Objective Changes in Pelvic Floor Muscle Strength and Length in Women With High-Tone Pelvic Floor Dysfunction After Pelvic Floor Physical Therapy (RELAX Trial).
Level 4 - case-series / case-control
Single-arm prospective pre-post study without a control group (case series).
PubMed 37093578 · doi:10.1097/SPV.0000000000001355
What was done
A prospective cohort study evaluated 26 women (22 completed) undergoing 6 sessions of pelvic floor physical therapy (PFPT) for high-tone pelvic floor dysfunction (HTPFD). Intravaginal squeeze closure force was measured using an instrumented speculum, levator hiatal dimensions were assessed via 3-dimensional endovaginal ultrasonography, and symptom severity was tracked using 3 validated questionnaires across visits up to session 6.
What was found
Vaginal closure force did not change significantly from baseline to session 6 (mean ± SD: 3.27 ± 2.34 N vs 3.67 ± 2.02 N, P = 0.18). Levator hiatal area increased significantly from 13.71 ± 1.77 cm² to 14.43 ± 2.17 cm² (P = 0.05), and transverse diameter increased from 3.83 ± 0.03 cm to 3.95 ± 0.03 cm (P = 0.04). Validated surveys demonstrated significant improvements across all genitourinary, lower gastrointestinal, pain, and quality-of-life measures.
Why it matters
These findings suggest that symptomatic relief from physical therapy in high-tone pelvic floor dysfunction may relate to muscle lengthening rather than measurable alterations in voluntary squeeze closure force.
Limits
The study is limited by a small sample size (n = 22 analyzed) and a single-arm, uncontrolled observational design, preventing causal attribution. Follow-up concluded immediately after 6 sessions, so long-term durability is unassessed.
Cited by
- supports Performing Kegel exercises can exacerbate symptoms in individuals who have a tight or hypertonic pelvic floor.