFM and gPFM, respectively) based on a modified Oxford scale. Failure rates were determined by a composite of subjective and objective anatomic outcomes. Subjects who underwent re-operations or procedures for recurrent prolapse of the anterior compartment were considered failures. A p value < 0.05 was considered statistically significant.Results Two hundred ninety-nine patients were included. The aPFM (n = 36), wPFM (n = 115) and gPFM (n = 148) groups had similar descriptive statistics, except subjects in the aPFM and wPFM groups were significantly older than the gPFM group (p = 0.008). All groups underwent similar reconstructive surgeries. Average length of follow-up of 143.9 weeks (41 to 717 weeks) was similar among the three groups (p = 0.472). For the primary outcome of composite failure, aPFM had significantly more anterior vaginal wall recurrences than both the wPFM and gPFM groups, 13.89% vs. 3.48% and 4.05%, respectively (p = 0.033).Conclusions Patients with preoperative absent pelvic floor muscle strength (nonfunctioning PFM) had a significantly higher anterior vaginal wall recurrence rate than those with weak or good pelvic floor muscle strength.
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Obesity, which is related to morbidity, appears to be mitigated by both prehabilitation and the implementation of evidence informed early recovery after surgery programmes.
“Obesity, which is related to morbidity, appears to be mitigated by both prehabilitation and the implementation of evidence informed early recovery after surgery programmes [8, 9, 10, 11, 12, 13].”
From How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025 (2026) · cites this paper as [12]
Cites
Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence
OLSEN, A., SMITH, V, BERGSTROM, J., COLLING, J., & CLARK, A. (1997) · Obstetrics & Gynecology · doi:10.1016/s0029-7844(97)00058-6 · Cited by 3,335 · see citing works
Jelovsek, J. E., Maher, C., & Barber, M. D. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60462-0 · Cited by 976 · see citing works
Lifetime Risk of Undergoing Surgery for Pelvic Organ Prolapse
Smith, F. J., Holman, C. D. J., Moorin, R. E., & Tsokos, N. (2010) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181f73729 · Cited by 822 · see citing works
Epidemiology and outcome assessment of pelvic organ prolapse
Barber, M. D., & Maher, C. (2013) · International Urogynecology Journal · doi:10.1007/s00192-013-2169-9 · Cited by 767 · see citing works
Swift, S., Woodman, P., O'Boyle, A., Kahn, M., Valley, M., Bland, D., Wang, W., & Schaffer, J. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.10.602 · Cited by 752 · see citing works
Evaluation of Female Pelvic-Floor Muscle Function and Strength
Bø, K., & Sherburn, M. (2005) · Physical Therapy · doi:10.1093/ptj/85.3.269 · Cited by 612 · see citing works
Risk factors for pelvic organ prolapse and its recurrence: a systematic review
Vergeldt, T. F. M., Weemhoff, M., IntHout, J., & Kluivers, K. B. (2015) · International Urogynecology Journal · doi:10.1007/s00192-015-2695-8 · Cited by 572 · see citing works
Messelink, B., Benson, T., Berghmans, B. C. M., Bø, K., Corcos, J., Fowler, C. J., Laycock, J., Lim, P. H., van Lunsen, R. H. W., Nijeholt, G. A. B. L. À., et al. (2005) · Neurourology and Urodynamics · doi:10.1002/nau.20144 · Cited by 545 · see citing works
Defining Success After Surgery for Pelvic Organ Prolapse
Barber, M. D., Brubaker, L., Nygaard, I., Wheeler, T. L., Schaffer, J., Chen, Z., & Spino, C. (2009) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181b2b1ae · Cited by 515 · see citing works
Bo, K., Frawley, H. C., Haylen, B. T., Abramov, Y., Almeida, F. G., Berghmans, B., Bortolini, M., Dumoulin, C., Gomes, M., McClurg, D., et al. (2017) · International Urogynecology Journal · doi:10.1007/s00192-016-3123-4 · Cited by 429 · see citing works
Barber, M. D., Brubaker, L., Burgio, K. L., Richter, H. E., Nygaard, I., Weidner, A. C., Menefee, S. A., Lukacz, E. S., Norton, P., Schaffer, J., et al. (2014) · JAMA · doi:10.1001/jama.2014.1719 · Cited by 428 · see citing works
Bø, K., Frawley, H., Haylen, B. T., Abramov, Y., de Almeida, F. G., Berghmans, B. C. M., Bortolini, M. A. T., Dumoulin, C. L., Gomes, M., McClurg, D., et al. (2016) · Neurourology and Urodynamics · doi:10.1002/nau.23107 · Cited by 415 · see citing works
Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse
Maher, C., Feiner, B., Baeßler, K., Christmann‐Schmid, C., Haya, N., & Marjoribanks, J. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012079 · Cited by 345 · see citing works
Conservative prevention and management of pelvic organ prolapse in women
Hagen, S., & Stark, D. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003882.pub4 · Cited by 326 · see citing works
