Systematic Review and Meta-analysis Exploring Outcomes linked to the use of Physiotherapy in managing Pelvic Organ Prolapse

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Elliot, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6073673/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Pelvic organ prolapse impacts millions globally, causing discomfort and reduced quality of life. Physiotherapy offers a potential non-invasive solution, strengthening pelvic muscles and appearing to offer an effective means of effectively improving symptoms. To better understand this relationship, we conducted a systematic review and meta-analysis. Methods A systematic methodology was designed before gathering eligible data from PubMed, ScienceDirect and Web of Science. All randomised clinical trials and non-clinical trials that were peer reviewed and published were included. Results A total of 7 studies were included in the final sample. Pelvic floor muscle training (PFMT) was a common technique to support the evaluation of perineal tears and episiotomy. A meta-analysis was conducted using symptom assessment scale over a 24-month period where the pooled mean difference showed − 2.76% (95% CI: [-4.19, -1.32]) statistically significant. Conclusion It is evident limited research has been conducted within this field, and long-term studies are required to improve the care offered to women with pelvic organ prolapse. Women's studies Pelvic organ prolapse Physiotherapy Pelvic floor Womens Health Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Introduction Pelvic organ prolapse (POP) is a prevalent condition characterized by the descent of one or more pelvic organs, such as the bladder, uterus, or rectum, from their normal anatomical position, exerting pressure on the vaginal walls ( 1 ). Estimating the true prevalence of POP is challenging due to underreporting and inconsistent diagnostic criteria. However, global studies suggest that POP affects approximately 30–50% of women to some degree, with severe cases reported in 5–10% of the population ( 2 ). While higher rates of diagnosis are observed in high-income countries due to improved healthcare access, POP remains a significant issue in low- and middle-income countries, where risk factors such as heavy manual labour and limited preventive care are more prevalent ( 3 ). Symptoms of POP range from mild discomfort to severe functional impairments, significantly affecting quality of life. Commonly reported symptoms include a sensation of pressure or fullness in the pelvic area, urinary incontinence, constipation, sexual dysfunction, and vaginal bulging ( 4 ). Additional symptoms may include lower back pain, vaginal bleeding, or discharge, depending on the prolapse's type and severity. These symptoms often worsen throughout the day and with activities that increase intra-abdominal pressure, such as heavy lifting. Beyond physical discomfort, POP can have profound psychological effects, including embarrassment, sexual distress, anxiety, and depression ( 5 ). The aetiology of POP is multifactorial, with age being one of the most significant determinants, with the aging global population expected to lead to a substantial increase in cases by 2050. Postmenopausal women are at a substantially higher risk due to hormonal changes that weaken connective tissues and pelvic support structures (Swift et al., 2005). Obstetric factors, including vaginal delivery, prolonged or complicated labour, and multiple pregnancies, also contribute to the condition by causing trauma to pelvic muscles and ligaments ( 6 ). Lifestyle factors can also increase the risk of POP such as obesity, smoking, chronic constipation, these include occupations involving heavy lifting that increase intra-abdominal pressure ( 7 ). Genetic predisposition plays a role, with family history suggesting a hereditary component linked to variations in collagen synthesis and connective tissue integrity ( 8 ). Other medical conditions, such as chronic respiratory disorders that lead to persistent coughing, can also precipitate, or aggravate prolapse ( 9 ). Management of POP is tailored to the severity of symptoms, with options ranging from conservative measures to surgical interventions. For mild cases, lifestyle modifications, such as weight management and dietary adjustments, combined with pelvic floor muscle training (PFMT), are recommended. Physiotherapy is central to conservative management, as PFMT strengthens pelvic floor muscles, improves support for pelvic organs, and reduces symptom severity ( 10 ). Evidence indicates that integrating PFMT into daily routines is particularly beneficial for women at high risk due to aging, childbirth, or obesity ( 11 ). For moderate-to-severe cases, the use of pessaries to provide mechanical support to the vaginal walls can be effective. Surgical interventions, including minimally invasive techniques such as laparoscopic sacrocolpopexy, are reserved for severe cases where conservative measures fail. However, debates regarding the long-term efficacy and complications