Morphological Changes After Pelvic Floor Muscle Training Measured by 3-Dimensional Ultrasonography: A Randomized Controlled Trial
Abstract
OBJECTIVE: To investigate morphological and functional changes after pelvic floor muscle training in women with pelvic organ prolapse. METHODS: This randomized controlled trial was conducted at a university hospital and a physical therapy clinic. One hundred nine women with pelvic organ prolapse stages I, II, and III were randomly allocated by a computer-generated random number system to pelvic floor muscle training (n=59) or control (n=50). Both groups received lifestyle advice and learned to contract the pelvic floor muscles before and during increases in intraabdominal pressure. In addition the pelvic floor muscle training group did individual strength training with a physical therapist and daily home exercise for 6 months. Primary outcome measures were pelvic floor muscle (pubovisceral muscle) thickness, levator hiatus area, pubovisceral muscle length at rest and Valsalva, and resting position of bladder and rectum, measured by three-dimensional ultrasonography. RESULTS: Seventy-nine percent of women in the pelvic floor muscle training group adhered to at least 80% of the training protocol. Compared with women in the control group, women in the pelvic floor muscle training group increased muscle thickness (difference between groups: 1.9 mm, 95% confidence interval [CI] 1.1-2.7, P<.001), decreased hiatal area (1.8 cm, 95% CI 0.4-3.1, P=.026), shortened muscle length (6.1 mm, 95% CI 1.5-10.7, P=.007), and elevated the position of the bladder (4.3 mm, 95% CI 2.1-6.5, P<.000) and rectum (6.7 mm, 95% CI 2.2-11.8, P=.007). Additionally, they reduced the hiatal area and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness. CONCLUSION: Supervised pelvic floor muscle training can increase muscle volume, close the levator hiatus, shorten muscle length, and elevate the resting position of the bladder and rectum. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, NCT00271297. LEVEL OF EVIDENCE: I.
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Brækken et al. (2010a) was the only study reporting on morphology and did not find any effect of advice to use "the Knack" on PFM strength or morphology.
“Brækken et al. (2010a) [25] was the only study reporting on morphology and did not find any effect of advice to use “the Knack” on PFM strength or morphology.”
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 [25]
The two RCTs offering supervised PFMT for a longer time showed improvement in bladder and anorectal symptoms in women with POP.
“The two RCTs offering supervised PFMT for a longer time showed improvement in bladder and anorectal symptoms in women with POP [25, 39, 74].”
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 [25]
Strength training has been shown to promote hypertrophy of targeted muscles, increasing constriction of the levator hiatus, shortening the pelvic floor muscles and lifting of the pelvic floor and reversing some of the changes associated with POP.
“Strength training has been shown to promote hypertrophy of targeted muscles, increasing constriction of the levator hiatus, shortening the PFM and lifting of the pelvic floor and reversing some of the changes associated with POP [25].”
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 [25]
In Brækken et al.-10, PFMT improved PFM strength by ↑13.1 cmH2O vs control ↑1.1 cmH2O (p < 0.01).
“PFM strength (p < 0.01):PFMT: ↑13.1 cmH2O (95% CI: 10.6–15.5); Control: ↑1.1 cmH2O (95% CI: 0.4–2.7).”
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 [25]
In Brækken et al.-10, bladder neck elevation was ↑2.3 mm vs ↓0.6 mm; difference 3.0 mm (95% CI 1.5-4.4), p < 0.001.
“Elevation of the bladder neck: ↑2.3 mm vs ↓0.6 mm; diff. 3.0 mm (95% CI: 1.5–4.4), p < 0.001”
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 [25]
In Brækken et al.-10, POP-Q stage improved one stage in 11 (19%) PFMT vs 4 (8%) controls (p = 0.04).
“POP-Q stage: 11 (19%) in the PFMT vs 4 (8%) controls improved one stage (p = 0.04)”
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 [25]
The overall best results found in the present review were in an RCT with 18 supervised training sessions over a 6-month training period.
“The overall best results found in our review were in an RCT with 18 supervised training sessions over a 6-month training period [25, 43].”
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 [25]
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- Authors
- Hoff Brækken, I., Majida, M., Engh, M. E., & Bø, K.
- Affiliations
- University of Oslo (NO)
- Venue
- Obstetrics & Gynecology
- Published
- 2010-02
- Volume
- 115
- Issue
- 2
- Pages
- 317-324
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W2054290162
- Cited by
- 168
- References
- 32
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 12 · 2023: 11 · 2022: 15 · 2021: 8 · 2020: 9 · 2019: 10 · 2018: 9 · 2017: 9 · 2016: 7 · 2015: 8 · 2014: 15 · 2013: 11 · 2012: 9
- FWCI
- 8.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Keywords
- pelvic floor muscle training, pelvic organ prolapse, levator hiatus, muscle length, Valsalva maneuver, three-dimensional ultrasonography, women's health
- MeSH terms
- Exercise Therapy, Female, Humans, Middle Aged, Muscle Contraction, Pelvis, Ultrasonography, Pelvic Floor, Imaging, Three-Dimensional, Pelvic Organ Prolapse
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