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In the journals: Pelvic floor muscle training can help reverse pelvic organ prolapse

Pelvic floor strengthening exercises, also known as Kegel exercises, are known to be effective for stress urinary incontinence in women, with cure rates of up to 80%. Now, in the largest trial of its kind, Norwegian researchers have found that pelvic floor strengthening can also improve pelvic organ prolapse and alleviate its symptoms. This condition develops when supporting structures of the pelvic area become lax and allow one or more pelvic organs (bladder, urethra, rectum, or uterus) to protrude into the vagina.

Surgery is the only definitive treatment, but pelvic floor exercises are often recommended to women who have mild symptoms or want to avoid surgery. The Norwegian study concludes that pelvic floor muscle training (PFMT) under the supervision of a physical therapist can not only help prevent the condition from worsening but also correct some of the underlying defects. Results were published in the American Journal of Obstetrics and Gynecology (August 2010).

The study. Researchers randomly assigned 109 women with pelvic organ prolapse to receive PFMT or to a control group. Both groups were taught to contract their pelvic floor muscles before and during a cough, sneeze, or other exertion, but those in the control group were asked not do any other pelvic floor exercises. Women in the PFMT group attended physical therapy sessions — weekly for three months, then biweekly for three months. They performed three sets of eight to 12 pelvic floor contractions in lying, sitting, and standing positions and were instructed to practice the exercises daily. At the outset and after six months, participants were examined to classify their prolapse severity according to a staging system. They also answered questions about the frequency and severity of prolapse symptoms (a feeling of vaginal bulging or heaviness) as well as bladder and bowel symptoms. The position of the bladder and rectum was monitored with ultrasound.

Results. The PFMT group showed much greater improvements in prolapse, bladder, and bowel symptoms; 74% felt less vaginal bulging or heaviness, compared with 31% in the control group. Severity of prolapse improved by one full stage in 19% of PFMT participants, compared with 8% of the control group. The exercisers also had greater improvements in pelvic floor muscle strength and endurance and in bladder and rectum position.

Limitations and implications. There was no follow-up after the six-month trial ended, so it’s unclear how long benefits last or whether further supervised instruction would be needed to preserve the benefits. On the other hand, these exercises appear to have no downside.

Resources. It’s important to use the proper technique. Your gynecologist or a physical therapist can help you locate the right muscles and perform the exercises correctly. You can also consult our step-by-step guide to Kegel exercises, at www.health.harvard.edu/womenextra.

Posted by: Dr.Health

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