of surgical options persist, emphasizing the need for individualized treatment planning ( 12 ). Physiotherapy is a cornerstone of both preventive and therapeutic strategies for POP. Preventively, PFMT enhances pelvic floor muscle tone and resilience, reducing the risk of prolapse. Physiotherapists also educate patients on strategies to minimize intra-abdominal pressure, such as proper lifting techniques and avoiding heavy lifting. For women with established POP, individualized PFMT programs, often combined with biofeedback, have demonstrated efficacy in improving symptoms like urinary incontinence and pelvic pressure ( 6 ). Additionally, addressing modifiable risk factors, such as constipation and obesity, through lifestyle guidance further complements physiotherapy's benefits. As the global burden of POP rises, multidisciplinary approaches that integrate physiotherapy with medical and surgical options can offer effective, patient-centred care. Therefore, it is important to understand more of how physiotherapy can be effectively and in which circumstances. To better understand this relationship this systematic review and meta analysis including an examination of the impact of pelvic floor muscle training (PFMT) on perineal tears and episiotomy Methods A systematic methodology was developed and published in PROSPERO (CRD42024577044). Searches and Eligibility Multiple databases of PubMed, Web of Science and ScienceDirect were used alongside of key terms of pelvic organ prolapse and physiotherapy . All studies reporting POP and physiotherapy, peer reviewed, and published in English from the 30th of April 1980 to the 30th of April 2024 were included. Data extraction and analysis The data extraction process is illustrated in the PRISMA diagram (Fig. 1 ). Quantitative measures, including mean, median, mode, and standard deviation, were extracted from each study. An independent reviewer refined the data, which was then pooled by two reviewers (EB and JS) using Endnote and Microsoft Excel. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated and reported. Statistical analysis The meta-analysis used either random-effects models or fixed-effects models based on the heterogeneity between studies. Statistical heterogeneity among studies was assessed using the Cochrane Q test and the I² statistic. Due to the limited number of studies included in the meta-analysis, Egger's test was not used, and only the funnel plot was presented to demonstrate publication bias. Data analysis was performed using the meta package (version 8.0–1) and the metafor package (version 4.6-0) in R software (version 4.4.2). Risk of bias The Newcastle Ottawa Quality Assessment Scale (NOS) was used to assess the risk of bias. The studies were evaluated using the following criteria: selection, comparability, and exposure. A maximum of four stars was awarded for selection, two for comparability and three for outcomes, with a maximum of nine stars. NOS was used to assess the quality of cohort studies, case control and cross-sectional studies (Table 1 ). The studies were categorised into low risk if they scored 7–9 stars, moderate risk if they scored 5–6 stars and high risk if they scored 0–4 stars. Cochrane Collaboration’s tool was used to assess the risk of bias in randomized control trials (Table 2 ). Table 1 Risk of bias assessing observational study using Newcastle Ottawa Quality Assessment Scale No Authors Selection (S) Comparability (C) Exposure/ Outcome (E/O) Total Stars Conclusion 1 2 3 4 1 1 2 3 26 N S Ali-Ross et al * * * * * ***** Moderate risk 1. Pelvic Floor Training for Women Postpartum Effectiveness of Perineal Massage and Pelvic Floor Muscle Training (PFMT) The impact of perineal massage combined with PFMT on preventing perineal tears and episiotomy was evaluated. The experimental group received this combined intervention, while the control group received only relevant education. A meta-analysis of two studies, with a total of 866 pregnant women (400 from Egypt and 466 from Spain), was conducted. 1.1 Demographic Characteristics of the Studied Groups The baseline demographic characteristics of the participants are summarised in the table below: Variable Treatment Group Control Group Sample Size 454 412 Age (Mean ± SD) 34.87 ± 4.45 33.61 ± 6.08 BMI (Mean ± SD) 25.68 ± 4.63 26.27 ± 5.65 1.2 Meta-Analysis 1.2.1 Duration of the Second Stage of Labor The impact of the duration of the second stage duration of labour between the experimental group and the control group was compared. The pooled mean difference in the second stage of labour was − 9.95 (95% CI: [-28.73, 8.83]), which was not statistically significant. These findings indicate no difference between the experimental and control groups. 1.2.2 Apgar Score at 1 Minute The pooled mean difference was 0.17 (95% CI: [-0.23, 0.15]), showing no statistically significant difference between the groups. 1.2.3 Apgar Score at 5 Minutes The pooled mean difference was 0.22 (95% CI: [-0.13, 0.56]), which was not statistically significant, indicating no difference in Apgar scores at 5 minutes. 