# Savonia Article Pro: Pelvic floor muscle training in the prevention and treatment of pelvic organ prolapse

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## Introduction

Pelvic organ prolapse (POP) is a falling, slipping, or downward displacement of one or more structures of the vagina – the anterior vaginal wall, posterior vaginal wall, uterus, or apex of the vagina – from the normal anatomical position (Lähderinne et al. 2026). The prevalence of prolapse increases with age, affecting approximately one in five women, although it is uncommon in young and nulliparous women (Rahkola-Soisalo et al. 2019; Tiitinen, 2025). Symptomatic prolapse affects approximately 5–10% of women, and the peak incidence occurs 20–30 years after the first childbirth (Rahkola-Soisalo et al. 2019; Tiitinen, 2025).

Although prolapse is generally not life-threatening, it can significantly reduce quality of life by affecting work ability and limiting participation in daily activities, physical activity, and sports (Laskeuma: Terveyskylä, 2020). Prolapse develops when the connective tissue and muscular structures of the pelvic floor become weakened, impairing the support needed for the normal position and function of the pelvic organs (Rahkola-Soisalo et al. 2019). Pregnancy and childbirth are among the most important risk factors for prolapse, with pregnancy approximately doubling the risk compared with women who have never given birth and each subsequent pregnancy potentially increasing the risk by approximately 10–20% (Rahkola-Soisalo et al. 2019). Other factors, including excess weight, repeated increases in intra-abdominal pressure (e.g., heavy physical work, heavy lifting, or chronic coughing), constipation, and genetic factors, may also contribute to the weakening of pelvic floor muscles and connective tissues and the development of prolapse (Laskeuma: Terveyskylä, 2020; Lähderinne et al. 2026; Tiitinen, 2025).

Symptoms vary depending on the type and severity of prolapse, and mild cases may be asymptomatic (Tiitinen, 2025). Common symptoms include a feeling of a bulge, pressure, or heaviness in the lower abdomen or pelvic floor area, which may worsen in the evening and improve when lying down (Laskeuma: Terveyskylä, 2020). POP can also affect bladder and bowel function and cause pain or discomfort during sexual intercourse (Lähderinne et al. 2026; Rahkola-Soisalo et al. 2019; Tiitinen, 2025).

POP can be treated surgically or conservatively, with conservative treatment including supportive devices, lifestyle modification, and physiotherapy (Rahkola-Soisalo et al. 2019). Physiotherapy, especially pelvic floor muscle training, has been shown to have a positive effect on urogenital symptoms and quality of life and is recommended as one of the first-line treatment options for women with symptomatic POP (Lähderinne et al. 2026).

Our group conducted a mini literature review as part of the physiotherapy degree programme at Savonia University of Applied Sciences. This article is part of a series produced within the course Professional in Physiotherapy, specifically its evidence-based physiotherapy section. During the course, students work in small groups to practice elements of a systematic literature review, including systematic literature searching, critical appraisal using the PEDro scale (PEDro, n.d.), and presenting the findings in the form of a scientific article.

The aim of our mini literature review was to examine the effects of pelvic floor muscle training on pelvic organ prolapse symptoms and severity.

## Methods

A mini literature review was conducted to examine randomized controlled trials (RCTs) investigating the effects of pelvic floor muscle training (PFMT) on pelvic organ prolapse (POP) symptoms and severity. A search of the PubMed database was performed using the search terms “pelvic organ prolapse” and “pelvic floor muscle training”. The search was initially limited to publications from the last 10 years (2016–2026) and identified 43 articles. As only a few studies met the inclusion criteria, the search period was extended to include publications from 2010 onwards.

Studies were selected based on the following inclusion criteria: (1) participants were women with pelvic organ prolapse; (2) pelvic floor muscle training was used as an intervention; (3) the studies included a control group; (4) the studies were randomized controlled trials (RCTs), including cluster-randomized trials; and (5) the outcomes included measures of prolapse symptoms and/or severity. Studies that did not meet these criteria were excluded.

Data extraction focused on participant characteristics, intervention type and duration, control groups, outcome measures and key findings. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) Scale (PEDro 1999). Following the selection process, three RCTs were included in the final review: Stüpp et al. (2011, Brazil), Hagen et al. (2017, United Kingdom), and Siyoum et al. (2025, Ethiopia).

## Results

In all three studies, guided pelvic floor muscle training (PFMT) produced better results than the control intervention in at least one outcome related to pelvic organ prolapse. However, differences in participants, training delivery, outcome measures and follow-up periods limit direct comparisons of the magnitude and persistence of these effects (Stüpp et al., 2011; Hagen et al., 2017; Siyoum et al., 2025).

