Skip to main content
NCBI home page
BMC Urology logoLink to BMC Urology
. 2026 Jul 9;26:232. doi: 10.1186/s12894-026-02230-1

Pelvic floor muscle training for pelvic organ prolapse: A systematic review and meta-analysis of randomized controlled trials

Zhicheng Cong 1, Zhao Wang 1, Junyi Sun 1, Zhengyan Tang 1,2,✉, Wenjie Yan 1,3,✉
PMCID: PMC13632309  PMID: 42420951

Abstract

Background

Pelvic organ prolapse (POP) substantially affects women’s health and quality of life. Pelvic floor muscle training (PFMT) is a promising conservative treatment for POP, but evidence from randomized controlled trials (RCTs) remains diversity. This systematic review and meta-analysis aimed to evaluate the effectiveness of PFMT for POP.

Methods

We conducted a systematic review by using the PICOS framework, including RCTs that aimed to compare PFMT with other conservative treatments for POP. Outcomes included POP Symptom Score (POP-SS), POP Quantification (POP-Q), self-reported symptom improvement, and pelvic floor muscle function (sEMG-MVC, endurance, Modified Oxford Grading).

Results

A total of 16 studies were included in this meta-analysis. Compared with the control group, PFMT group was associated with lower POP-SS, higher sEMG-MVC, and greater pelvic floor muscle endurance. PFMT also improved self-reported symptom improvement, overall POP-Q stage, and anterior vaginal wall prolapse. No clear benefit was seen for posterior vaginal wall prolapse or Oxford grade. Short-term PFMT (≤ 6 months) showed beneficial effects, whereas long-term efficacy (> 6 months) and effects in individuals aged ≥ 55 years were not statistically significant.

Conclusions

PFMT may improve short-term symptoms and pelvic floor muscle function in women with POP. However, long-term efficacy and effects in older women remain uncertain and require further investigation.

Trial registration

Not applicable.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12894-026-02230-1.

Keywords: Pelvic organ prolapse, Pelvic floor muscle training, Systematic review, Meta-analysis, Randomized controlled trial, Conservative treatment.

Background

Pelvic organ prolapse (POP) is the descent of one or more of the pelvic organs (uterus, vagina, bladder, or bowel) [1]. POP is a common clinical condition in women, the pelvic organs descend due to weakness or damage to the muscles and connective tissues which normally support them [2, 3]. POP can have a significant negative impact on patients’ quality of life, and produce symptoms secondary to weakened pelvic floor support structures, vaginal bulge, urinary disorder, intestinal and sexual dysfunction [4–6].

At present, there are many treatment schemes for POP, which can be roughly divided into conservative treatments and surgical treatments, both of which have distinctive advantages and disadvantages [7]. Conservative treatments usually include: pelvic floor muscle training (PFMT), pessary, electro-stimulation and so on. Among them, PFMT occupies an undeniable position [8, 9]. PFMT is usually recommended as a conservative treatment of POP or an adjuvant treatment in POP surgical management [10–13]. PFMT was initially proposed by researcher Arnold Kegel, in the beginning, it is used to treat urinary and gynecological dysfunction by strengthening pelvic floor muscles(PFM) [14]. At the same time, it can also help patients to enhance sexual function, prevent the relaxation of PFM and provide treatment for POP [15].

To date, there is no reliable evidence that other exercise programs such as hypopressive exercise, yoga, etc. are more effective than PFMT for POP [16]. Although PFMT has been established as the first-line treatment for stress urinary incontinence (SUI), it has not yet reached the same level of evidence for POP treatment [17, 18]. Furthermore, the conclusions of existing RCTs in this field are divergent, the therapeutic effect of PFMT on POP remains undetermined. Moreover, there are differences in the measuring strategy of outcomes selected by different RCTs, which also brings difficulties to systematic assessment of the therapeutic effect of PFMT on POP.

The primary objective of this study is to provide a relatively systematic evaluation and review of existing RCTs, to evaluate the therapeutic effect of PFMT on POP comprehensively. Secondary, we expect to obtain updated evidence on the efficacy of PFMT for women with POP and to offer insights for designing future RCTs in this area.

Methods

This systematic review was designed and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines to ensure transparent, complete, and reproducible reporting of the review process. A PRISMA flow diagram and checklist are provided to document the study selection process and reporting completeness. And prospectively registered our protocol on PROSPERO (Registration number: CRD42024618189).

Selection criteria and data extraction

Using the PICOS framework, we would extract relevant variables from studies which meet the following criteria.

  • Population: Women over the age of 18 who have been diagnosed with POP without national or ethnic restrictions, and whose diagnosis criteria for POP are evaluated by professional doctors using the Pelvic Organ Prolapse Quantification System (POP-Q system). Recent postpartum women are excluded. Because the pelvic floor support structures have been extensively damaged and the prolapse is so severe that there is a clear indication for surgery. PFMT alone is difficult to produce measurable anatomical repositioning, Participants with stage IV prolapse are excluded.

  • Intervention: All PFMT programs that provide detailed implementation protocols will be included. Variations in the teaching methods of PFMT, types of contractions (fast or sustained), and the times of contractions are permitted. However, PFMT combined with other conservative treatments or surgical interventions is excluded.

  • Comparison: Watchful waiting or other types of conservative therapies including vaginal pessary, vaginal laser, lifestyle recommendations only, not muscle training or contractions for PFM.

  • Outcomes: The publication should include at least one of the following outcome measures of interest, such as self-reported change in prolapse symptoms, change in Pelvic Organ Prolapse Symptom Score (POP-SS), improvement in the severity stage of prolapse which was assessed using POP-Q system, change in total quality of life based on the validated Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7), evaluation of changes in PFM function by using Modified Oxford Grading (MOG), surface electromyography - maximal voluntary contraction (sEMG-MVC), and endurance of PFM as analysis criteria.

  • Study design: RCTs which explicitly reported first author, year of publication, trial location, training program of PFMT, trial length, and follow-up duration, outcome measures.

