Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: Randomized controlled trial
Abstract
Objectives: To evaluate the effect of preoperative pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction, symptoms of pelvic organ prolapse (POP) and anatomical POP, 6 months after prolapse surgery, and to assess the overall changes in PFM contraction, POP symptoms and pelvic organ descent after surgery. Methods: This was a randomized controlled trial of 159 women with symptomatic POP, Stage 2 or higher, scheduled for surgery. Participants were randomized to intervention including daily PFMT from inclusion to surgery (n = 81) or no intervention (controls; n = 78). Participants were examined at inclusion, on the day of surgery and 6 months after surgery. PFM contraction was assessed by: vaginal palpation using the Modified Oxford scale (MOS; 0–5); transperineal ultrasound, measuring the percentage change in levator hiatal anteroposterior diameter (APD) from rest to maximum PFM contraction; vaginal manometry; and surface electromyography (EMG). POP distance from the hymen in the compartment with the most dominant prolapse and organ descent in the anterior, central and posterior compartments were measured on maximum Valsalva maneuver. POP symptoms were assessed based on the sensation of vaginal bulge, which was graded using a visual analog scale (VAS; 0–100 mm). Linear mixed models were used to assess the effect of PFMT on outcome variables. Results: Of the 159 women randomized, 151 completed the study, comprising 75 in the intervention and 76 in the control group. Mean waiting time for surgery was 22 ± 9.7 weeks and follow‐up was performed on average 28 ± 7.8 weeks after surgery. Postoperatively, no difference was found between the intervention and control groups with respect to PFM contraction assessed by vaginal palpation (MOS, 2.4 vs 2.2; P = 0.101), manometry (19.4 vs 19.7 cmH 2 O; P = 0.793), surface EMG (33.5 vs 33.1 mV; P = 0.815) and ultrasound (change in hiatal APD, 20.9% vs 19.3%; P = 0.211). Furthermore, no difference between groups was found for sensation of vaginal bulge (VAS, 7.4 vs 6.0 mm; P = 0.598), POP distance from the hymen in the dominant prolapse compartment (−1.8 vs −2.0 cm; P = 0.556) and sonographic descent of the bladder (0.5 vs 0.8 cm; P = 0.058), cervix (−1.3 vs −1.1 cm; P = 0.569) and rectal ampulla (0.3 vs 0.4 cm; P = 0.434). In all patients, compared with findings at initial examination, muscle contraction improved after surgery, as assessed by palpation (MOS, 2.1 vs 2.3; P = 0.007) and ultrasound (change in hiatal APD, 17.5% vs 20.1%; P = 0.001), and sensation of vaginal bulge was reduced (VAS, 57.6 vs 6.7 mm; P < 0.001). In addition, compared with the baseline examination, POP distance from the hymen in the dominant prolapse compartment (1.9 vs −1.9 cm; P < 0.001) and sonographic descent of the bladder (1.3 vs 0.6 cm; P < 0.001), cervix (0.0 vs −1.2 cm; P < 0.001) and rectal ampulla (0.9 vs 0.4 cm; P = 0.001) were reduced. Conclusions: We found no effect of preoperative PFMT on PFM contraction, POP symptoms or anatomical prolapse after surgery. In all patients, PFM contraction and POP symptoms were improved at the 6‐month follow‐up, most likely due to the anatomical correction of POP. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Eleven full publications or meeting abstracts published from 2005 until 2021 were included in the review of PFMT in connection with POP surgery.
“Eleven full publications or meeting abstracts which were published from 2005 until 2021 [62–72] were included.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [70]
In Nyhus et al. (2020) and Mathew et al. (2021), neither trial demonstrated significant differences between preoperative PFMT and standard care in postoperative outcomes, including pelvic floor muscle strength, prolapse symptom severity, or quality of life at six months.
“Despite their methodological rigor and adequate statistical power, neither trial demonstrated significant differences between PFMT and standard care in postoperative outcomes, including pelvic floor muscle strength, prolapse symptom severity, or quality of life at six months.”
From Pelvic Floor Muscle Training Following Surgery for Pelvic Organ Prolapse: Recommendation from Scientific Literature (2026) · cites this paper as [44]
In Nyhus et al. (2020), preoperative PFMT had no effect on pelvic floor muscle contraction, POP symptoms, or anatomical prolapse after surgery.
“Nyhus et al. (2020) [44], showed no effect of preoperative PFMT on pelvic floor muscle contraction, POP symptoms, or anatomical prolapse after surgery.”
From Pelvic Floor Muscle Training Following Surgery for Pelvic Organ Prolapse: Recommendation from Scientific Literature (2026) · cites this paper as [44]
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- Authors
- Nyhus, M. Ø., Mathew, S., Salvesen, Ø., Salvesen, K. Å., Stafne, S., & Volløyhaug, I.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Nyhus, M. Ø.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2020-06-09
- Volume
- 56
- Issue
- 1
- Pages
- 28-36
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W3009789533
- Cited by
- 27
- References
- 52
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 4
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Keywords
- pelvic floor muscle training, pelvic organ prolapse, prehabilitation, pelvic floor muscle contraction, pelvic organ descent, pelvic organ prolapse surgery, surface electromyography, transperineal ultrasound, pelvic floor muscle strength, women's health, pelvic floor dysfunction, postoperative outcomes
- MeSH terms
- Electromyography, Exercise Therapy, Female, Humans, Middle Aged, Muscle Contraction, Urinary Incontinence, Stress, Treatment Outcome, Pelvic Floor, Pelvic Organ Prolapse
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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