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Pelvic Floor Disorders pp 661–665Cite as

Pelvic Floor Muscle Training in Prevention and Treatment of Pelvic Organ Prolapse

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Abstract

This chapter describes randomized controlled trials (RCTs) published on the effect of pelvic floor muscle training (PFMT) to treat anatomic pelvic organ prolapse (POP) and symptoms of prolapse. Eleven RCTs have been found and the results show a significant effect of PFMT on both stage of prolapse and symptoms. One research group used ultrasound to assess the position of the bladder and the rectal ampulla at rest, in addition to assessment of morphological changes of the pelvic floor muscles. There was a significant reduction in stage of prolapse, symptoms, bother, and increase in pelvic floor muscle strength. Significant hypertrophy of the pelvic floor muscles, shortening of muscle length, and narrowing of the levator hiatus were found in the treatment group only. The RCTs on PFMT for POP differ in training dosage such as intensity of the contractions, duration of the training period, and therapist contact. These factors are all known to affect outcome. Today there is 1A level of evidence that PFMT is effective in treating POP. Further studies are needed to understand differences between responders and nonresponders and especially the role of PFMT in primary prevention of POP.

Conclusion: There is 1A level evidence for PFMT in treatment of POP and there is no known side effects or complication. PFMT should therefore be first-line treatment.

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References

  1. Milsom I, Altman D, Cartwright R, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams PH, Cardoza L, Khoury AE, Wein A, editors. Incontinence, vol. 2. 6th ed. International Consultation on Urinary Incontinence, Plymbridge United Kingdom: Health Publication Ltd; 2015, p. 62.

    Google Scholar 

  2. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M. Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:497–503.

    Article  PubMed  Google Scholar 

  4. Slieker-Ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, et al. Symptomatic pelvic organ prolapse and possible risk factors in a general population. Am J Obstet Gynecol. 2009;200:184–7.

    Article  PubMed  Google Scholar 

  5. Lawrence JM, Lukacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008;111:678–85.

    Article  PubMed  Google Scholar 

  6. Mouritsen L. Classification and evaluation of prolapse. Best Pract Res Clin Obstet Gynaecol. 2005;19:895–911.

    Article  PubMed  Google Scholar 

  7. Miedel A, Tegerstedt G, Maehle-Schmidt M, et al. Symptoms and pelvic support defects in specific compartments. Obstet Gynecol. 2008;112(4):851–8.

    Article  PubMed  Google Scholar 

  8. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.

    Article  Google Scholar 

  9. Bo K, Frawley HC, Haylen BT, Abramov Y, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191–213.

    Article  PubMed  Google Scholar 

  10. Maher C, Baessler K, Barber M, et al. Pelvic organ prolapse surgery. In: Abrams PH, Cardoza L, Khoury AE, Wein A, editors. Incontinence, vol. 2. 6th ed. International Consultation on Urinary Incontinence, Plymbridge United Kingdom: Health Publication Ltd; 2015. p. 1855–992.

    Google Scholar 

  11. Thakar R, Stanton S. Management of genital prolapse. BMJ. 2002;324:1258–62.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Maher C, Feiner B, Baessler K, et al. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;(11):CD004014.

    Google Scholar 

  14. Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol. 2004;191:1533–8.

    Article  PubMed  Google Scholar 

  15. Handa VL, Garrett E, Hendrix S, et al. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190:27–32.

    Google Scholar 

  16. Miedel A, Ek M, Tegerstedt G, et al. Short-term natural history in women with symptoms indicative of pelvic organ prolapse. Int Urogynecol J. 2011;22(4):461–8.

    Article  PubMed  Google Scholar 

  17. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;(12):CD003882.

    Google Scholar 

  18. Dumoulin C, Hay-Smith EJ, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;(5):CD005654.

    Google Scholar 

  19. Dumoulin C, Bradley C, Burgio K, et al. Adult conservative management. In: Abrams PH, Cardoza L, Khoury AE, Wein A, editors. Incontinence, vol. 2. 6th ed. International Consultation on Urinary Incontinence, Plymbridge United Kingdom: Health Publication Ltd; 2016. p. 1443–628.

    Google Scholar 

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

    Article  Google Scholar 

  21. Piya-Anant M, Therasakvichya S, Leelaphatanadit C, Techatrisak K. 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. 2003;86:509–15.

    Google Scholar 

  22. Ghroubi S, Kharrat O, Chaari M. Effect of conservative treatment in the management of low-degree urogenital prolapse. Ann Readapt Med Phys. 2008;51:96–102.

    Article  CAS  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;20:45–51.

    Article  PubMed  Google Scholar 

  24. Brækken IH, Majida M, Ellstrom-Engh M, Bø K. Pelvic floor muscle training in treatment of pelvic organ prolapse a single blind randomised controlled trial. Neurourol Urodyn. 2009;28:663–4.

    Google Scholar 

  25. Brækken IH, Majida M, Ellstrom-Engh M, Bø K. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasound: a randomized controlled trial. Obstet Gynecol. 2010;115(Part I):317–24.

    Article  Google Scholar 

  26. Stupp L, Magalhaes Resende AP, Oliveira E, et al. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor blinded randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct. 2011;22(10):1233–9.

    Article  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.

