Pelvic floor muscle training can improve symptoms in women with pelvic organ prolapse and may help to reverse prolapse.

Question: Does pelvic floor muscle training reverse pelvic organ prolapse and improve symptoms in women with pelvic organ prolapse? Design: Randomised, controlled trial with concealed allocation and blinded outcome assessment. Setting: A university hospital and physiotherapy clinic in Norway. Participants: Women with pelvic organ prolapse were included. Key exclusion criteria were pelvic organ prolapse stage IV (complete vaginal eversion), inability to contract the pelvic floor muscles, and previous pelvic organ prolapse surgery. Randomisation of 109 participants allocated 59 to the intervention group and 50 to a control group. Interventions: Both groups received lifestyle advice and were taught how to contract their pelvic floor muscles before and during increases in abdominal pressure (‘the Knack’). In addition, the intervention group completed pelvic floor muscle training over 6 months. Women received up to 18 sessions supervised by a physiotherapist, a booklet and DVD showing the program, and were advised to do 3 sets of 8 to 12 close to maximum pelvic floor muscle contractions per day at home. The control group received no other intervention. Outcome measures: The primary outcomes assessed at 6 months were: change in severity of pelvic organ prolapse according to the pelvic organ prolapse classification (POP-Q) system, stage 0 (no prolapse) to stage IV; position of bladder and rectum assessed by ultrasound; and improvement in frequency and bother of prolapse symptoms (feeling of vaginal bulging/heaviness) assessed on 4-point scales by questionnaire. Results: 107 participants completed the study. Women in the intervention group adhered to 89% of prescribed exercise sessions and no adverse events were reported. At 6 months, more women in the intervention group (11, 19%) compared with the control group (4, 8%) had improved POP-Q stage, (Number needed to treat [NNT] 10, 95% CI > 4.2). At 6 months, women in the intervention group had a greater elevation of the bladder (mean difference 3.0 mm, 95% CI 1.5 to 4.4) and rectum (mean difference 5.5. mm 95% CI 1.4 to 7.3) compared with the control group. At 6 months more women in the intervention group had reduced frequency (NNT 3, 95% CI 1.5 to 4.6) and bother of prolapse symptoms (NNT 4, 95% CI 2.1 to 65.0). Conclusion: Daily pelvic floor muscle training over 6 months can improve symptoms in women with pelvic organ prolapse and may help to reverse the development of the prolapse.