1.2.4 Severe Perineal Trauma (Grades III & IV) The pooled odds ratio (OR) was 0.33 (95% CI: [0.19, 0.59]), indicating a significantly lower risk of severe perineal trauma in the experimental group compared to the control group. 1.2.5 Episiotomy The pooled OR for episiotomy was 0.50 (95% CI: [0.26, 0.56]), demonstrating that the risk of episiotomy in the experimental group was half that of the control group. 1.2.6 Pain Severity (Moderate or Severe Pain) The pooled OR was 0.50 (95% CI: [0.36, 0.71]), indicating that the risk of moderate or severe pain was halved in the experimental group compared to the control group. 1.2.7 Postpartum Analgesia Requirement The pooled OR was 0.49 (95% CI: [0.28, 0.86]), showing a significantly lower need for postpartum analgesia in the experimental group than in the control group. 2. Pelvic Floor Muscle Training for Women with Pelvic Organ Prolapse (POP) Effectiveness of PFMT in Alleviating POP Symptoms The effectiveness of PFMT was evaluated in three studies conducted in Denmark, India, and the UK/Australia, involving a total of 676 women with pelvic organ prolapse. The experimental group received PFMT, while the control group received no intervention. 2.1 Demographic Characteristics of the Studied Groups Variable Treatment Group Control Group Sample Size 346 330 Age (Mean) 54.61 57.95 Parity (Mean) 2.23 2.30 2.2 Meta-Analysis 2.2.1 Symptom Assessment Using the POP-SS (24-Week Follow-Up) The POP-SS scale is a questionnaire tool used to assess symptoms of pelvic organ prolapse in women. A comparison of changes in the POP-SS scores between the experimental group and the control group over a 24-month follow-up period were conducted. The pooled mean difference in POP-SS scores was − 2.76 (95% CI: [-4.19, -1.32]), which was statistically significant. Women in the experimental group experienced greater reductions in POP symptoms compared to the control group. 2.2.2 Symptom Assessment Using the PFIQ-7 (24-Week Follow-Up) The PFIQ-7 consists of 7 questions that need to be answered 3 times each considering symptoms related to the bladder or urine, vagina or pelvis, and bowel or rectum and their effect on function, social health, and mental health in the past 3 months. The pooled mean difference in PFIQ-7 scores was − 1.17 (95% CI: [-2.24, -0.10]), indicating a significant reduction in prolapse symptoms in the experimental group. 3. Pelvic Floor Muscle Training for Women Undergoing Pelvic Organ Prolapse Surgery Effectiveness of PFMT in Surgical Outcomes A meta-analysis of two studies (one from Norway and one from Brazil) involving 241 women undergoing POP surgery was conducted. 3.1 Demographic Characteristics of the Studied Groups Variable Treatment Group Control Group Sample Size 118 123 Age (Mean) 62.64 60.36 BMI (Mean) 27.75 27.60 Parity (Mean) 3.12 3.30 Smoker (n) 15 8 3.2 Meta-Analysis 3.2.1 Symptom Assessment Using the UDI-6 The Urogenital Distress Inventory-6 (UDI-6) is a short-form questionnaire designed to assess the impact of lower urinary tract symptoms and genital prolapse on a woman’s quality of life. This study compared the changes in UDI-6 scores between the experimental group and the control group before and after surgery. The pooled mean difference in UDI-6 scores was 3.24 (95% CI: [0.49, 5.99]), which was statistically significant. This indicates better outcomes in the control group compared to the experimental group. 3.2.2 Symptom Assessment Using the CRADI-8 The Colorectal-Anal Distress Inventory-8 (CRADI-8) is a short-form questionnaire designed to assess the distress and impact of colorectal and anal symptoms in women with pelvic floor disorders. The pooled mean difference in CRADI-8 scores was 2.63 (95% CI: [-1.97, 7.24]), which was not statistically significant, indicating no difference between the groups. Publication bias The following funnel plots illustrate the publication bias for all outcomes. Due to the limited number of studies included in the meta-analysis, it is not possible to use Egger's test to assess the symmetry of the funnel plot. Discussion This study highlights the effectiveness of pelvic floor muscle training (PFMT) in improving pelvic health outcomes across postpartum recovery, pelvic organ prolapse (POP) management, and surgical contexts. The results support the therapeutic role of PFMT, emphasizing its potential to reduce symptoms, prevent complications, and improve overall quality of life for women. Given its widespread impact, addressing POP requires comprehensive public health strategies. These should prioritize education on preventive measures, increasing access to healthcare, and promoting conservative management approaches, particularly in underserved regions. Awareness campaigns to reduce stigma and encourage early consultation could significantly improve outcomes. Additionally, expanding access to affordable physiotherapy services and training healthcare providers in conservative management techniques could bridge the gap in low-resource settings. Postpartum Pelvic Floor Training The combination of perineal