Pelvic Floor Muscle Training Research Articles

Prenatal Exercise Decreases Urinary Incontinence in Late Pregnancy and Three Months Postpartum: A Randomized Controlled Trial

ABSTRACT Purpose This study aimed to evaluate the impact of a supervised exercise program, including Pelvic Floor Muscle Training (PFMT), throughout pregnancy on Urinary Incontinence (UI). Methods A randomized clinical trial (NCT04563065) was conducted. Initially, 600 pregnant women were screened for eligibility, with data from 356 participants eventually analyzed. Of these, 172 were allocated to the Exercise Group (EG) and 184 to the Control Group (CG). Participants in the EG engaged in a supervised moderate exercise program three days per week, each session lasting 60 minutes, from 8-10 weeks to 38-40 weeks of gestation, achieving an adherence rate of 73.5%. Results A lower prevalence of UI in the EG compared to the CG was observed during late pregnancy (χ2 = 20.04; p = 0.001) and at three months postpartum (χ2 = 12.52; p = 0.03), as well as in birth weight (F = 4.16; p = 0.04). No significant differences were found between the groups in other maternal and newborn outcomes. Conclusions Supervised exercise during pregnancy, which included PFMT, effectively reduced the incidence of urinary incontinence in late pregnancy and at three months postpartum.

FORTALECENDO O CONTROLE PÉLVICO PARA UMA VIDA SEM LIMITAÇÕES: UMA REVISÃO DE LITERATURA SOBRE A EFICÁCIA DA FISIOTERAPIA COM EXERCÍCIO DE KEGEL NO TRATAMENTO DA INCONTINÊNCIA URINÁRIA

The pelvic floor muscles support organs such as the bladder and uterus, and can weaken due to pregnancy and aging, which results in problems such as urinary incontinence or prolapse. The latter affects millions of women, being associated with factors such as age and number of births. Evaluation, especially through ultrasound, is crucial. Treatments include Kegel exercises, behavioral therapy, and mechanical devices. Innovative strategies, such as the gamification of Kegel exercises, have shown promise for improving adherence and treatment outcomes. The importance of pelvic floor muscles and their dysfunctions, such as urinary incontinence, was addressed, highlighting the need for effective and innovative approaches to improve patients' quality of life. An analysis of the efficacy of Kegel exercise on urinary incontinence in women was conducted, reviewing studies, synthesizing results, and offering recommendations for future research. A systematic review of the literature, conducted between February and May 2024, was adopted to analyze studies on Kegel exercise in urinary incontinence in women, searching for articles in databases such as VHL, PubMed, ScienceDirect, and JSTOR, with strict inclusion criteria. Studies on treatments for pelvic floor dysfunctions, such as prolapse and urinary incontinence, have revealed several approaches. Some have shown effectiveness in personalized training of the muscles, while others have compared methods such as electrical stimulation and active training. In addition, innovative techniques such as position detection during Kegel exercises and mechanotherapy were explored. The efficacy of simple interventions, such as Kegel exercises combined with behavioral therapy, was highlighted. These studies highlighted the complexity of pelvic floor dysfunctions and the importance of multifaceted and individualized approaches to treatment, highlighting the challenges faced and the need for more effective interventions to improve patients' health and quality of life. Authors have emphasized the importance of pelvic muscles and treatments such as training and behavioral therapy, while innovative strategies such as gamification have shown promise for promoting better physical, emotional, and social well-being and outcomes.

Cutting-Edge Approaches in Urinary Incontinence Treatment: A Comprehensive Review