Data extraction was performed independently by two independent reviewers and disagreements were resolved by a third senior reviewer when necessary. The following information was extracted from each selected article: (1) author and year of publication; (2) Sample characteristics: age, disease type and BMI; (3) Study design; (4) Intervention measures: control group and experimental group; (5) Training characteristics: specific scheme and details of PFMT; (6) Follow up time and related information of different outcomes. All data items are listed and defined in a specific template. The reviewers used standardized templates for data extraction and included data from each study or group. For all outcomes, we reported the number of participants actually analyzed rather than intention-to-treat populations, as some studies had substantial dropout rates affecting specific measures.

Search strategy

A comprehensive literature search was performed in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science from inception to 16 November 2024. The search was restricted to English-language literature, and the search strategy combined medical subject headings and free text terms, with publication type restricted to RCTs. The search terms included: “pelvic organ prolapse”, “pelvic floor”, “pelvis”, “uterine prolapse”, “POP”, “pelvic organ”, “physical therapy modalities”, “PFMT”, “exercise”, “physical fitness”, “exercise training” and so on. This article is based on previously conducted studies and does not contain any new studies with human participants performed by any of the authors. The complete search strategy for each database is provided in Supplementary Table 1.

Two independent reviewers screened titles/abstracts and performed full-text assessments. Data extraction and risk-of-bias assessments were conducted independently by two paired reviewers. Disagreements of all stages were resolved through consensus discussion or adjudication by a third senior reviewer. Authors of trials were contacted for additional information when necessary.

Risk of bias assessment

Two independent reviewers used the Cochrane Risk of Bias tool to assess the methodological quality of included RCTs [19]. Disagreements were resolved by a third senior reviewer. The following domains were assessed: random sequence generation and allocation concealment (selection bias); blinding of participants and personnel (performance bias); blinding of assessment for POP symptoms, POP stage and other outcomes (detection bias); handling of incomplete outcome data (attrition bias); selective reporting (reporting bias); and other bias (including contamination with alternate PFMT regimen in intervention and control groups and adherence to structured PFMT in intervention group). Risk of bias judgment for each domain was classified as “low risk”, “high risk”, or “unclear risk” in accordance with the criteria for judgment in the “Risk of Bias” assessment tool. The quality of evidence was evaluated using the GRADE framework with five considerations (study limitations, inconsistency, imprecision, indirectness, publication bias).

Assessment of the quality of evidence

We used the five GRADE considerations (study limitations, inconsistency of effect, imprecision, indirectness and publication bias) to assess the quality of evidence. We used the methods and recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions using GRADEpro GDT software [19]. Two independent reviewers working independently assessed the quality of the evidence and reached a consensus on the downgrading decisions.

Statistical analysis

Only final assessment time points from each study were pooled in the primary meta-analysis to avoid multiple comparisons from the same participant cohort and reduce dependency between effect estimates. However, this approach does not account for substantial variation in follow-up durations across included studies, which may introduce time-lag bias and limit comparability between short-term and long-term outcomes.

For dichotomous outcomes, we reported treatment effects as risk ratios (RRs) and their 95% confidence intervals (95% CI). For continuous outcomes, we reported treatment effects as weighted mean difference (WMD) and their 95% CI. Means and standard deviations before and after intervention were used to calculate the WMDs and 95% CI [20–22]. Level of significance was set at P = 0.05 for all outcomes. Heterogeneity between pooled RCTs was achieved by χ2 test for heterogeneity and the I2 statistic. According to the Cochrane Handbook, I2 > 75% indicates considerable heterogeneity.

Publication bias was assessed visually using funnel plots for all main outcomes. But the number of studies included in each funnel plot ranged from 3 to 7. Funnel plots should be interpreted with caution because fewer than 10 studies were included for all outcomes and substantial heterogeneity was present in several analyses; thus, these figures do not represent a formal assessment of publication bias. Funnel plots are presented as Supplemental Fig. 1.

In some cases, we applied subgroup analyses with pre designed criteria (The specific subgroup analysis methods will be shown in detail in the following sections). Pre-specified subgroup analyses included intervention duration (≤ 6 vs. > 6 months), age (≥ 55 years), and prolapse site (anterior vs. posterior vaginal wall). All other subgroup analyses were exploratory. Several subgroup analyses were based on a small number of studies, resulting in limited statistical power; these analyses are hypothesis-generating only and not confirmatory.

Intention-to-treat (ITT) analyses were not available in most included RCTs; therefore, per-protocol (completer) analyses were used for all meta-analyses. Differential dropout across studies may introduce attrition bias. Sensitivity analyses based on ITT estimates were not feasible because insufficient ITT data were reported in the primary studies. All data were analyzed by using RevMan 5.3 (Cochrane Community, London, United Kingdom, June 2014).

Results

Characteristics of the studies included

After removing 1852 duplicate records, we initially screened a total of 4697 records based on their titles and abstracts, and excluded 4619 articles for various reasons. For the 78 articles retained, we assessed their eligibility for inclusion through full-text review. Through this process, 16 articles were ultimately included in our study [23–38]. The process of screening and selection are detailed in Fig. 1. The study by Page et al. did not explicitly mention PFMT, but it provided a relatively structured and reasonable pelvic floor exercise (PFE) protocol and course, with the treatment process supervised one-on-one by a pelvic floor physiotherapist, and thus was included in our meta-analysis [38]. The studies by Stüpp et al. and Resende et al. involved the same research population and provided identical data suitable for meta-analysis, complementing each other in terms of study design and execution [25, 26]. Caagbay et al. instructed the experimental group on PFMT and lifestyle advice through an informational flipchart [37]. Two studies by Due et al. involving the same study population but with different follow-up times and reported different results [31, 32]. Three studies limited their research population to women with POP aged at least 55 years old [29, 33, 35]. Among them, the study by Panman et al. reported the 2-year effects of the same population as in the study by Wiegersma et al. [29, 35] However, both studies provided analyses of relevant outcome indicators that could be used for subgroup analyses, and therefore they were both retained. The characteristics included in the study are detailed in Supplementary Table 2.