massage and PFMT was found to significantly reduce the incidence of severe perineal trauma and episiotomies in postpartum women compared to education-only controls. Pain severity and the need for postpartum analgesia were also significantly lower in the treatment group. These findings reinforce previous evidence that targeted pelvic floor interventions enhance tissue resilience and muscle function, reducing trauma and facilitating postpartum recovery (Hagen & Stark, 2011). Despite these benefits, there were no significant differences in the duration of the second stage of labour or neonatal Apgar scores. This suggests that while PFMT is instrumental in maternal recovery, it does not directly influence neonatal outcomes, highlighting its primary utility as a maternal health intervention. Pelvic Floor Muscle Training for Women with Pelvic Organ Prolapse The results provide robust evidence of PFMT’s effectiveness in reducing POP symptoms, as demonstrated by significant improvements in Pelvic Organ Prolapse Symptom Score (POP-SS) outcomes. The pooled mean difference of -2.76 (95% CI: [-4.19, -1.32]) at the 24-week follow-up represents a clinically meaningful reduction in symptoms in the treatment group compared to the control. The negative value confirms that the intervention group experienced lower symptom scores, further emphasizing PFMT's benefit in alleviating prolapse-related distress. However, only three studies were included in this meta-analysis, and their geographical diversity—spanning Denmark, India, the UK, and Australia—may not fully represent broader populations. Differences in healthcare systems, cultural practices, and patient characteristics could influence the generalizability of these findings. For instance, demographic differences in age and parity between the treatment (mean age 54.61 years) and control groups (mean age 57.95 years) may have introduced bias. Older age is associated with greater symptom severity in POP, potentially skewing outcomes in favour of the treatment group. Additionally, the reliance on self-reported symptom severity via the POP-SS tool, while validated, introduces potential subjective bias. These limitations notwithstanding, the findings underscore PFMT’s promise as a conservative management strategy for POP, particularly in settings where surgical interventions may not be readily accessible. Pelvic Floor Muscle Training and Pelvic Organ Prolapse Surgery The role of PFMT in women undergoing POP surgery yielded mixed outcomes. While the intervention group did not exhibit better Urogenital Distress Inventory-6 (UDI-6) scores compared to controls, no significant differences were observed in colorectal-anal distress (CRADI-8) scores between groups. The better UDI-6 outcomes in the control group raise questions regarding the timing, intensity, and focus of PFMT protocols in the perioperative period. These results suggest that surgical recovery may require tailored interventions to complement PFMT. The lack of significant differences in CRADI-8 scores suggests that PFMT may have limited utility in addressing colorectal symptoms following POP surgery. This finding warrants further exploration into specific symptom domains that PFMT can effectively target postoperatively. Clinical Implications The evidence supports the integration of PFMT into routine care for postpartum women and those with POP, emphasizing its role as a non-invasive, cost-effective intervention. For postpartum women, combining PFMT with perineal massage could prevent significant complications, while for women with POP, PFMT offers a viable strategy to reduce symptom burden and delay surgical intervention. However, the mixed results in surgical cohorts highlight the need for further research to optimize PFMT protocols in perioperative settings. Efforts to standardize interventions, improve adherence, and evaluate their long-term impact are critical for advancing pelvic health management. Public Health Perspective These findings have important public health implications, particularly for underserved populations where access to surgical care is limited. Expanding access to PFMT through community-based programs and training healthcare providers to deliver consistent guidance can reduce the burden of POP and improve maternal health outcomes. Moreover, promoting awareness of PFMT’s benefits through education and public health campaigns could empower women to seek early intervention, reducing stigma and improving quality of life. Study Limitations and Future Directions The primary limitations include the small number of studies included in the POP analysis and the potential demographic and subjective biases in the data. Variability in healthcare practices and patient characteristics across study sites may limit the broader applicability of findings. Future research should focus on standardizing PFMT protocols across clinical contexts and evaluating their efficacy in larger, more diverse populations. Additionally, exploring adjunctive therapies, such as biofeedback or electrical stimulation, could