Introduction: Urinary incontinence is a prevalent health issue that profoundly impacts the quality of life for patients worldwide. Traditional treatments, including pharmacotherapy and surgical procedures, often fall short, leaving many individuals struggling with bladder control issues that restrict physical and social activities and cause significant psychological distress. Recent advancements in therapeutic methods—encompassing behavioral therapies, cutting-edge medical technologies, innovative pharmacotherapy, and advanced surgical techniques—offer promising alternatives. By exploring the effectiveness and advantages of these novel approaches, we can enhance treatment accessibility and elevate the quality of care for those affected by urinary incontinence, ultimately improving their daily functioning and overall well-being. Abbreviated description of the state of knowledge:Current research on innovative treatments for urinary incontinence indicates significant advancements in enhancing patients' quality of life. These cutting-edge methods encompass behavioral therapies like pelvic floor muscle training, state-of-the-art medical technologies such as nerve stimulation, new pharmacological treatments with high efficacy and minimal side effects, and advanced surgical interventions, including artificial sphincter implants and urinary tract modifications. Conclusions: Urinary incontinence is a prevalent health issue that significantly deteriorates the quality of life, particularly affecting half of women and one-third of men over the age of 80. As our society ages and the number of individuals affected by this condition rises, understanding and advancing treatment methods become increasingly crucial. Ongoing research aims to discover new and improved therapeutic approaches with minimal side effects, offering hope for enhanced patient outcomes and better management of urinary incontinence in the future.

Do Women with Urinary Incontinence and Pelvic Organ Prolapse Receive Optimal First-Line Treatment?

There is scant knowledge on previous pelvic floor muscle training (PFMT) in women with urinary incontinence (UI) and pelvic organ prolapse (POP) referred to hospitals. We hypothesized that women with predominately UI and POP had not received optimal primary care conservative management. This was a descriptive, cross-sectional survey among women attending a gynecological outpatient's clinic. The questionnaire included questions about demographics, PFMT dosage, whether ability to contract had been assessed and whether the patients had used precontraction before increase in intra-abdominal pressure ("the knack"). One hundred two women, mean age 52.5 (SD 13.4) years, responded; 37.3% had never been treated previously. There was no statistically significant difference in age, BMI, level of education, parity, time since last birth, SUI, or POP between the women who had been treated conservatively or not before the hospital visit. Thirty-three percent had trained with a physiotherapist and > 35% reported that their ability to contract had not been assessed or were unsure whether it had been assessed; 37% were not able to stop their urine stream; 52% reported that they performed "the knack," with 15.7% reporting it to be effective. Reasons for not having trained the PFM before visiting the hospital included not being motivated, not knowing how to do PFMT, not being told/advised to do PFMT and not believing PFMT would help. The results of this study indicated that there is a need for improvement within first-line health care service for women with predominately UI and POP.

EFFECTIVENESS OF HYPOPRESSIVE EXERCISES ON POSTNATAL MOTHERS WITH URINARY INCONTINENCE-A PILOT STUDY.

Background: Pelvic Floor Muscle Dysfunctions can lead to Urinary Incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence. Hypopressive Exercise is one of these methods used to prevent Urinary Incontinence. Objective: The purpose of the study is to find the Effectiveness of Hypopressive Exercises on Postnatal Mothers with Urinary Incontinence. Methods: 30 Mothers (between the age group of 25 – 35 years) clinically pre diagnosed with urinary incontinence with PERFECT score were included in the study. with informed consent, the protocol was explained to the subjects. Mothers were given Hypopressive Exercises for 3 sessions per week for 4 weeks. This session lasted between 30 to 40 minutes. The outcome measure of the Exercises was measured using UI – QUID and PERFECT test. Results were tabulated using statistical analysis. Result: The analysis shows that the mothers who underwent Hypopressive exercises have significant reduction in urinary incontinence (p-value) P<0.0001. Conclusion: This study concluded that the mothers underwent Hypopressive exercises have significant reduction in Urinary Incontinence and increase in Pelvic Floor Muscle Strength Implications: The Hypopressive Exercises strengthens the Deep Core Muscles which increases body awareness by training the Pelvic Floor Muscles in women and reduces Urinary Incontinence. These Exercises not only pay attention to maintaining proper body posture and Pelvic Floor Muscles activation. But also had a positive impact on the Quality of Life and reduction of incidents of urine leakage among mothers.

Physical therapy approach and non-invasive modalities in treatment of vaginal laxity: a literature review.

