The effect of preoperative pelvic floor muscle training on urinary and colorectal-anal distress in women undergoing pelvic organ prolapse surgery: A randomized controlled trial
Open accessAbstract
Introduction and hypothesis: Pelvic floor muscle training (PFMT) improves urinary incontinence and mild pelvic organ prolapse (POP). We aimed to investigate the effect of preoperative PFMT on urinary and colorectal-anal distress and related quality of life (QoL) in women with severe POP scheduled for surgery. Methods: Randomized controlled trial of 159 women scheduled for POP surgery (intervention = 81, controls = 78). Intervention consisted of daily PFMT from inclusion to the day of surgery. Symptoms and QoL were assessed at inclusion, day of surgery and 6 months postoperatively using the Urinary Distress Inventory (UDI-6), Colorectal-Anal Distress Inventory (CRADI-8), Urinary Impact Questionnaire (UIQ) and Colorectal-Anal Impact Questionnaire (CRAIQ) (range 0–100). Mixed model statistical analyses were used. Results: One hundred fifty-one (95%) women completed the study (intervention = 75, controls = 76). Mean waiting times until surgery and follow-up were 22 and 28 weeks. There was no difference in mean postoperative symptom and QoL scores (95% CI) between the intervention and control group: UDI-6 16 (12–21) vs. 17 (13–22), CRADI-8 15 (11–18) vs. 13 (10–16), UIQ 11 (7–15) vs. 10 (6–13) and CRAIQ 5 (2–7) vs. 6 (4–9), all p > 0.05. Overall mean scores were reduced from baseline to postoperative follow-up: UDI-6 37 (33–41) vs. 17 (14–20), CRADI-8 22 (19–25) vs. 14 (11–16); UIQ 28 (24–32) vs. 10 (7–13) and CRAIQ 16 (12–19) vs. 5 (3–7), all p < 0.01. Conclusions: We found no added effect of preoperative PFMT on symptoms or QoL related to urinary and colorectal-anal distress in women scheduled for POP surgery. They achieved symptomatic improvement postoperatively regardless of PFMT. Clinical trial registration: The study was registered in clinicaltrials.gov: NCT 03,064,750.
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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 [42]
The Discussion reports no added effect of preoperative PFMT on urinary or colorectal-anal distress and related quality of life at six months. It also reports that an earlier publication from the same trial found no difference in muscle strength or prolapse symptoms. The claim is broader than this paper's quality-of-life finding, and its assertion of adequate statistical power is qualified by the Discussion's statement that no power calculation was performed for the symptom and quality-of-life outcomes. (LLM, conf=0.85)
Experimental — accuracy not yet measuredEleven 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 [68]
In Mathew et al. (2021), preoperative PFMT had no added effect on symptoms or quality of life related to urinary and colorectal-anal discomfort in women scheduled for POP surgery; postoperative symptomatic improvements were reached regardless of PFMT.
“Mathew et al. (2021) [42] found no added effect of preoperative PFMT on symptoms or quality of life related to urinary and colorectal-anal discomfort in women scheduled for POP surgery; postoperative symptomatic improvements were reached regardless of PFMT.”
From Pelvic Floor Muscle Training Following Surgery for Pelvic Organ Prolapse: Recommendation from Scientific Literature (2026) · cites this paper as [42]
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“Two recent studies on the same sample [27,31] demonstrated that pre-operative 22-week PFMT did not improve pelvic-floor strength, vaginal bulge sensation, anatomical change in POP, urinary and intestinal symptoms, or quality of life compared with the control group after 6 months of surgery.”
BackgroundPerioperative interventions in pelvic organ prolapse surgery
Shahid, U., Haya, N., Baessler, K., Christmann-Schmid, C., Yeung, E., Chen, Z., & Maher, C. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013105.pub2 · Cited by 5 · see citing works
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“Mathew et al. (2021) [42] found no added effect of preoperative PFMT on symptoms or quality of life related to urinary and colorectal-anal discomfort in women scheduled for POP surgery; postoperative symptomatic improvements were reached regardless of PFMT. Similarly, Nyhus et al. (2020) [44],…”
Prestanti, I., Serafini, S., Rocco, F. D., Cavuto, R., Fusco, A., Izzicupo, P., & Baldassarre, A. D. (2025) · Physiologia · doi:10.3390/physiologia6010001
- Authors
- Mathew, S., Nyhus, M. Ø., Salvesen, Ø., Salvesen, K. Å., Stafne, S. N., & Volløyhaug, I.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Mathew, Seema
- ORCID
- Venue
- International Urogynecology Journal
- Published
- 2021-02-13
- Volume
- 32
- Issue
- 10
- Pages
- 2787-2794
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- PMC
- PMC8455377
- OpenAlex
- W3127170724
- Cited by
- 4
- References
- 30
- Citations by year
- 2025: 2 · 2022: 2
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Urogynecology Journal (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- The Liasion Committee for Education, Research and Innovation in Central Norway (P-101830-1)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- pelvic floor muscle training, pelvic organ prolapse, prehabilitation, urinary incontinence, quality of life, pelvic organ prolapse surgery, women, postoperative symptoms, pelvic floor dysfunction, UDI-6
- MeSH terms
- Female, Humans, Quality of Life, Surveys and Questionnaires, Colorectal Neoplasms, Pelvic Floor, Pelvic Organ Prolapse
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