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

Abstract

This chapter describes the four randomized controlled trials (RCTs) published on the effect of pelvic floor muscle training (PFMT) to treat pelvic organ prolapse (POP) and symptoms of prolapse. The results of all four trials show a significant effect of PFMT. However, to date there is only one full-scale RCT using the gold standard Pelvic Organ Prolapse Quantification (POP-Q) system to evaluate stage of prolapse and a validated symptom questionnaire to assess the results. The same research group also 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, and bother, and increase in pelvic floor muscle strength. Significant hypertrophy of the pelvic floor muscles, shortening of muscle length, and constriction of the levator hiatus were found in the treatment group only. The four RCTs in this area differ in training dosage such as intensity of the contractions, duration of the training period, and therapist contact, factors that are all known to affect outcome. The results of PFMT in treatment of POP are promising. Further studies are needed to understand differences between responders and non-responders and especially the role of PFMT in primary prevention of POP.