Pelvic floor physical therapy (PFPT) and noninvasive modalities can be more safe and available treatments for vaginal laxity (VL) with less risk of postsurgical complications. The purpose of this review is to define the concepts of PFPT and noninvasive modalities, examine the evidence supporting those modalities as a treatment for VL, and evaluate their effectiveness. Between 2002 and 2023, clinical studies including women diagnosed with VL were examined in the Web of Science, Cochrane Library, Scopus, and PubMed databases. Exclusion criteria included studies with no outcomes or inadequate data, procedures, suggestions, editorials, book chapters, letters to editors, reviews, meta-analyses, animal research, and articles in languages other than English. Only seventeen studies have been identified. Four studies have demonstrated the impact of PFPT (low- and medium-energy radiofrequency (RF), ultrasound, low-energy laser treatment, par sacral stimulation, the knack method, and pelvic floor exercises), and thirteen studies have discussed the impact of noninvasive modalities (RF, combined multipolar RF with pulsed electromagnetic, combined RF and pulsed electromagnetic field, high-intensity focused ultrasound, CO2 laser, combining multipolar RF and hybrid fractional laser, microfocused ultrasound, and the VIVEVE surface-cooled RF) on vaginal laxity. This review indicates many knowledge areas that must be attempted in order to understand the influence of nonstrengthening physical therapy and noninvasive methods on vaginal laxity. In addition to the mechanisms behind their impacts. In addition, we strongly recommend that more clinical trials of high methodological and interventional quality are required to investigate the efficacy of various physical therapy approaches, including electrical stimulation, biofeedback exertion, acupressure, manual therapy, neuromodulation, core exercise therapy, hydrotherapy, well-designed ultrasound therapy protocols, and vaginal weight training.

Pressure-Mediated Biofeedback With Pelvic Floor Muscle Training for Urinary Incontinence

Supervised pelvic floor muscle training (PFMT) has been recommended as the first-line treatment for women with stress urinary incontinence (SUI), but more evidence on whether adjunctive methods would provide additional benefits is needed. To compare the efficacy of PFMT with or without a home-based pressure-mediated biofeedback (BF) device. This multicenter assessor-blinded randomized clinical trial was conducted in the obstetric clinics of 5 participating tertiary hospitals in China. Participants included eligible women with new-onset postpartum SUI who were enrolled from March 28, 2022, to October 13, 2023. All participants received 3 months of supervised PFMT and were randomized to either the intervention (PFMT with a home-based pressure-mediated BF device) or the control group (home-based PFMT). The primary outcome was the severity of urinary incontinence evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form after 3 months of supervised PFMT. The secondary outcomes included the cure and improvement rates, PFM strength, quality of life, self-efficacy, and adherence. A total of 452 participants (median age, 34 [IQR, 31-36] years; median body mass index [calculated as the weight in kilograms divided by the height in square meters], 23.71 [IQR, 21.37-25.97]; median time since delivery, 50 [IQR, 43-61] days) were included in the analysis, with 223 in the intervention group and 229 in the control group. Compared with the control group, the intervention group achieved a significantly greater reduction in incontinence severity (median, 3.00 [IQR, 1.00-6.00] vs 2.00 [IQR, 0-4.00] points; z = -3.05; P = .002), significantly increased cure rate (45 of 223 [20.2%] vs 20 of 229 [8.7%]; z = 12.02; P = .001) and improvement (132 of 223 [59.2%] vs 102 of 229 [44.5%]; z = 9.71; P = .002), significantly greater pelvic floor muscle strength (median, 26.00 [IQR, 17.00-38.00] vs 21.00 [IQR, 13.50-33.50] cm H2O; z = -2.28; P = .02), and a significantly greater correlation between subjective and objective adherence (r = 0.825 vs r = 0.627). In this randomized clinical trial, the efficacy of pressure-mediated BF combined with PFMT was superior to that of PFMT alone. These findings support the use of pressure-mediated BF devices for improving treatment outcomes for patients with SUI. ClinicalTrials.gov Identifier: NCT05115864.

Combined effects of high-intensity focused electromagnetic therapy and pelvic floor exercises on pelvic floor muscles and sexual function in postmenopausal women. A randomized controlled trial.