further enhance PFMT outcomes. Long-term studies are also needed to assess the durability of PFMT’s benefits and its role in preventing symptom recurrence or progression. Conclusion PFMT is a cornerstone intervention for postpartum recovery and POP management, offering significant symptom relief and prevention of complications. While its role in surgical recovery requires further clarification, PFMT represents a critical component of women’s pelvic health care. Addressing disparities in access to care and fostering awareness at the community level remain critical for improving the quality of life for women affected by POP worldwide. Efforts to improve access and adherence to PFMT programs have the potential to transform outcomes for women globally, addressing an unmet need in pelvic health management. Declarations Funding: Not funded Conflicts of interest: All authors report no conflict of interest. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the Academic institutions. Availability of data and material: The data shared within this manuscript is publicly available. Code availability: Not applicable Author contributions: GD developed the evidence synthesis methodology. GD, ME, and SE conceptualised the study. First draft was written by ES and GD and furthered by all other authors. JS completed data collection, whilst JQS and GD conducted the analysis. All authors critically appraised, reviewed and commented on all versions of the manuscript. All authors read and approved the final manuscript. Ethics approval: Not applicable Consent to participate: No participants were involved within this paper Consent for publication: All authors consented to publish this manuscript References Ajayi O, Chilaka VN (2021) Pelvic Organ Prolapse. Contemporary Obstetrics and Gynecology for Developing Countries. :497–505 Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE et al (2014) Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstet Gynecol 123(1):141–148 Walker GJ, Gunasekera P (2011) Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J 22:127–135 Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166 Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M et al (2013) Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 309(19):2016–2024 Hagen S, Stark D Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Reviews. 2011(12). Miedel A, Tegerstedt G, Mæhle-Schmidt M, Nyrén O, Hammarström M (2009) Nonobstetric risk factors for symptomatic pelvic organ prolapse. Obstet Gynecol 113(5):1089–1097 Kammerer-Doak D, Rogers R (2021) Female sexual dysfunction. Pelvic Floor Disorders: A Multidisciplinary Textbook. :909 – 21 Ghandi S, Sand P (2005) History and physical examination of pelvic floor disorders. Taylor & Francis Group, Boca Raton, FL, pp 119–139 Dumoulin C, Cacciari LP, Hay-Smith EJC Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane database Syst reviews. 2018(10). Bø K, Mørkved S, Frawley H, Sherburn M (2009) Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. Neurourol Urodynamics: Official J Int Cont Soc 28(5):368–373 Barber MD, Maher C (2013) Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 24:1783–1790 Tables Table 2 is available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files PhysioTable1revised.docx Table2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6073673","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":418688147,"identity":"13c488a9-5f39-45ff-9911-67c7e06d8c3c","order_by":0,"name":"Snehal Ghosh","email":"","orcid":"","institution":"University of Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Snehal","middleName":"","lastName":"Ghosh","suffix":""},{"id":418688148,"identity":"9456ff51-4de0-46ed-952e-35499a751f15","order_by":1,"name":"Sun Jie","email":"","orcid":"","institution":"Southern University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Sun","middleName":"","lastName":"Jie","suffix":""},{"id":418688149,"identity":"20d9f117-87bc-44d5-aa4c-708c9c7878b8","order_by":2,"name":"Elena Bedggood","email":"","orcid":"","institution":"University of Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Elena","middleName":"","lastName":"Bedggood","suffix":""},{"id":418688150,"identity":"f1952f31-38d3-4842-b645-100f23815acb","order_by":3,"name":"Vindya Pathiraja","email":"","orcid":"","institution":"University of Ruhuna","correspondingAuthor":false,"prefix":"","firstName":"Vindya","middleName":"","lastName":"Pathiraja","suffix":""},{"id":418688151,"identity":"25fa1217-98bb-4cd7-991e-0b0aa24ad49a","order_by":4,"name":"Mark T. 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3","display":"","copyAsset":false,"role":"figure","size":62655,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the mean difference of the Apgar score at 1 minute between treatment group and controlgroup.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/88701abd6410234bb26b45e7.png"},{"id":77279991,"identity":"0d6bdf12-d157-4238-8ab6-99e132a93d66","added_by":"auto","created_at":"2025-02-27 03:48:38","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":67508,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the mean difference of the Apgar score at 5 minute between treatment group and control group.