Siyoum et al. (2025) investigated midwife-led PFMT in a cluster-randomized trial involving 187 Ethiopian women with symptomatic stage I–III prolapse. Of these women, 86 received PFMT alongside lifestyle counselling, while 101 received lifestyle counselling alone. After six months, symptom reduction and improvements in prolapse-related quality of life favoured the PFMT group. The between-group difference in mean change in POP-SS was −4.11 points (99% CI −5.38 to −2.83). Approximately 84% of women receiving PFMT reported an improvement in their condition, compared with approximately 42% of controls. The authors also reported greater benefits among women with stage I–II prolapse than among those with stage III prolapse (Siyoum et al., 2025).

Hagen et al. (2017) examined PFMT among women with stage I–III prolapse who had not previously sought treatment. Although 414 women were initially randomized, the analysis population comprised 412 participants following the exclusion of two women, one from each group. The intervention combined individual physiotherapy appointments, support for home training and Pilates-based pelvic floor exercise classes. Controls received a leaflet containing lifestyle advice. At the two-year assessment, average POP-SS scores were 3.2 in the intervention group and 4.2 in the control group. The adjusted between-group difference was −1.01 points (95% CI −1.70 to −0.33), showing a modest but statistically significant symptom benefit associated with the intervention (Hagen et al., 2017).

Stüpp et al. (2011) conducted a pilot trial involving 37 Brazilian women with stage II prolapse. Twenty-one women were allocated to PFMT and 16 to a control group receiving advice on pelvic floor contractions and lifestyle. After 14 weeks, anatomical outcomes for both the anterior and posterior vaginal walls favoured the PFMT group. The study also reported reduced prolapse symptoms and greater improvements in pelvic floor muscle strength, endurance and surface electromyography measures in the intervention group. However, the small sample and short follow-up limit conclusions about the generalizability and long-term persistence of these benefits (Stüpp et al., 2011).

## Methodological quality

The methodological quality of the included studies was assessed using the PEDro Scale. The scale includes 11 criteria, of which 10 contribute to the total score. These criteria assess internal validity and statistical reporting, including random allocation, allocation concealment, baseline comparability, blinding, follow-up completeness and intention-to-treat analysis (PEDro, 1999).

Stüpp et al. (2011) received a confirmed PEDro score of 5/10. The study met the criteria for random allocation, baseline comparability, assessor blinding, between-group comparisons, and reporting point estimates and variability. It did not meet the criteria for allocation concealment, participant or therapist blinding, adequate follow-up completeness, or intention-to-treat analysis (PEDro, 2026).

Hagen et al. (2017) received a confirmed PEDro score of 6/10. Its strengths included random allocation, concealed allocation, baseline comparability, intention-to-treat analysis, between-group comparisons and reporting point estimates and variability. The study did not meet the criteria for participant, therapist or assessor blinding, or adequate follow-up completeness (PEDro, 2026).

Siyoum et al. (2025) received a confirmed PEDro score of 7/10. The study met the criteria for random allocation, concealed allocation, baseline comparability, adequate follow-up, intention-to-treat analysis, between-group comparisons and reporting point estimates and variability. Participants and care providers were not blinded. Although the researchers collecting outcome data were blinded, the primary outcomes were reported by participants who knew which intervention they had received. Therefore, the PEDro criterion for assessor blinding was not met (PEDro, 2026; Siyoum et al., 2025).

Overall, all three studies used random allocation, had comparable groups at baseline and reported between-group comparisons with measures of variability. The main methodological limitations concerned blinding and, in two studies, follow-up completeness. Blinding participants and therapists is difficult in exercise interventions, but this does not eliminate the possibility of bias. These limitations should be considered when interpreting the findings.

## Conclusion

This mini literature review supports considering guided pelvic floor muscle training (PFMT) as part of individualized conservative care for women with pelvic organ prolapse (POP). The findings suggest that PFMT can reduce prolapse symptoms, although the extent of benefit and its effects on other outcomes vary between studies. Symptom relief should therefore be distinguished from anatomical improvement, and treatment goals should reflect each woman’s symptoms, needs and preferences (Stüpp et al., 2011; Hagen et al., 2017; Siyoum et al., 2025).

The studies were conducted in different cultural and healthcare settings, suggesting that PFMT may be relevant beyond a single care context. This supports considering its use in different settings while adapting guidance and delivery to local resources and individual needs. However, these findings do not establish that PFMT is equally effective across all cultures, age groups or stages of prolapse.