This study aimed to explore the impact of high-intensity focused electromagnetic therapy (HIFEMT) on the pelvic floor muscles (PFM), sexual function, and quality of life (QoL) among postmenopausal women. Fifty postmenopausal women with PFM weakness and sexual dysfunction were randomly allocated into two equal groups. The HIFEMT group participated in the PFM training program in addition to HIFEMT, whereas the control group performed PFM training only. For 12 weeks, HIFEMT was scheduled two times a week, while PFM training was performed daily. At baseline and after 12 weeks, PFM strength and endurance were assessed using a perineometer and sexual function was examined using the female sexual function index (FSFI) and menopause-specific quality of life questionnaire (MENQOL). The HIFEMT and control groups showed significant increases in PFM strength and endurance and FSFI scores, and significant declines in MENQOL compared with baseline measures (P<0.05). Compared to the control group, the HIFEMT group showed substantial improvements in all measured variables after 12 weeks (P<0.05). Addition of HIFEMT to PFM training improved the PFM strength, endurance, sexual function, and QoL in postmenopausal women with PFM weakness and sexual dysfunction.

Knowledge of pelvic floor muscles in community-dwelling women aged over 60: its relationship with urinary incontinence.

To investigate the awareness of the pelvic floor muscles (PFMs) and PFM exercises (PFME) knowledge, training and experience in community-dwelling women aged 60 and over and its relationship with urinary incontinence (UI). This is a questionnaire based study which was carried out in 9 Physical Medicine and Rehabilitation Centers, including a total of 500 women aged 60 and over and living in the community. The questionnaire included questions about awareness of PFMs, UI complaints and PFME knowledge, training and experience. Knowledge and awareness of PFMs and PFME knowledge, training and experience were compared in subgroups with or without urinary incontinence. The mean age of the women included in the study was 67.8 ± 6.1 (60-88). Knowledge and awareness of PFMs and PFME knowledge, training and experience were low in the study population. Knowledge and awareness of PFMs were significantly low in the subgroup with urinary incontinence (p < 0.05). Kegel exercise training and experience were significantly low in the subgroup without urinary incontinence (p = 0.01, p < 0.01). Knowledge and awareness of PFMs and PFME knowledge, training and experience are low in community-dwelling women aged 60 and over and training programs should be organized to teach the function of the PFMs and to perform PFME correctly in this population.

Effects of using a mobile application on pelvic floor training in women with stress urinary incontinence: A randomized controlled clinical study.

Urinary incontinence (UI) is defined as any involuntary loss of urine that causes negative impacts on women's lives. Pelvic floor muscle training (PFMT) is considered to be "level A" of scientific evidence in the treatment of UI. Despite its efficacy, it is known that the effect of PFMT may depend on continuous adherence. Therefore, healthcare professionals are looking for alternatives to improve adherence in their patients. Healthcare has been innovating through mobile device apps. Thus, the objective of this study was to verify the effects of PFMT with the use of a mobile device app in incontinent women. This was a controlled, randomized clinical trial that occurred remotely. A total of 104 women with stress UI and/or mixed incontinence, over 18 years old, literate, with preserved cognitive capacity, with internet access and a mobile device with the Android system, participated in this study. They were randomly divided into two groups: The App group and the Booklet group, which underwent a PFMT protocol guided by a mobile app and a booklet, respectively. Both groups received daily reminders to perform the exercises. Before and after 12 weeks of intervention, it was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the King's Health Questionnaire (KHQ). Both groups showed improvements in the final ICIQ-SF score. However, superior results were shown for the Booklet group (App: pre: 11.5 [±3.8], post: 9.8 [±4.5]; Booklet: pre: 12.6 [±4.5], post: 7.4 [±4.3]; p = 0.03). It was concluded that PFMT, with the use of a mobile app, is capable of reducing UI and the impact of UI, but it is not superior to training with the use of booklet instructions.

Long-term effects of pelvic floor training in male chronic pelvic pain, correlation between subjective and objective outcomes: a study protocol for a randomised controlled trial

IntroductionChronic primary pelvic pain syndrome (CPPPS) is a condition characterised by pain in the pelvic area together with lower urinary tract symptoms. Pathophysiology remains largely unclear. Common treatment modalities show...