Fig. 1.

Fig. 1

Open in a new tab

The workflow for screening publications according to inclusion and exclusion criteria for this meta-analysis. Abbreviations: PFMT, pelvic floor muscle training; POP, pelvic organ prolapse; RCT, randomized controlled trial

Risk of bias assessments

The bias risk assessment results for included studies are shown in Fig. 2. Blinding of participants and personnel in PFMT is not feasible, therefore, the performance bias for each study was judged to be at high risk. In addition, one study did not report the method of random sequence generation, and one study explicitly recorded that blinding was not used during the study process [24, 27]. Due to the relatively poor adherence to PFMT as required on a regular program, loss to follow-up is not surprising. Under the conditions above, we ensured a moderate quality of the literature.

Fig. 2.

Fig. 2

Open in a new tab

Risk of bias graph summary of the articles included.Risk of bias was assessed using the Cochrane Risk of Bias tool across seven domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias

Assessment of the quality of evidence

The quality of evidence for each key outcome was rated using the GRADE approach, with detailed ratings provided in Supplemental Table 3. For most outcomes, evidence was downgraded due to serious inconsistency (substantial statistical heterogeneity) across studies, serious imprecision (small sample sizes, wide confidence intervals or low event numbers), and potential publication bias. Only the overall POP-Q stage improvement was rated as high-quality evidence, as it showed no significant heterogeneity and relatively precise estimates. All other key outcomes were rated as moderate, low, or very low certainty. Notably, long-term outcomes (> 6 months) and results in patients aged ≥ 55 years were downgraded to very low certainty owing to extreme heterogeneity, wide confidence intervals, and small numbers of studies. Overall, the certainty of evidence for the main outcomes of this meta-analysis was low to moderate.

Outcomes

The included 16 RCTs comprised a total of 2063 women who received PFMT or other conservative treatments. Information from each study is summarized in Supplemental Table 2. The Actual numbers of participants per group for each analysis were provided detailly in Supplemental materials 5. There are some differences in measured outcomes and follow-up time reported in those RCTs.

POP-SS

The Pelvic Organ Prolapse Symptom Score (POP-SS) is a tool used to assess symptoms of pelvic organ prolapse, with higher scores indicating more severe symptoms [39]. Three studies reported changes in POP-SS scores that were suitable for meta-analysis [23, 28, 34]. All three studies provided improvements in POP-SS scores at different time points, ranging from 20 weeks to 2 years. By pooling the results from all studies at the final assessment time point, the results showed that PFMT had a significant effect on improving POP-SS scores (WMD − 2.43, 95% CI − 3.70, − 1.15, P = 0.04; I2 = 69%; Fig. 3).

Fig. 3.

Fig. 3

Open in a new tab

POP-SS between PFMT and control group. Values are presented as weighted mean difference (WMD) with 95% confidence interval (CI). A lower POP-SS indicates less severe prolapse symptoms

Self-reported change in prolapse symptoms

Self-reported change in prolapse symptoms is reported by the patients themselves, can directly reflect their subjective perception of symptom changes. The reported outcomes of Self-reported change in prolapse symptoms include better, no change, or worse. After receiving those interventions in each group, if participants reported “better”, we consider the treatment to have achieved relatively effective outcomes.

Seven studies presented Self-reported change in prolapse symptoms that were suitable for meta-analysis [23, 27, 28, 31, 33, 35, 38]. Four of these studies provided improvements in Self-reported change in prolapse symptoms at different time points [23, 28, 31, 38]. By pooling the results from all studies at the final assessment time point, the results showed that PFMT had a positive effect on improving Self-reported change in prolapse symptoms, but this result should be interpreted cautiously with substantial heterogeneity. (RR 2.43, 95% CI 1.35, 4.38, P < 0.00001; I2 = 89%; Fig. 4).

Fig. 4.

Fig. 4

Open in a new tab

Self-reported change in prolapse symptoms between PFMT and control group. Values are presented as relative risk (RR) with 95% CI. Improved symptoms were defined as patient-reported “better” after intervention

Subgroup analysis was conducted by using six months as the threshold to distinguish between short-term and long-term PFMT treatment. The results indicated that short-term PFMT provided benefits for the improvement of Self-reported change in prolapse symptoms (≤ 6 months: RR 3.00, 95% CI 1.96, 4.59, P = 0.73; I2 = 0%), while long-term PFMT showed inconclusive results with substantial heterogeneity precluding definitive conclusions (> 6 months: RR 1.37, 95% CI 0.84–2.24; P = 0.001; I²=81%; Fig. 5). Two studies focused on patients aged at least 55 years old, but subgroup analysis of these studies showed high heterogeneity, limiting interpretability of the pooled estimate (RR 1.52, 95% CI 0.41, 5.65, P = 0.0002; I2 = 93%; Fig. 6).

Fig. 5.

Fig. 5

Open in a new tab

Self-reported change in prolapse symptoms between PFMT and control group by subgroup of intervention period (Cutoff is 6 months). Values are presented as relative risk (RR) with 95% CI. Short-term: ≤6 months; long-term: >6 months

Fig. 6.

Fig. 6

Open in a new tab

Self-reported change in prolapse symptoms between PFMT and control group by subgroup of patients’ age (only greater than or equal 55 years old). Values are presented as relative risk (RR) with 95% CI

After excluding a relatively low-quality study with a high risk of detection bias, compared to the primary analysis, no significant changes were observed.

