Supervised exercise and pelvic floor muscle training eases current pelvic and genital pain but not worst pelvic and genital pain in women with endometriosis: a randomised trial

QUESTION: How much does adding supervised group and independent individual exercise including pelvic floor muscle training (PFMT) to multidisciplinary pain management affect pelvic and genital pain in women with endometriosis? How much does it affect dyspareunia, dysuria, quality of life (with emphasis on psychological distress, including symptoms of depression and anxiety), symptoms of chronic constipation and pelvic floor muscle (PFM) function? DESIGN: A two-armed, parallel-group, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. PARTICIPANTS: Women aged 18 to 45 years with laparoscopically confirmed endometriosis experiencing pelvic/genital pain. INTERVENTION: All participants attended a pain management course. The exercise group (n = 41) then performed weekly supervised general exercise training including PFMT for 4 months, and home training two to three times/week. The control group (n = 40) received no further intervention. OUTCOME MEASURES: Primary outcomes were the change in worst pelvic/genital pain over 1 month and current pelvic/genital pain measured on a numerical rating scale at 4 and 12 months. Secondary outcomes measured at the same time points were: location and concerns related to dyspareunia; presence of dysuria; symptoms of chronic constipation assessed with the Knowles-Eccersley-Scott-Symptom scale; and quality of life with emphasis on psychological distress, including symptoms of depression and anxiety assessed with Hopkins Symptom Checklist-5. PFM function was measured with surface electromyography and manometry at baseline and 4 months. RESULTS: The intervention did not improve worst pelvic/genital pain but it did have a clear benefit on current pelvic/genital pain at the end of the intervention (MD 1.1, 95% CI 0.2 to 2.1). This benefit was still present at the 12-month follow-up (MD 1.5, 95% CI 0.2 to 2.7). The effects on other outcome measures were unclear. CONCLUSION: Adding supervised group and independent individual exercise including PFMT to pain management did not improve worst pelvic/genital pain but improved current pelvic/genital pain. Effects on other outcomes warrant further investigation. REGISTRATION: NCT05091268.