Pelvic Floor Muscle Training for the Prevention and Management of Low Anterior Resection Syndrome in Patients with Rectal Cancer: An Evidence-Based Summary

Pelvic Floor Muscle Training for the Prevention and Management of Low Anterior Resection Syndrome in Patients with Rectal Cancer: An Evidence-Based Summary

Midwifery-led antenatal pelvic floor muscle exercise intervention to reduce postnatal urinary incontinence: APPEAL research programme including a feasibility and pilot cluster RCT

Midwifery-led antenatal pelvic floor muscle exercise intervention to reduce postnatal urinary incontinence: APPEAL research programme including a feasibility and pilot cluster RCT

Stable pelvic floor muscle training improves urinary incontinence in women with gestational diabetes mellitus

Background Gestational diabetes mellitus (GDM) is a common metabolic disease that contributes to urinary incontinence (UI) in pregnant women. The aim of this study was to investigate the therapeutic potential of stable pelvic floor muscle (PFM) training with transverse abdominal muscle for pregnancy-specific UI in patients with GDM. Methods This was a randomised controlled trial. A total of 73 pregnant women with GDM and pregnancy-specific UI were screened, 35 of whom received stable PFM training with transverse abdominal muscle in the second trimester. After six weeks of training, UI status was assessed by the quantity of fluid loss and the International Consultation on Incontinence Questionnaire short form (ICI-Q-SF), and the quality of life was evaluated by the Incontinence Quality of Life Questionnaire score. Additionally, the thickness of the transverse abdominal muscle was measured by ultrasonography. Results At 6 weeks later, the quantity of fluid loss and ICI-Q-SF score were significantly lower, and the overall healing rate was significantly higher in the training group than those in the control group. The training also significantly improved the quality of life, especially in terms of behavioural limitation and psychosocial impact. Additionally, the thickness of transverse abdominal muscle under the status of maximal contractions of transverse abdominal muscle and PFM was significantly higher in the training group than in the control group after 6 weeks. Conclusions Stable PMF training with transverse abdominal muscle alleviated UI and improved the quality of life in patients with GDM. The thickening of transverse abdominal muscle induced by the training contributes to the remission of UI through the cooperation of PMF.

Improving Pelvic Floor Muscle Training with AI: A Novel Quality Assessment System for Pelvic Floor Dysfunction.

The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a ±1 scale point with 97% accuracy. These results demonstrate the system's potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously.

Efficacy of electrical stimulation in comparison to active training of pelvic floor muscles on stress urinary incontinence symptoms in women: a systematic review with meta-analysis

Efficacy of electrical stimulation in comparison to active training of pelvic floor muscles on stress urinary incontinence symptoms in women: a systematic review with meta-analysis

Management of Fecal Incontinence: Etiology, Diagnostic Approach, and Conservative Therapy

Background: Fecal incontinence is a common problem especially in the elderly resulting in a reduced quality of life. Summary: The etiology of fecal incontinence is often multifactorial with little options for a causal therapy. The mechanisms causing incontinence can be detected by sophisticated methods in most of the patients. Using therapeutic algorithms, incontinence can be improved or even continence restored in many patients. Key Messages: Diagnostic work-up starts with history, digital investigation, and anoproctoscopy. The specialist will further investigate with anorectal manometry, anal endosonography, and electromyography of the external anal sphincter muscle. Nonoperative therapy comprises hygienic methods, medical therapy, intraanal electrostimulation, and training methods like pelvic floor exercises or biofeedback. Second-line conservative therapies are tibial nerve stimulation, transanal irrigation, or anal inserts.

Validation of the Pelvic Floor and Core Exercise Protocol in Indian Women with Chronic Non-specific Low Back Pain

Validation of the Pelvic Floor and Core Exercise Protocol in Indian Women with Chronic Non-specific Low Back Pain

To contract or not to contract: should we use pelvic floor muscle exercises in the treatment of dyspareunia

