Skip to main content

A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse


Forty-seven women participated in a pilot study for a multi-centre randomized controlled trial of the effectiveness of pelvic floor muscle training (PFMT) for women with prolapse. Women with symptomatic stage I or II prolapse [measured by Pelvic Organ Prolapse Quantification (POP-Q)] were randomized to a 16-week physiotherapy intervention (PFMT and lifestyle advice; n = 23) or a control group receiving a lifestyle advice sheet (n = 24). Symptom severity and quality of life were measured via postal questionnaires. Blinded POP-Q was performed at baseline and follow-up. Intervention women had significantly greater improvement than controls in prolapse symptoms (mean score decrease 3.5 versus 0.1, p = 0.021), were significantly more likely to have an improved prolapse stage (45% versus 0%, p = 0.038) and were significantly more likely to say their prolapse was better (63% versus 24%, p = 0.012). The data support the feasibility of a substantive trial of PFMT for prolapse. A multi-centre trial is underway.

This is a preview of subscription content, access via your institution.


  1. Abrams P, Cardozo L, Khoury S, Wein A (eds) (2005) Incontinence: 3rd International Consultation on Incontinence, 3rd edn. Health Publications Ltd., Paris

  2. Hagen S, Stark D, Cattermole D (2004) A United Kingdom-wide survey of physiotherapy practice in the treatment of pelvic organ prolapse. Physiotherapy 90(1):19–26

    Article  Google Scholar 

  3. Hay-Smith EJC, Dumoulin C (2006) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, Issue 1. Art. No.:CD005654. doi:10.1002/14651858.CD005654

  4. Hagen S, Stark D, Maher C, Adams E. Conservative management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD003882. doi:10.1002/14651858.CD003882.pub3

  5. Piya-Anant M, Therasakvichya S, Leelaphatanadit C, Techatrisak K (2003) Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assos Thail 86:509–515

    Google Scholar 

  6. Ghroubi S, Kharrat O, Chaari M, Ben Ayed B, Guermazi M, Elleuch MH (2008) Effect of conservative treatment in the management of low-degree urogenital prolapse. Ann Readapt Med Phys 51:96–102

    PubMed  CAS  Google Scholar 

  7. Bump R, Anders M, Bo K, Brubaker LP, O’Lancey J, Klarskov P, Shull BL, Smith RB (1996) The standardisation of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    PubMed  Article  CAS  Google Scholar 

  8. Laycock J, Jerwood D (2001) Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy 87(12):631–642

    Article  Google Scholar 

  9. Miller JM, Ashton-Miller JA, DeLancey JOL (1998) A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc 46(7):870–874

    PubMed  CAS  Google Scholar 

  10. Bugge C, Hagen S, Glazener C (2005) The POPPY study: a qualitative evaluation of a pelvic organ prolapse outcome questionnaire. ICS(UK), Glasgow

    Google Scholar 

  11. Avery K, Donovan J, Abrams P (2001) Validation of a new questionnaire for incontinence: the International Consultation on Incontinence Questionnaire (ICI-Q). Neurourol Urodyn 20(4):510–512

    Google Scholar 

  12. Abrams P, Avery K, Gardener N, Donovan J, on behalf of the ICIQ Advisory Board (2006) The International Consultation on Incontinence modular questionnaire: J Urol 175:1063–1066

    PubMed  Article  Google Scholar 

  13. Ware JE, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233

    PubMed  Article  Google Scholar 

  14. Bo K (2006) Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstet Gynecol 85:263–268

    Article  Google Scholar 

  15. Laycock J, Standley A, Crothers E, Naylor D, Garside S, Kiely E, Knight S, Pearson A (2001) Clinical guidelines for the physiotherapy management of females aged 16–65 with stress urinary incontinence. Chartered Society of Physiotherapy, London

    Google Scholar 

  16. National Institute for Health and Clinical Excellence (2006) The management of urinary incontinence in women. NICE, London

    Google Scholar 

  17. Bo K (1995) Pelvic floor muscle exercise for the treatment of stress urinary incontinence: an exercise physiology perspective. Int Urogynecol J 6:282–291

    Article  Google Scholar 

  18. Frawley HC, Galea MP, Phillips BA, Sherburn M, Bo K (2006) Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn 25:236–242

    PubMed  Article  Google Scholar 

Download references


Thanks are due to the participants who made the study possible and the staff; in Aberdeen, Chris Bain (Gynaecologist), Lynne Swan (recruitment), Sandra Whyte (intervention physiotherapist), Liz Crothers (intervention physiotherapist); and in Glasgow, Stewart Pringle (Gynaecologist), Sarah Hinks (recruitment), Jackie Montgomery (intervention physiotherapist), June McGourty (intervention physiotherapist) and Philippa Dall (data entry).


This study was funded by the Chief Scientist Office, Scottish Government (CZH/4/95).

Conflicts of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Suzanne Hagen.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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 20, 45–51 (2009).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Pelvic floor muscle training
  • Pelvic organ prolapse
  • Physiotherapy
  • pilot study
  • POP-Q