POP-Q

The Pelvic Organ Prolapse Quantification System (POP-Q) is a standardized system for assessing POP in women. It involves the quantitative measurement of six specific anatomical points on the anterior and posterior vaginal walls and the apex to describe and stage pelvic organ prolapse [40]. According to the POP-Q system, participants who have improved at least one stage will be considered to have received effective treatment. Six studies reported data on changes in POP-Q stage suitable for meta-analysis, with three studies involving prolapse of anterior vaginal wall, posterior vaginal wall, and apical vaginal wall [23, 24, 28, 33, 35, 37]. Improvement of POP-Q stage was defined as a reduction of at least one stage in POP-Q stage from pre-treatment to post-treatment. Analysis showed that the positive effect of PFMT on improving POP-Q stage is clinically suggestive but statistically inconclusive (RR 1.46, 95% CI 1.12, 1.91, P = 0.34; I2 = 12%; Fig. 7).

Fig. 7.

Fig. 7

Open in a new tab

POP-Q improvement between PFMT and control group. Values are presented as relative risk (RR) with 95% CI. Improvement was defined as ≥ 1-stage reduction in POP-Q stage

Subgroup analysis was conducted using six months as the threshold to distinguish between short-term and long-term PFMT treatment. Compared with other conservative treatments, short-term PFMT showed improvement in POP-Q stage (RR 1.51, 95% CI 1.06, 2.14, P = 0.46; I2 = 0%), while long-term PFMT did not demonstrate significant statistical differences (RR 1.13, 95% CI 0.50, 2.55, P = 0.09; I2 = 65%; Fig. 8). The two studies involving long-term PFMT focused on patients over 55 years of age, suggesting that the evaluation of long-term PFMT’s effect on POP-Q improvement may be influenced by this demographic factor.

Fig. 8.

Fig. 8

Open in a new tab

POP-Q improvement between PFMT and control group by subgroup of intervention period (Cutoff is 6 months). Values are presented as relative risk (RR) with 95% CI. Short-term: ≤6 months; long-term: >6 months

PFMT demonstrated a clinically relevant but statistically non-significant improvement on improving anterior wall prolapse (RR 1.98, 95% CI 1.38, 2.85, P = 0.57; I2 = 0%), but it did not show statistical differences for posterior wall prolapse (RR 1.26, 95% CI 0.59, 2.66, P = 0.28; I2 = 21%; Fig. 9). Only one study reported observations on changes in apical prolapse symptoms, indicating that PFMT did not produce significant improvement in apical prolapse [37].

Fig. 9.

Fig. 9

Open in a new tab

POP-Q improvement between PFMT and control group by subgroup of different wall of prolapse. Values are presented as relative risk (RR) with 95% CI

The changes of PFM

The strength of PFM can be assessed through various methods. The Modified Oxford Grading (MOG) is a quantification standard for assessing PFM strength [41]. Surface electromyography (sEMG) can evaluate the resting tone, maximum voluntary contraction (MVC) and endurance of PFM. The sEMG-MVC is a widely used indicator for assessing muscle function and can be utilized to evaluate the function and dysfunction of PFM [42, 43]. Using MOG, sEMG-MVC and endurance of PFM as analytical criteria, there are four studies reporting changes in PFM function suitable for meta-analysis [25, 26, 30, 36]. PFMT did not show statistical difference in its effect on MOG between the two groups (RR 0.90, 95% CI 0.62, 1.18, P = 0.59; I2 = 0%; Fig. 10a). However, PFMT demonstrated a numerical increase of MVC (sEMG-MVC: WMD 5.10, 95% CI 3.88, 6.32, P = 0.59; I2 = 0%; Fig. 10b) and endurance of PFM (WMD 3.37, 95% CI 1.91, 4.83, P = 0.04; I2 = 76%; Fig. 10c). But those results should be interpreted cautiously given the potential for ecological bias and heterogeneity.

Fig. 10.

Fig. 10

Open in a new tab

Comparisons of pelvic floor muscle (PFM) function outcomes between PFMT and control groups: (a) muscle power grade (MOG); (b) surface electromyography-maximal voluntary contraction (sEMG-MVC); (c) endurance of PFM. Values are presented as weighted mean difference (WMD) with 95% CI

Discussion

This meta-analysis aims to analyze the therapeutic effects of PFMT on POP, provide clinical recommendations for healthcare professionals, and inform the direction of future designs of RCTs in this field. By meticulously selecting outcome measures from included studies, we had analyzed the therapeutic effects of PFMT on POP systematically. In comparison with previous studies, this meta-analysis was designed to update the existing evidence, ameliorate the limitations of current systematic reviews in this field, and rectify the analytical strategies in prior meta-analyses that we deem to be flawed.

Overall, this meta-analysis revealed that PFMT can improve several important outcomes in patients with POP, but the evidence was moderate, low or even very low-quality (see Supplemental Table 3). The results of meta-analysis suggested that PFMT was associated with improvement in POP-SS, POP-Q stage, anterior vaginal wall prolapse, self-reported change in prolapse symptoms, sEMG-MVC and Endurance of PFM. However, PFMT did not demonstrate significant benefits for posterior vaginal wall prolapse or the MOG of PFM.

This meta-analysis classified outcomes into three categories: symptom-based (POP-SS, self-reported symptoms), anatomical (POP-Q stage, anterior/posterior wall prolapse), and pelvic floor muscle function (MOG, sEMG-MVC, endurance). These three types of outcomes are conceptually distinct and should not be treated as equivalent measures of treatment effect. Improvements in muscle function do not necessarily mean anatomical improvement of prolapse. In addition, pooling highly heterogeneous outcomes may overestimate the consistency of observed effects, which represents a potential limitation.

In comparison with previous studies, this meta-analysis was designed to update the existing evidence, ameliorate the limitations of current systematic reviews in this field, and rectify the analytical strategies in prior meta-analyses that we deem to be flawed. The selection of relevant evaluation metrics was updated at the same time as the study and the improvement of said metrics was assessed. For example, we utilize MOG, sEMG-MVC and endurance of PFM as outcome measures in our study. As the manners recommended by the International Continence Society (ICS), the function of PFM can be evaluated by visual inspection, digital palpation, ultrasound, MRI, manometer, and electromyography [44]. Although MOG, sEMG-MVC and endurance of PFM are correlated, each of them reflects distinct aspect of PFM function. For RCTs focusing on the treatment of POP with PFMT, incorporating these metrics allows for a quantitative assessment of pelvic anatomical restoration and improvements in PFM function.