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/15c75ad9960f0452f12bb715.png"},{"id":77281252,"identity":"7887cb98-5454-4055-ac67-fd444ece3c08","added_by":"auto","created_at":"2025-02-27 04:04:38","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":57787,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the odds ratio for the risk of severe perineal traumabetween treatment group and control group.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/46c07a999f73497f561b73f6.png"},{"id":77281998,"identity":"490e111a-cf73-4eaf-8701-a3ea16cb307e","added_by":"auto","created_at":"2025-02-27 04:12:38","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":58833,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the odds ratio for the risk of episiotomybetween treatment group and control group.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/0cffd299e76dfd53adf607aa.png"},{"id":77280999,"identity":"1555272a-8f8e-4791-88f9-9f167ca0d418","added_by":"auto","created_at":"2025-02-27 03:56:39","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":58080,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the odds ratio for the risk of requiring postpartum analgesia between treatment group and control group.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/dd70e4c3a4d9adb5fdd11fe4.png"},{"id":77281255,"identity":"04553c6c-d616-4a44-9965-c1e5e250fa46","added_by":"auto","created_at":"2025-02-27 04:04:39","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":82014,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the mean difference of the POP-SS scalebetween treatmentgroup and controlgroup.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/8be132e990182e81f03c302a.png"},{"id":77279788,"identity":"989b54bc-0364-468e-becc-4ab44249b03e","added_by":"auto","created_at":"2025-02-27 03:40:39","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":79436,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the mean difference of the PFIQ-7 scalebetween treatmentgroup and controlgroup.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/a566b4a829a6c2f29a8187a2.png"},{"id":77279799,"identity":"c366f898-08c5-4146-b013-5a26e46625b2","added_by":"auto","created_at":"2025-02-27 03:40:40","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":79942,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot illustrating the mean difference of the UDI-6 scalebetween treatmentgroup and 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13","display":"","copyAsset":false,"role":"figure","size":31303,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot based on the data of Figure 2\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"13.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/9771ff304976301966c1d3c9.png"},{"id":77281003,"identity":"0ce36c50-e2b5-4f24-9a71-1a8821905a67","added_by":"auto","created_at":"2025-02-27 03:56:40","extension":"png","order_by":14,"title":"Figure 14","display":"","copyAsset":false,"role":"figure","size":39692,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot based on the data of Figure 3\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"14.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/73325a761c61b41d5ce0fde6.png"},{"id":77281002,"identity":"f238862b-5004-4a11-a814-755c66349e4e","added_by":"auto","created_at":"2025-02-27 03:56:39","extension":"png","order_by":15,"title":"Figure 15","display":"","copyAsset":false,"role":"figure","size":39868,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot based on the data of Figure 4\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"15.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/9163763e7719bbe13b4394a1.png"},{"id":77279816,"identity":"cadaf307-97e4-41c7-bb5f-17889df7346a","added_by":"auto","created_at":"2025-02-27 03:40:40","extension":"png","order_by":16,"title":"Figure 16","display":"","copyAsset":false,"role":"figure","size":41228,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot based on the data of Figure 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22","display":"","copyAsset":false,"role":"figure","size":35080,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot based on the data of Figure 11\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"22.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/159d090a6e22157f4b4e6cad.png"},{"id":77280025,"identity":"ca4e7c3e-b8a6-48cb-86d7-6e622fdf7f50","added_by":"auto","created_at":"2025-02-27 03:48:41","extension":"png","order_by":23,"title":"Figure 23","display":"","copyAsset":false,"role":"figure","size":29289,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot based on the data of Figure 12\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"23.png","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/27b51e210b2a13d73c5bb3f0.png"},{"id":77279767,"identity":"9870bb14-3a06-49af-ac65-d17d0b331cb6","added_by":"auto","created_at":"2025-02-27 03:40:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26202,"visible":true,"origin":"","legend":"","description":"","filename":"PhysioTable1revised.docx","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/d352e6d832e9fc02b84c50ed.docx"},{"id":77279797,"identity":"ab5b0c8f-4df5-4a6f-ae28-8680d9cc6086","added_by":"auto","created_at":"2025-02-27 03:40:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":68402,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6073673/v1/73d3a56954c25f24e3ca744a.