Effects of prehabilitation interventions on pelvic floor muscle outcomes in patients with gynecological cancers: a systematic review.

PURPOSE: Pelvic floor dysfunction (PFD) is a highly prevalent sequela of gynecological cancer therapy (surgery, radiotherapy, chemotherapy), severely impacting quality of life (QoL). This systematic review evaluates evidence on prehabilitation interventions initiated before or during primary cancer therapy for improving pelvic floor muscle (PFM) function, reducing PFD symptoms, and enhancing QoL.

METHODS

Following PRISMA 2020 guidelines, we searched MEDLINE, EMBASE, CINAHL, AMED, and Web of Science (2010–2025) for randomized controlled trials, cohort, and quasi-experimental studies. The review was prospectively registered (PROSPERO CRD42024580658). Included studies involved gynecological cancer patients receiving structured prehabilitation reporting PFM outcomes, PFD symptoms, or QoL. Risk of bias was assessed using JBI tools and GRADE.

RESULTS

Five heterogeneous studies (N = 255; endometrial, ovarian, cervical, uterine, vulvar cancers; mean age 42–66 years) were included. One comparative cohort study demonstrated improved postoperative recovery (6MWT: 404 m vs. 371 m, p < 0.001) and reduced complications (30% vs. 54%, p = 0.02). Uncontrolled studies showed potential benefits including improved lean mass (+ 1.0 kg, p = 0.015), reduced incontinence (urinary: 53.6%→46.4%; fecal: 39.3%→25.0%), and enhanced QoL domains, with adherence 52–98%. However, direct evidence for improved objective PFM strength remains lacking. Evidence quality was “very low” (GRADE) due to heterogeneity, uncontrolled designs, small samples, and moderate-to-high risk of bias.

CONCLUSION

Prehabilitation is feasible but evidence is insufficient for definitive conclusions on pelvic-floor-specific efficacy. Findings are hypothesis-generating. High-quality RCTs with standardized PFD outcome measures are urgently needed. This review identifies critical knowledge gaps and provides recommendations for future research.