Reliability of pelvic floor muscle strength assessment using different test positions and tools
Frawley, H., Galea, M. P., Phillips, B. A., Sherburn, M., & Bø, K. (2005) · Neurourology and Urodynamics · doi:10.1002/nau.20201 · Cited by 240 · see citing works
Dumoulin, C. L., Hay-Smith, J. E., Habée-Séguin, G. M., et al. (2014) · Neurourology and Urodynamics · doi:10.1002/nau.22700 · Cited by 199 · see citing works
Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer
Ferreira, C. H. J., Barbosa, P. B., Souza, F. D. O., Antônio, F. I., Franco, M. M., & Bø, K. (2010) · Physiotherapy · doi:10.1016/j.physio.2010.06.007 · Cited by 190 · see citing works
Wynants, L., Bouwmeester, W., Moons, K. G. M., Moerbeek, M., Timmerman, D., Huffel, S. V., CALSTER, B. V., & Vergouwe, Y. (2015) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2015.02.002 · Cited by 178 · see citing works
Comparative assessment of pelvic floor strength using a perineometer and digital examination
Isherwood, P. J., & Rane, A. (2000) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2000.tb10404.x · Cited by 168 · see citing works
Li, C., Gong, Y., & Wang, B. (2016) · International Urogynecology Journal · doi:10.1007/s00192-015-2846-y · Cited by 154 · see citing works
The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA
Shah, A. D., Kohli, N., Rajan, S. S., & Hoyte, L. P. J. (2007) · International Urogynecology Journal · doi:10.1007/s00192-007-0457-y · Cited by 147 · see citing works
Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse
Vakili, B., Zheng, Y. T., Loesch, H., Echols, K. T., Franco, N., & Chesson, R. R. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.11.022 · Cited by 131 · see citing works
Navarro-Brazález, B., Torres-Lacomba, M., de la Villa, P., Sánchez-Sánchez, B., Prieto-Gómez, V., Asúnsolo, Á., & McLean, L. (2017) · Neurourology and Urodynamics · doi:10.1002/nau.23287 · Cited by 126 · see citing works
Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study
McClurg, D., Hilton, P., Dolan, L., Monga, A., Hagen, S., Frawley, H., & Dickinson, L. (2014) · International Urogynecology Journal · doi:10.1007/s00192-013-2301-x · Cited by 45 · see citing works
Stanford, E. J., Cassidenti, A. P., & Moen, M. D. (2011) · International Urogynecology Journal · doi:10.1007/s00192-011-1584-z · Cited by 44 · see citing works
Pelvic muscle exercises: physiotherapy for the pelvic floor.
Laycock, J. (1994) · PubMed · Cited by 37 · see citing works
The natural history of cystocele recurrence
Dietz, H. P., Hankins, K. J., & Wong, V. (2014) · International Urogynecology Journal · doi:10.1007/s00192-014-2339-4 · Cited by 22 · see citing works
Perineometer and digital examination for assessment of pelvic floor strength
Uyar, Y., BAYTUR, Y. B., & Inceboz, U. S. (2007) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2007.03.015 · Cited by 15 · see citing works
Measurement of pelvic floor muscular strength with the Colpexin pull test: a comparative study
Jean‐Michel, M., Biller, D. H., Bena, J., et al. (2010) · International Urogynecology Journal · doi:10.1007/s00192-010-1130-4 · Cited by 9 · see citing works
Zebede, S., Smith, A. L., Lefevre, R., Aguilar, V. C., & Davila, G. W. (2012) · International Urogynecology Journal · doi:10.1007/s00192-012-1862-4 · Cited by 8 · see citing works
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Mastwyk, S., McClelland, J., Rosamilia, A., & Frawley, H. (2019) · Neurourology and Urodynamics · doi:10.1002/nau.24025 · Cited by 5 · see citing works
Kearney, R., Wagg, A., Bower, W., Chapple, C., Khullar, V., Robinson, D., Taithongchai, A., Hobson, P. T., Wein, A., & Abrams, P. (2026) · Neurourology and Urodynamics · doi:10.1002/nau.70272 · Cited by 1 · see citing works
- Authors
- Schachar, J. S., Devakumar, H., Martin, L., Farag, S., Hurtado, E. A., & Davila, G. W.
- Affiliations
- Cleveland Clinic Florida (US)
- Corresponding author
- Schachar, Jeffrey S.
- Venue
- International Urogynecology Journal
- Published
- 2018-03-19
- Volume
- 29
- Issue
- 11
- Pages
- 1661-1667
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- OpenAlex
- W2792839991
- Cited by
- 9
- References
- 30
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- International Urogynecological Association
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- pelvic floor muscle weakness, cystocele, prolapse recurrence, Oxford scale, composite failure, pelvic organ prolapse surgery
- MeSH terms
- Aged, Female, Humans, Middle Aged, Postoperative Period, Recurrence, Reoperation, Retrospective Studies, Risk Factors, Uterine Prolapse, Vagina, Treatment Outcome, Pelvic Floor, Muscle Weakness, Plastic Surgery Procedures, Muscle Strength, Pelvic Floor Disorders
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