    Article  PubMed  Google Scholar 

  28. Frawley HC, Hagen S, Sherburn M, et al. Changes in prolapse following pelvic floor muscle training: a randomised controlled trial. Neurourol Urodyn. 2012;31(6):938–9.

    Google Scholar 

  29. Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicenter randomised controlled trial. Lancet. 2014;383(9919):796–806.

    Article  PubMed  Google Scholar 

  30. Wiegersma M, Panman CM, Kollen BJ, et al. Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care. Maturitas. 2014;77(2):168–73.

    Article  PubMed  Google Scholar 

  31. Alves FK, Riccetto C, Adami DB, et al. A pelvic floor muscle training program in postmenopausal women: a randomized controlled trial. Maturitas. 2015;81(2):300–5.

    Article  PubMed  Google Scholar 

  32. Due U, Brostrom 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.

    Article  PubMed  Google Scholar 

  33. Caufriez M. Gymnastique abdominale hypopressive: M. Caufriez; 1997.

    Google Scholar 

  34. Resende APM, Stupp 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.

    Article  PubMed  Google Scholar 

  35. Bernardes BT, Resende AP, Stüpp L, et al. Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial. Sao Paulo Med J. 2012;130:5–9.

    Article  PubMed  Google Scholar 

  36. Bø Bo K, Hilde G, Tennfjord MK, et al. Randomized controlled trial of pelvic floor muscle training to prevent and treat pelvic organ prolapse in postpartum primiparous women. Neurourol Urodyn. 2013;32(6):806–7.

    Google Scholar 

  37. Braekken IH, Majida M, Ellstrom EM, et al. Pelvic floor function is independently associated with pelvic organ prolapse. BJOG. 2009;116(13):1706–14.

    Article  CAS  PubMed  Google Scholar 

  38. Barber MD, Brubaker L, Burgio KL, et al. Factorial comparison of two transvaginal surgical approaches and of perioperative behavioral therapy for women with apical prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Pauls RN, Crisp CC, Novicki K, et al. Impact of physical therapy on quality of life and function after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg. 2013;19(5):271–7.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. Frawley HC, Phillips BA, Bø K, Galea MP. Physiotherapy as an adjunct to prolapse surgery: an assessor-blinded randomized controlled trial. Neurourol Urodyn. 2010;29(5):719–25.

    Article  PubMed  Google Scholar 

  42. McClurg D, Hilton P, Dolan L, et al. Pelvic floor muscle training as an adjuvant to prolapse surgery: a randomized feasibility study. Int Urogynecol J. 2014;25(7):883–91.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Zhang FW, Wei F, Wang HL, et al. Does pelvic floor muscle training augment the effect of surgery in women with pelvic organ prolapse? A systematic review of randomized controlled trials. Neurourol Urodyn. 2016;35(6):666–74.

    Article  CAS  PubMed  Google Scholar 

  44. Hagen S. Abstract: Long-term follow-up of a multicentre randomised controlled trial of pelvic floor muscle training intervention for women with pelvic organ prolapse. Int Urogynecol J. 2015;26(Suppl 1):S25–6. Meeting Abstract: PP 02.

    Google Scholar 

  45. Bø K, Aschehoug A. Pelvic floor and exercise science strength training. In: Bo K, Berghmans B, Morkved S, Kampen MV, editors. Evidence-based physical therapy for the pelvic floor. Edinburgh: Elsevier; 2007. p. 119–32.

    Google Scholar 

  46. Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:76–84.

    Article  PubMed  Google Scholar 

  47. Bø K. Pelvic floor muscle training for stress urinary incontinence. In: Bo K, Berghmans B, Morkved S, Kampen MV, editors. Evidence-based physical therapy for the pelvic floor. Edinburgh: Elsevier; 2007. p. 171–87.

    Google Scholar 

  48. Miller JM, Perucchini D, Carchidi LT, et al. Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol. 2001;97:255–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Peschers UM, Fanger G, Schaer GN, et al. Bladder neck mobility in continent nulliparous women. BJOG. 2001;108:320–4.

    CAS  PubMed  Google Scholar 

  50. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36:897–909.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway

    Kari Bø

  2. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

    Ingeborg H. Brækken

Authors
  1. Kari Bø
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  2. Ingeborg H. Brækken
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Correspondence to Kari Bø .

Editor information

Editors and Affiliations

  1. Tertiary Referral Pelvic Floor and Incontinence Center, IV°Division of General Surgery, Regional Hospital, Treviso, University of Padua, Padua, Italy

    Giulio A. Santoro

  2. Department of Pediatric Radiology, Medical University of Lublin, Children’s University Hospital, Lublin, Poland

    Andrzej P. Wieczorek

  3. Urogynaecology and Pelvic Floor, Reconstruction Unit, Croydon University Hospital, St George’s University of London, London, UK

    Abdul H. Sultan

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Bø, K., Brækken, I.H. (2021). Pelvic Floor Muscle Training in Prevention and Treatment of Pelvic Organ Prolapse. In: Santoro, G.A., Wieczorek, A.P., Sultan, A.H. (eds) Pelvic Floor Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-40862-6_52

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  • DOI: https://doi.org/10.1007/978-3-030-40862-6_52

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  • Online ISBN: 978-3-030-40862-6

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