Confidence in the conclusions is limited by the small number of selected studies, methodological weaknesses and differences in participants, interventions and follow-up periods. This mini literature review therefore provides an indicative synthesis rather than a comprehensive assessment of the evidence. Further research should examine long-term outcomes and the delivery of PFMT in diverse populations using clearly described interventions and comparable outcome measures.

#### Authors

Mimmi Keinonen, physiotherapy student, Savonia University of Applied Sciences

Norairis Sihvonen, physiotherapy student, Savonia University of Applied Sciences

Tatiana Oleynikova, physiotherapy student, Savonia University of Applied Sciences

Supervisor: Marja Äijö, PhD, principal lecturer of rehabilitation and physiotherapy, Savonia University of Applied Sciences

This article was prepared with the help of AI.

#### References

Hagen, S., Glazener, C., McClurg, D., Macarthur, C., Elders, A., Herbison, P., Wilson, D., Toozs-Hobson, P., Hemming, C., Hay-Smith, J., Collins, M., Dickson, S., Logan, J. & Frawley, H. 2017. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. The Lancet 389 (10067), 393–402. Accessed 29 September 2026. [https://doi.org/10.1016/S0140-6736(16)32109-2](https://doi.org/10.1016/S0140-6736(16)32109-2)

Lähderinne, R., Törnävä, M. & Kankkunen, P. 2026. Assessment Methods Used in Pelvic Floor Physiotherapy in the Rehabilitation Process of a Patient with Pelvic Organ Prolapse: Qualitative Research. Nordic Journal of Rehabilitation. [http://urn.fi/urn:nbn:fi:jamk-issn-2954-1069-16](http://urn.fi/urn:nbn:fi:jamk-issn-2954-1069-16). Accessed 2 October 2026.

Laskeuma. Terveyskylä. Reviewed 22 October 2020. [https://www.terveyskyla.fi/naistalo/gynekologinen-terveys/laskeuma](https://www.terveyskyla.fi/naistalo/gynekologinen-terveys/laskeuma). Accessed 2 October 2026.

PEDro scale. 1999. Physiotherapy Evidence Database. PEDro [https://pedro.org.au/](https://pedro.org.au/). Accessed 28 October 2026.

PEDro. 2026. Detailed search result: Hagen et al. (2017), confirmed PEDro score 6/10. Accessed 29 September 2026. [https://search.pedro.org.au/search-results/record-detail/48422](https://search.pedro.org.au/search-results/record-detail/48422)

PEDro. 2026. Detailed search result: Siyoum et al. (2025), confirmed PEDro score 7/10. Accessed 19 October r 2026. [https://search.pedro.org.au/search-results/record-detail/84111](https://search.pedro.org.au/search-results/record-detail/84111)

PEDro. 2026. Detailed search result: Stüpp et al. (2011), confirmed PEDro score 5/10. Accessed 29 September 2026. [https://search.pedro.org.au/search-results/record-detail/30928](https://search.pedro.org.au/search-results/record-detail/30928)

Rahkola-Soisalo, P., Raatikainen, K. & Mikkola T. 2019. Gynekologiset laskeumat. Lääketieteellinen Aikakauskirja Duodecim 2019, 135(7), 639-46. [https://www.duodecimlehti.fi/duo14854](https://www.duodecimlehti.fi/duo14854). Accessed 2 October 2026.

Siyoum, M., Nardos, R., Sirak, B., Spitznagle, T., Teklesilasie, W. & Astatkie, A. 2025. Effect of midwife-led pelvic floor muscle training on prolapse symptoms and quality of life in women with pelvic organ prolapse in Ethiopia: A cluster-randomized controlled trial. PLoS Medicine 22 (3), e1004468. Accessed 28 September 2026. [https://doi.org/10.1371/journal.pmed.1004468](https://doi.org/10.1371/journal.pmed.1004468)

Stüpp, L., Resende, A. P. M., Oliveira, E., Castro, R. A., Girão, M. J. B. C. & Sartori, M. G. F. 2011. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. International Urogynecology Journal 22 (10), 1233–1239. Accessed 29 September 2026. [https://pubmed.ncbi.nlm.nih.gov/21484362/](https://pubmed.ncbi.nlm.nih.gov/21484362/)

Tiitinen, A. Kohdunlaskeuma. 2025. Lääkärikirja Duodecim. Helsinki: Kustannus Oy Duodecim. [https://www.terveyskirjasto.fi/dlk00140](https://www.terveyskirjasto.fi/dlk00140). Accessed 2 October 2026.

Use of Artificial Intelligence (AI):

ChatGPT (OpenAI, 2026) was used to generate one illustration and to check the spelling and grammar of the article.