The limitations of this study are mainly the limited number of studies and the quality of evidence. The differences highlighted by the subgroup analysis between short-term and long-term PFMT treatment effects are generally consistent with the results reported in extant studies [2, 45]. Short-term PFMT (≤ 6 months) showed positive improvements in self-reported change in prolapse symptoms and POP-Q stage. In contrast, long-term PFMT (> 6 months) did not show statistical differences in treatment effects, particularly among individuals aged ≥ 55 years. To provide new high-quality evidences that support clinical decision-making, there is an urgent need for additional high-quality RCTs, particularly those with follow-up periods exceeding 6 months.

Among the studies included in our review, only two focused on women aged at least 55 years old. Factors such as declining hormone levels, comorbidities, age-related loss of muscle mass, and aging of the PFM may have a more negative impact on older women with POP [46, 47]. These factors may also increase complexity due to potential confounding effects related to aging and underlying conditions. Moreover, the perioperative tolerance, compliance, and acceptance of surgical treatment in elderly female POP participants are sometimes worse than those in other age groups. For elderly POP female participants, conducting more RCTs focusing on PFMT treatment plans for perimenopausal women with POP will help better guide clinical practice and address related clinical issues.

POP has a significantly negative impact on women’s quality of life in aspects of biological, physical, psychological and social [48, 49]. Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and the Pelvic Floor Distress Inventory-20 (PFDI-20) are both questionnaires designed to assess the impact of pelvic floor health problems on women’s quality of life [50]. In the studies included in this review, four studies reported the changes in PFDI-20 scores [31–33, 35], and three studies reported the changes in PFIQ-7 scores [31, 32, 35]. However, only the results reported by U. Due et al. could be used for meta-analysis [32].

In the studies by U. Due et al., the 6-month follow-up results showed no significant difference in PFDI-20 score changes between the Lifestyle advice and Lifestyle advice with PFMT groups [32]. The Lifestyle advice group showed better improvement in the bowel subscale (CRAIQ-7) of the PFIQ-7 scores. The 12-month follow-up results suggested that both groups showed improvements in PFDI-20 and PFIQ-7 scores [31, 32]. In the study by C. M. C. R. Panman et al., the PFDI-20 scores in the PFMT group decreased at 3 months but slowly increased thereafter, and by 24 months, it was almost equal to the baseline score. In contrast, the improvement in PFDI-20 scores in the pessary group remained until the end of the study [33]. In another study by C. M. C. R. Panman et al., the 24-month follow-up results indicated that, for both PFMT and Watchful waiting groups, analyses of the PFDI-20 subscales indicated improvements in the PFMT group in terms of prolapse (POPDI-6), anorectal (CRADI-8), and urinary (UDI-6) symptoms [35]. However, there was no statistical difference in changes in PFIQ-7 scores between the two groups. In summary, current RCTs are unable to definitively establish the effectiveness of PFMT in improving PFDI-20 and PFIQ-7 scores. There is an urgent need for more high-quality RCTs in this field that focus on quality of life.

During the meta-analysis process, we excluded 12 studies that used PFMT as an adjunctive treatment for POP surgery. The high heterogeneity of these studies making it impossible to present as the method of meta-analysis. Results from nine of these studies indicated that compare to surgery alone, the addition of PFMT during surgery did not show obvious benefits [51–59]. Regardless of whether PFMT was used preoperatively, postoperatively, or both preoperatively and postoperatively, patients who underwent surgery alone and those who received PFMT as an adjunct to surgery both showed improvements in POP symptoms, urogenital symptoms, PFM function, and quality of life, with no obvious differences between groups.

The study by D. McClurg et al. suggested that patients who received PFMT both preoperatively and postoperatively reported no significant differences in symptoms compared to the control group at 6 months, but reported fewer symptoms at 12 months. However, the researchers also cautioned that these results should be interpreted with care, as they are primarily based on responses from one site [13]. The study by C. Brandt et al. concluded that PFMT after pelvic floor reconstructive surgery has not a beneficial impact on POP symptoms and quality of life, but have positive effect on pelvic and abdominal muscle function [60]. S. K. Jarvis et al. found that for incontinence and/or prolapse surgery, preoperative and postoperative PFMT can help improve surgical outcomes and quality of life for women, but this study did not report specific surgical procedures and did not strictly distinguish between incontinence and POP [61]. To sum up, there is currently no explicit evidence that PFMT as an adjunctive treatment for POP surgery can provide benefits to patients, and this area also requires more high-quality RCTs to provide relative data. Funnel plots for the main outcomes were generated to assess potential publication bias. Given the limited number of eligible studies per analysis, relevant statistical tests were not conducted.

Limitations of the study

Several limitations should be acknowledged when interpreting the findings of this systematic review and meta-analysis. Regarding the limitations of the included studies, most trials were associated with a high risk of performance bias due to the nature of pelvic floor muscle training, which cannot be fully blinded. Additionally, many included studies had small sample sizes, insufficient reporting of outcome indicators, and substantial clinical and statistical heterogeneity. Intervention protocols, outcome measurement tools, and follow-up durations also varied considerably across the randomized controlled trials.

Clinical heterogeneity was evident across included studies with regard to PFMT protocols, supervision intensity, training frequency, and patient adherence, which may have contributed to variability in treatment effects. Adverse events, potential harms, and patient burden associated with PFMT were not systematically evaluated or synthesized in this review. Therefore, the safety and tolerability of PFMT remain unclear. The conclusions of this meta-analysis are limited to the study populations and interventions included and cannot be broadly generalized beyond the available evidence.

