Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care

Wiegersma, M.; Panman, C. M. C. R.; Kollen, B. J.; Berger, M. Y.; Lisman-Van Leeuwen, Y.; Dekker, J. H.

doi:10.1136/bmj.g7378

Cited by 126Pelvic floor disorders treatmentsSexual function and dysfunction studiesUrinary Bladder and Prostate Research

Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care

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Wiegersma, M., Panman, C. M. C. R., Kollen, B. J., Berger, M. Y., Lisman-Van Leeuwen, Y., Dekker, J. H.·2014·BMJ

DOI 10.1136/bmj.g7378PMC PMC4273538

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Abstract

OBJECTIVE: To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. DESIGN: Randomised controlled trial. SETTING: Dutch primary care. PARTICIPANTS: Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. INTERVENTIONS: Pelvic floor muscle training versus watchful waiting. MAIN OUTCOME MEASURES: The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients' perceived change in symptoms. RESULTS: Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. CONCLUSIONS: Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points). Nevertheless, 57% of the participants in the intervention group reported an improvement of overall symptoms. More studies are needed to identify factors related to success of pelvic floor muscle training and to investigate long term effects.Trial registration Dutch Trial Register (www.trialregister.nl) identifier: NTR2047.

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In Wiegersma et al. (2014), participants did strength training but also many other exercise modalities, and the exercise program was up to the physical therapist with no standardization.
“In the study of Wiegersma et al. (2014) [38], the participants did strength training, but also many other exercise modalities and the chosen exercise program was up to the physical therapist with no standardization of the training protocol.”
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 [38]
The Methods (Interventions) and Discussion (Strengths and limitations) say physiotherapists tailored the programme and did not use a standard pelvic floor muscle training protocol. But all participants began with the same basic exercise scheme; strengthening, relaxation exercises, and other techniques were used according to individual needs. The claim overstates the lack of standardization and implies that participants generally did strength training alongside many other exercise modalities. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Eight studies found that PFMT improved bladder symptoms and five studies found improvement of anorectal symptoms in women with POP.
“Eight studies found that PFMT improved bladder symptoms [38, 39, 43, 44, 47, 60, 61, 74] and five studies found improvement of anorectal symptoms [39, 43, 44, 47, 61, 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 [38]
In the Results (Table 2), this trial reports a significant improvement in urinary symptoms with PFMT compared with watchful waiting. Colorectal/anal symptom scores fell in both groups, but the between-group difference was not significant. The paper therefore supports the bladder-symptom finding, not a clear PFMT-specific improvement in anorectal symptoms; as one trial, it does not establish the cited counts of studies. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Two studies of pelvic floor muscle training for pelvic organ prolapse focused on secondary prevention by including women who had not sought health care for assessment or treatment of the condition.
“two studies focused on secondary prevention, as they included women who had not sought health care for assessment or treatment of the condition [37, 38]”
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 [38]
Both Wiegersma et al. (2014) and Hagen et al. (2017) found statistically significant positive short-term effects on symptoms of POP, but not on POP-Q stage.
“Both studies found statistically significant positive short-term effects on symptoms of POP, but not on POP-Q stage.”
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 [38]
In Wiegersma et al.-14, there was no difference in POP-Q, but significant improvement in PFDI-20 in PFMT vs control; 57% vs 13% reported overall improvement in symptoms.
“No difference in POP-Q. Significant improvement in PFDI-20 in PFMT vs control; 57% in PFMT vs 13% in control reported overall improvement in symptoms”
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 [38]

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Authors: Wiegersma, M., Panman, C. M. C. R., Kollen, B. J., Berger, M. Y., Lisman-Van Leeuwen, Y., & Dekker, J. H.
Affiliations: University Medical Center Groningen (NL)
Corresponding author: Dekker, J. H.
ORCID: Berger, M. Y.
Dekker, J. H.
Venue: BMJ
Publisher: BMJ
Published: 2014-12-22
Volume: 349
Issue: dec22 1
Pages: g7378-g7378
ISSN: 1756-1833 (ISSN-L)
DOI: 10.1136/bmj.g7378
PMC: PMC4273538
OpenAlex: W2157103386
Cited by: 122
References: 34
Citations by year: 2026: 6 · 2025: 8 · 2024: 12 · 2023: 22 · 2022: 11 · 2021: 11 · 2020: 11 · 2019: 7 · 2018: 5 · 2017: 8 · 2016: 9 · 2015: 11 · 2014: 1
FWCI: 8.02
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
Locations: BMJ (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
HighWire Press Open Archive (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Funders: ZonMw (4201.1001)
Topics: Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Keywords: pelvic floor muscle training, expectant management, pelvic organ prolapse, older women, pelvic floor symptoms, bladder symptoms, bowel symptoms, quality of life, sexual function, pelvic floor muscle function, primary care, non-surgical management
MeSH terms: Aged, Female, Humans, Middle Aged, Netherlands, Primary Health Care, Surveys and Questionnaires, Treatment Outcome, Pelvic Floor, Physical Therapy Modalities, Pelvic Organ Prolapse, Watchful Waiting

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Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care

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