Pelvic floor muscle contraction-plus-relaxation versus relaxation-only with mindfulness for women with endometriosis-associated pelvic pain: A randomised controlled feasibility study

Introduction: Pelvic floor muscle (PFM) exercises are commonly prescribed to women with endometriosis-associated pelvic pain (EAPP) but the feasibility and effects of different PFM protocols remain unknown. Objectives: To evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) comparing PFM contraction-plus-relaxation (PFMC + R) and PFM relaxation-only (PFMR) protocols combined with mindfulness in women with EAPP, and to explore changes in pelvic pain and PFM morphometry. Methods: An 8-week hybrid intervention of PFMC + R or PFMR with mindfulness was evaluated in a feasibility RCT. Primary outcomes were feasibility and acceptability; secondary outcomes were EAPP symptoms and PFM morphometry. Results: Of 95 participants assessed for eligibility, 45 were randomised to PFMC + R ( n = 23) or PFMR ( n = 22). The PFMC + R group had higher retention (86% vs 63%) and acceptability rates (82% vs 63%), and greater improvements in pelvic pain (mean difference (MD) = −2.80, 95% confidence interval (CI) −4.22, −1.45), dyspareunia (MD = −2.43, 95% CI: −3.90, −1.03), anorectal angle (MD = 3.61, 95% CI: 2.52, 9.48) and levator hiatus (MD = 0.34, 95% CI: 0.14, 0.63) at rest than the PFMR group. Conclusion: The PFMC + R protocol was more feasible and acceptable than the PFMR protocol and demonstrated greater improvements in EAPP symptoms and PFM morphometry. Larger studies are needed to verify these findings. Trail Registration: The Australian New Zealand Clinical Trials Registry, registration number: ACTRN12622001393741, trial registry URL).