For the limitations of the review process, this study was restricted to English-language publications of four major electronic databases (PubMed, CENTRAL, Embase, and Web of Science). Grey literature was not included, which may have resulted in potential missing studies. Potential reviewer subjectivity could not be fully eliminated despite dual independent review and third-party arbitration.

Only final follow-up time points were pooled across studies with widely varying follow-up durations, which may introduce time-lag bias and limit the comparability of short-term and long-term treatment effects. Time-stratified subgroup analyses were performed for several outcomes but were limited by the small number of studies in each stratum. This represents a major limitation of the present meta-analysis.

Regarding the meta-analysis, high statistical heterogeneity was observed in several outcome analyses. Some pooled results were based on a limited number of included studies, which reduced the reliability of the effect estimates. The use of per-protocol analyses rather than intention-to-treat (ITT) analyses may bias effect estimates owing to differential dropout in PFMT trials, which further reduces the certainty of evidence.

According to GRADE ratings, most outcomes were downgraded due to high heterogeneity, imprecision (small samples and wide confidence intervals), and potential publication bias. Long-term efficacy (> 6 months) and effects in patients aged ≥ 55 years were rated as very low certainty, indicating substantial uncertainty. No definitive conclusions can be drawn due to the overall low-to-moderate certainty of evidence.

Funnel plots were generated for exploratory purposes but cannot be considered a reliable assessment of publication bias, as all outcomes included fewer than 10 studies and several showed substantial heterogeneity. Many subgroup analyses were based on only a small number of studies, leading to low statistical power. Accordingly, these results should be considered hypothesis-generating rather than definitive. Conclusions regarding intervention duration and age effects were interpreted cautiously to avoid overstatement of findings from non-significant or highly heterogeneous results.

Finally, these findings are applicable to adult women with stage I–III pelvic organ prolapse, excluding women in the early postpartum period and those with stage IV prolapse. The long-term efficacy beyond 6 months and effects in elderly patients aged 55 years and older remain unclear due to limited evidence. Owing to the low-to-moderate quality of evidence, the conclusions of this review should be interpreted with caution.

Conclusions

Based on low-to-moderate certainty evidence, PFMT may provide improvements in pelvic organ prolapse symptoms, POP-SS, POP-Q stage, and some pelvic floor muscle function outcomes among women with stage I–III POP. Compared to other conservative treatment options, PFMT has a certain degree of therapeutic effectiveness in improving POP-SS, POP-Q stage, anterior vaginal wall prolapse, Self-reported change in prolapse symptoms, sEMG-MVC and endurance of PFM for POP patients. But PFMT does not present clear improvement for posterior vaginal wall prolapse and MOG of PFM. Subgroup analysis results indicate that compared to other conservative treatment options, short-term PFMT (≤ 6 months) has a positive effect on improving Self-reported change in prolapse symptoms and POP-Q stage. However, long-term PFMT (> 6 months) and long-term PFMT specifically targeting individuals aged ≥ 55 years do not show statistical effects on improving Self-reported change in prolapse symptoms and POP-Q stage. In addition, our systematic review was limited by the quality of the original data. However, the magnitude of benefit remains uncertain due to high risk of bias, substantial heterogeneity, and imprecision across included studies. Long-term efficacy beyond 6 months and effects in older women aged ≥ 55 years are particularly uncertain and cannot be confirmed due to very low–quality evidence. Future large, well-blinded, long-term RCTs with standardized protocols are needed to establish the efficacy, optimal duration, and long-term outcomes of PFMT for POP.

Supplementary Information

Supplementary Material 1 (234B, txt)
Supplementary Material 2 (22.4KB, docx)
Supplementary Material 3 (29.5KB, docx)
Supplementary Material 4 (12.5KB, xlsx)
Supplementary Material 5 (271.2KB, docx)
Supplementary Material 6 (24.2KB, docx)
Supplementary Material 7 (862KB, docx)
Supplementary Material 8 (48.2KB, docx)
Supplementary Material 9 (56.6KB, docx)
Supplementary Material 10 (1.4MB, docx)

Acknowledgements

We thank all researchers of the included studies for their contributions. No artificial intelligence (AI) or automated writing tools were used in the preparation of this manuscript.

Authorship

All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship.

Abbreviations

BMI

Body mass index

CENTRAL

Cochrane Central Register of Controlled Trials

CI

Confidence interval

GRADE

Grading of Recommendations Assessment, Development and Evaluation

ICS

International Continence Society

ITT

Intention-to-treat

MOG

Modified Oxford Grading

POP

Pelvic organ prolapse

POP-Q

Pelvic Organ Prolapse Quantification system

POP-SS

Pelvic Organ Prolapse Symptom Score

PFE

Pelvic floor exercise

PFIQ-7

Pelvic Floor Impact Questionnaire-7

PFDI-20

Pelvic Floor Distress Inventory-20

PFM

Pelvic floor muscles

PFMT

Pelvic floor muscle training

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PP

Per-protocol

PROSPERO

International Prospective Register of Systematic Reviews

RCT

Randomized controlled trial

RR

Risk ratio

sEMG-MVC

Surface electromyography-maximal voluntary contraction

SUI

Stress urinary incontinence

WMD

Weighted mean difference

Authors’ contributions

Z.C and Z.W designed the primary research protocol and wrote the main manuscript text.Z.C, Z.W, and J.S were responsible for the process of literature selection and screening. Z.C, Z.T, and W.Y had jointly conducted the data analysis and table preparation, and revised the manuscript.All authors reviewed the manuscript.

Funding

None. This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This study is a systematic review and meta-analysis based exclusively on previously published data. No new human or animal participants were involved; therefore, ethical approval and informed consent were not required. All included studies reported adherence to recognized ethical standards, such as the Declaration of Helsinki, and had obtained informed consent from their participants as stated in their original publications. Data privacy and confidentiality were maintained throughout the process, as no individual-level data were accessed or disclosed. The review protocol was registered in PROSPERO under registration number CRD42024618189, in accordance with best practices for systematic reviews and to ensure transparency and reproducibility.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Zhengyan Tang, Email: xytzyan@163.com.

