Authors (including presenting author) :
So YM, Choi WW, Fung YK
Affiliation :
Physiotherapy Department, Tseung Kwan O Hospital(TKOH)
Keyword 1: :
Pelvic Floor Muscle Prehabilitation
Keyword 3: :
Gynecological Surgery
Introduction :
Enhanced Recovery After Surgery(ERAS) programs traditionally emphasize cardiopulmonary conditioning and physical fitness to reduce postoperative complications. Gynecological surgery adds risk to pre existing pelvic floor muscle(PFM) dysfunction and may lead to postoperative urinary incontinence(UI) and pelvic organ prolapse, both of which significantly affect quality of life. To address this concern, TKOH incorporated structured PFM prehabilitation into the gynecological ERAS pathway.
Objectives :
1. To strengthen and improve PFM control prior to elective gynecological surgery.
2. To reduce the risk of postoperative PFM deterioration and UI.
Methodology :
All patients enrolled in the TKOH gynecological ERAS program received standard ERAS components. Preoperative pelvic floor screening was conducted in Preoperative Clinic(T1) and patients were triaged into:
-At Risk Group: Patients with any risk factor (hysterectomy, age >50, obesity, diabetes, or spontaneous vaginal delivery) but without UI. They attended a preoperative education and exercise class covering home PFM exercises, bladder health and lifestyle advice.
-Dysfunction Group: Patients presenting with UI, presumed to have weak PFM. They received a detailed PFM assessment and a course of individual PFM training including electrical stimulation therapy if indicated.
Outcomes were reviewed when completed prehabilitation(T2) and post-operative rehabilitation(T3) using:
-At-Risk Group: UI symptoms
-Dysfunction Group: UI symptoms, International Consultation on Incontinence Questionnaire–Short Form(ICIQ SF), Urogenital Distress Inventory 6(UDI 6), Incontinence Impact Questionnaire 7(IIQ 7). Parametric t-test were used to compared in-group difference.
Result & Outcome :
From July 2020 to September 2025, a total of 904 patients were screened. 266 patients were triaged into the at-risk group and able to attend the preoperative class, 94.7% reported no symptoms of UI postoperatively. 95 patients were triaged into the dysfunction group, 43 of them attended an average of 3.8(Standard Deviation(SD)=2.8) prehabilitation and 4.4(SD=4.0) rehabilitation sessions. The average UDI-6 and IIQ-7 scores significantly improved from T1 to T2(31.4 vs 21.2, p=0.004) and from T2 to T3(22.1 vs 9.5, p=0.001). The average ICIQ-SF score significantly improved from T1 to T2(9.3 vs 6.6, p=0.0001) and from T2 to T3(6.5 vs 3.6, p=0.0001). Patients also reported a subjective improvement of 59% at T2 and further improved to 84% at T3. Conclusion:
Integrating PFM prehabilitation into the gynecological ERAS pathway effectively optimizes pelvic floor function and reduces postoperative dysfunction. Early screening and targeted physiotherapy interventions particularly for patients with pre existing UI demonstrate meaningful improvements in symptoms and recovery outcomes.