Pelvic floor physiotherapy incorporates pelvic floor muscle (PFM) exercises (PFMEs), i.e. various tasks involving contraction and relaxation. These are widely used as an integral part of conservative treatment for different pelvic health conditions (e.g. urinary incontinence). Currently, there is a debate about the adoption of PFMEs for pelvic pain conditions, specifically dyspareunia. The prevailing belief within both the physiotherapy community and wider social media platforms is that PFMEs for dyspareunia are not appropriate and may even be harmful. The aim of this study was to investigate the role of PFMEs in the treatment of dyspareunia, including an exploration of potential mechanisms through which these exercises may alter its symptoms. Specifically, the authors addressed the following questions: What is the rationale for PFMEs in dyspareunia? What are the documented side effects, if any? What are the outcomes following PFMEs? A list of relevant studies was compiled from extensive searches conducted for the purpose of other reviews performed by the authors, and additional, complementary searches utilizing a combination of keywords associated with dyspareunia, physiotherapy and PFMEs. The inclusion criteria were any studies discussing and investigating the use of PFMEs, such as (but not limited to) repeated contractions or hold contractions as a sole intervention or as part of multimodal treatment. Data were extracted and narratively synthesized to identify arguments advocating for and against PFMEs in the treatment of dyspareunia. Part of the narrative analysis included 10 studies involving women with different types of dyspareunia, such as vulvodynia, postpartum dyspareunia, dyspareunia related to menopause and dyspareunia in cancer survivors. Pelvic floor muscle exercises were implemented as a main intervention or as a part of multimodal physiotherapy. All of the studies reported positive results favouring interventions involving PFMEs across various outcomes, such as pain intensity, sexual function, symptom severity and inconvenience, and PFM morphometry and function. None of the studies reported any side effects following interventions incorporating PFMEs. These exercises may have multiple applications in the treatment of dyspareunia. It appears essential to consider PFMEs as a multifaceted intervention that can be adapted in various forms for diverse objectives that extend beyond simple strengthening. Contrary to prevailing beliefs, PFMEs have been widely incorporated in research studies that have reported positive outcomes and demonstrated the safety of the interventions implemented.

Physiotherapists working with pessaries

Pessaries and the physiotherapy profession have evolved over the past 10 years, and pelvic health physiotherapists can now prescribe vaginal pessaries. Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) is developing ways to support members with these skills. Globally, up to 50% of women will suffer from pelvic organ prolapse (POP) (Carroll et al. 2022), and this condition costs the UK National Health Service £45 million every year (PCWHF 2019). The most common symptom is a vaginal bulge. The National Institute for Health and Care Excellence guidelines recommend either doing nothing, or pelvic floor muscle exercises (PFMEs), vaginal pessaries or surgery (NICE 2019). Pessary services are provided in dedicated clinics, usually in general practice or secondary care. There has been an increase in physiotherapists delivering pessary care over the past decade: in 2013, it was reported that 1.4% were part of the pessary workforce compared to 5% in 2020 (Bugge et al. 2013; Brown et al. 2021). Currently, ineffective patient pathways, poor service provision and lack of training are barriers to treatment. Poorly designed patient pathways are frustrating, and women are often required to return to primary or secondary care to get a referral to a pessary clinic. Physiotherapists are well placed to offer a pessary alongside PFMEs since it is part of the range of conservative treatment options. They also build strong a rapport with their patients because of the therapeutic nature of the treatment sessions, and typically, offer longer appointments than postnatal period. A prospective multicentre trial demonstrated the acceptability of and compliance with using a pessary immediately after childbirth irrespective of any pelvic floor dysfunction or mode of delivery (Baessler et al. 2019). The majority of women used the pessary to treat the symptoms of POP. Further work is required to investigate pessary use and the prevention of pelvic floor dysfunction in this cohort of women. The results of the TOPSY [Treatment Of Prolapse with Self-care pessarY] trial (Hagen et al. 2023) highlighted that pessary self-management is cost-effective and reduces complications. This is excellent news because physiotherapists are well placed to teach women pessary self-management because of: generally longer appointments; and the well-established rapport built up over time while teaching PFMEs. Despite women reporting that pessary use during exercise relieves their symptoms, this is an under-researched area. The impact of exercise on POP, and whether there are any protective factors involved that prevent its progression, are not fully understood. There also remains a gap in the evidence with regard to the use of PFMEs and vaginal pessaries. Research proposals are currently in development to address this. A pessary course is being developed by POGP, and this will be launched in 2024 alongside a mentoring programme as part of the pessary accreditation scheme jointly written with the United Kingdom Continence Society. Further governance documents have been created by the Physiotherapists Working with Pessaries subgroup of POGP, including a standard operating procedure, emergency out-of-hours statement, note proformas and template letters (POGP 2024).