Wenjie Yan, Email: 8301180215@csu.edu.cn.

References

  • 1.Baessler K, Christmann-Schmid C, Maher C, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018;8(8):Cd013108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Bø K, Anglès-Acedo S, Batra A, et al. International urogynecology consultation Chap. 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training. Int Urogynecol J. 2022;33(10):2633–67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Lubna R. Pathophysiology of Pelvic Organ Prolapse. In: Raheela MR, editor. Pelvic Floor Disorders. Rijeka: IntechOpen; 2018. Ch. 2. [Google Scholar]
  • 4.Raju R, Linder BJ. Evaluation and Management of Pelvic Organ Prolapse. Mayo Clin Proc. 2021;96(12):3122-9. [DOI] [PubMed]
  • 5.Robinson MO, Linder BJ. Evaluation and treatment of pelvic organ prolapse. Minerva Med. 2023;114(4):516–28. [DOI] [PubMed] [Google Scholar]
  • 6.Collins S, Lewicky-Gaupp C. Pelvic Organ Prolapse. Gastroenterol Clin North Am. 2022;51(1):177–93. [DOI] [PubMed] [Google Scholar]
  • 7.Tunn R, Baessler K, Knüpfer S, et al. Urinary Incontinence and Pelvic Organ Prolapse in Women. Dtsch Arztebl Int. 2023;120(5):71–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Basnet R. Impact of pelvic floor muscle training in pelvic organ prolapse. Int Urogynecol J. 2021;32(6):1351–60. [DOI] [PubMed] [Google Scholar]
  • 9.García-Sánchez E, Ávila-Gandía V, López-Román J et al. What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019;16(22):4358. [DOI] [PMC free article] [PubMed]
  • 10.Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;(12):Cd003882. [DOI] [PMC free article] [PubMed]
  • 11.Haya N, Feiner B, Baessler K, et al. Perioperative interventions in pelvic organ prolapse surgery. Cochrane Database Syst Rev. 2018;8(8):Cd013105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Lakeman MM, Koops SE, Berghmans BC, et al. Peri-operative physiotherapy to prevent recurrent symptoms and treatment following prolapse surgery: supported by evidence or not? Int Urogynecol J. 2013;24(3):371–5. [DOI] [PubMed] [Google Scholar]
  • 13.McClurg D, Hilton P, Dolan L, et al. Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study. Int Urogynecol J. 2014;25(7):883–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56(2):238–48. [DOI] [PubMed] [Google Scholar]
  • 15.Cho ST, Kim KH. Pelvic floor muscle exercise and training for coping with urinary incontinence. J Exerc Rehabil. 2021;17(6):379–87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Bø K, Anglès-Acedo S, Batra A, et al. Are hypopressive and other exercise programs effective for the treatment of pelvic organ prolapse? Int Urogynecol J. 2023;34(1):43–52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Culbertson S, Davis AM. Nonsurgical Management of Urinary Incontinence in Women. JAMA. 2017;317(1):79–80. [DOI] [PubMed] [Google Scholar]
  • 18.Todhunter-Brown A, Hazelton C, Campbell P, et al. Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2022;9(9):Cd012337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Higgins JPTTJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester (UK): John Wiley & Sons. 2019.
  • 20.Deeks J, Higgins J, Altman D. Chapter 10: Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions (64) Cochrane Training. 2023.
  • 21.Cai S, Zhou J, Pan J. Estimating the sample mean and standard deviation from order statistics and sample size in meta-analysis. Stat Methods Med Res. 2021;30(12):2701–19. [DOI] [PubMed] [Google Scholar]
  • 22.McGrath S, Zhao X, Steele R, et al. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res. 2020;29(9):2520–37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Hagen S, Stark D, Glazener C, et al. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(1):45–51. [DOI] [PubMed] [Google Scholar]
  • 24.Brækken IH, Majida M, Engh ME, et al. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e1-.e7. [DOI] [PubMed] [Google Scholar]
  • 25.Stüpp L, Resende APM, Bernardes BT, et al. Pelvic floor muscle training for treatment of pelvic organ prolapse: Randomized controlled trial. Neurourol Urodyn. 2010;29(6):1040–1. [Google Scholar]
  • 26.Resende APM, Stüpp L, Bernardes BT, et al. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse? Neurourol Urodyn. 2012;31(1):121–5. [DOI] [PubMed] [Google Scholar]
  • 27.Kashyap R, Jain V, Singh A. Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapse. Int J Gynaecol Obstet. 2013;121(1):69–73. [DOI] [PubMed] [Google Scholar]
  • 28.Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014;383(9919):796–806. [DOI] [PubMed] [Google Scholar]
  • 29.Wiegersma M, Panman CM, Kollen BJ, et al. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care. BMJ (Clinical Res ed). 2014;349:g7378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Alves FK, Riccetto C, Adami DBV, et al. A pelvic floor muscle training program in postmenopausal women: A randomized controlled trial. Maturitas. 2015;81(2):300–5. [DOI] [PubMed] [Google Scholar]
  • 31.Due U, Brostrøm S, Lose G. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial. Int Urogynecol J. 2016;27(4):555–63. [DOI] [PubMed] [Google Scholar]
  • 32.Due U, Brostrøm S, Lose G. The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse. Acta Obstet Gynecol Scand. 2016;95(7):811–9. [DOI] [PubMed] [Google Scholar]
  • 33.Panman CMCR, Wiegersma M, Kollen BJ, et al. Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care. Menopause. 2016;23(12):1307–18. [DOI] [PubMed] [Google Scholar]
  • 34.Hagen S, Glazener C, McClurg D, et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. Lancet (london england). 2017;389(10067):393–402. [DOI] [PubMed] [Google Scholar]
  • 35.Panman CMCR, Wiegersma M, Kollen BJ, et al. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care. BJOG: Int J Obstet Gynecol. 2017;124(3):511–20. [DOI] [PubMed] [Google Scholar]
  • 36.Resende APM, Bernardes BT, Stüpp L, et al. Pelvic floor muscle training is better than hypopressive exercises in pelvic organ prolapse treatment: An assessor-blinded randomized controlled trial. Neurourol Urodyn. 2019;38(1):171–9. [DOI] [PubMed] [Google Scholar]
  • 37.Caagbay D, Raynes-Greenow C, Dangal G, et al. Impact of an informational flipchart on lifestyle advice for Nepali women with a pelvic organ prolapse: a randomized controlled trial. Int Urogynecol J. 2020;31(6):1223–30. [DOI] [PubMed] [Google Scholar]
  • 38.Page AS, Borowski E, Bauters E, et al. Vaginal erbium laser versus pelvic floor exercises for the treatment of pelvic organ prolapse: A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol. 2024;303:165–70. [DOI] [PubMed] [Google Scholar]
  • 39.Hagen S, Glazener C, Sinclair L, et al. Psychometric properties of the pelvic organ prolapse symptom score. BJOG. 2009;116(1):25–31. [DOI] [PubMed] [Google Scholar]
  • 40.Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7. [DOI] [PubMed] [Google Scholar]
  • 41.Haslam J. Visiting Lecturer) JL. Therapeutic Management of Incontinence and Pelvic Pain. London, UK: Springer London; 2008. [Google Scholar]
  • 42.Brækken IH, Stuge B, Tveter AT, et al. Reliability, validity and responsiveness of pelvic floor muscle surface electromyography and manometry. Int Urogynecol J. 2021;32(12):3267–74. [DOI] [PubMed] [Google Scholar]
  • 43.de Oliveira Ferro JK, Lemos A, de Santana Chagas AC, et al. Techniques for Registration of Myoelectric Activity of Women’s Pelvic Floor Muscles: A Scoping Review. Int Urogynecol J. 2024;35(5):947–54. [DOI] [PubMed] [Google Scholar]
  • 44.Staskin D, Kelleher CJ, Avery K, et al. editors. Initial assessment of urinary and faecal incontinence in adult male and female patients2009.
  • 45.Wang T, Wen Z, Li M. The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis. Int Urogynecol J. 2022;33(7):1789–801. [DOI] [PubMed] [Google Scholar]
  • 46.Suskind AM, Zhao S, Boscardin WJ, et al. Comparative Outcomes for Pelvic Organ Prolapse Surgery among Nursing Home Residents and Matched Community Dwelling Older Adults. J Urol. 2021;205(1):199–205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Obinata D, Hara M, Hashimoto S, et al. Association Between Frailty and Pelvic Organ Prolapse in Elderly Women: A Retrospective Study. Int Urogynecol J. 2024;35(9):1889–98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Carroll L, C OS, Doody C, et al. Pelvic organ prolapse: The lived experience. PLoS ONE. 2022;17(11):e0276788. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Carroll L, Sullivan CO, Doody C, et al. Pelvic organ prolapse: Women’s experiences of Accessing Care & Recommendations for improvement. BMC Womens Health. 2023;23(1):672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. [DOI] [PubMed] [Google Scholar]
  • 51.Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Borello-France D, Newman DK, Markland AD et al. Adherence to Perioperative Behavioral Therapy With Pelvic Floor Muscle Training in Women Receiving Vaginal Reconstructive Surgery for Pelvic Organ Prolapse. Phys Ther. 2023;103(9):pzad059. [DOI] [PMC free article] [PubMed]
  • 53.Duarte TB, Bø K, Brito LGO, et al. Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial. J physiotherapy. 2020;66(1):27–32. [DOI] [PubMed] [Google Scholar]
  • 54.Frawley HC, Phillips BA, Bø K, et al. Physiotherapy as an adjunct to prolapse surgery: An assessor-blinded randomized controlled trial. Neurourol Urodyn. 2010;29(5):719–25. [DOI] [PubMed] [Google Scholar]
  • 55.Jelovsek JE, Barber MD, Brubaker L, et al. Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial. JAMA. 2018;319(15):1554–65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Liang Y, Li X, Wang J, et al. Effect of Pelvic Floor Muscle Training on Improving Prolapse-related Symptoms After Surgery. J Nurse Practitioners. 2019;15(8):600–5. [Google Scholar]
  • 57.Mathew S, Nyhus M, Salvesen Ø, et al. The effect of preoperative pelvic floor muscle training on urinary and colorectal-anal distress in women undergoing pelvic organ prolapse surgery-a randomized controlled trial. Int Urogynecol J. 2021;32(10):2787–94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Nyhus M, Mathew S, Salvesen Ø, et al. Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial. Ultrasound Obstet Gynecol. 2020;56(1):28–36. [DOI] [PubMed] [Google Scholar]
  • 59.Weidner AC, Barber MD, Markland A, et al. Perioperative Behavioral Therapy and Pelvic Muscle Strengthening Do Not Enhance Quality of Life After Pelvic Surgery: secondary Report of a Randomized Controlled Trial. Phys Ther. 2017;97(11):1075–83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Brandt C, van Vuuren ECJ. Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: a Randomized Controlled Clinical Trial. Physiotherapy Can Physiotherapie Can. 2022;74(2):126–38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Jarvis SK, Hallam TK, Lujic S, et al. Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: Results of a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2005;45(4):300–3. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (234B, txt)
Supplementary Material 2 (22.4KB, docx)
Supplementary Material 3 (29.5KB, docx)
Supplementary Material 4 (12.5KB, xlsx)
Supplementary Material 5 (271.2KB, docx)
Supplementary Material 6 (24.2KB, docx)
Supplementary Material 7 (862KB, docx)
Supplementary Material 8 (48.2KB, docx)
Supplementary Material 9 (56.6KB, docx)
Supplementary Material 10 (1.4MB, docx)

Data Availability Statement

No datasets were generated or analysed during the current study.

Articles from BMC Urology are provided here courtesy of BMC

RESOURCES