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSystematic Review and Meta-analysis Exploring Outcomes linked to the use of Physiotherapy in managing Pelvic Organ Prolapse\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePelvic organ prolapse (POP) is a prevalent condition characterized by the descent of one or more pelvic organs, such as the bladder, uterus, or rectum, from their normal anatomical position, exerting pressure on the vaginal walls (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Estimating the true prevalence of POP is challenging due to underreporting and inconsistent diagnostic criteria. However, global studies suggest that POP affects approximately 30\u0026ndash;50% of women to some degree, with severe cases reported in 5\u0026ndash;10% of the population (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While higher rates of diagnosis are observed in high-income countries due to improved healthcare access, POP remains a significant issue in low- and middle-income countries, where risk factors such as heavy manual labour and limited preventive care are more prevalent (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSymptoms of POP range from mild discomfort to severe functional impairments, significantly affecting quality of life. Commonly reported symptoms include a sensation of pressure or fullness in the pelvic area, urinary incontinence, constipation, sexual dysfunction, and vaginal bulging (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Additional symptoms may include lower back pain, vaginal bleeding, or discharge, depending on the prolapse's type and severity. These symptoms often worsen throughout the day and with activities that increase intra-abdominal pressure, such as heavy lifting. Beyond physical discomfort, POP can have profound psychological effects, including embarrassment, sexual distress, anxiety, and depression (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe aetiology of POP is multifactorial, with age being one of the most significant determinants, with the aging global population expected to lead to a substantial increase in cases by 2050. Postmenopausal women are at a substantially higher risk due to hormonal changes that weaken connective tissues and pelvic support structures (Swift et al., 2005). Obstetric factors, including vaginal delivery, prolonged or complicated labour, and multiple pregnancies, also contribute to the condition by causing trauma to pelvic muscles and ligaments (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLifestyle factors can also increase the risk of POP such as obesity, smoking, chronic constipation, these include occupations involving heavy lifting that increase intra-abdominal pressure (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Genetic predisposition plays a role, with family history suggesting a hereditary component linked to variations in collagen synthesis and connective tissue integrity (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Other medical conditions, such as chronic respiratory disorders that lead to persistent coughing, can also precipitate, or aggravate prolapse (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eManagement of POP is tailored to the severity of symptoms, with options ranging from conservative measures to surgical interventions. For mild cases, lifestyle modifications, such as weight management and dietary adjustments, combined with pelvic floor muscle training (PFMT), are recommended. Physiotherapy is central to conservative management, as PFMT strengthens pelvic floor muscles, improves support for pelvic organs, and reduces symptom severity (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Evidence indicates that integrating PFMT into daily routines is particularly beneficial for women at high risk due to aging, childbirth, or obesity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor moderate-to-severe cases, the use of pessaries to provide mechanical support to the vaginal walls can be effective. Surgical interventions, including minimally invasive techniques such as laparoscopic sacrocolpopexy, are reserved for severe cases where conservative measures fail. However, debates regarding the long-term efficacy and complications of surgical options persist, emphasizing the need for individualized treatment planning (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePhysiotherapy is a cornerstone of both preventive and therapeutic strategies for POP. Preventively, PFMT enhances pelvic floor muscle tone and resilience, reducing the risk of prolapse. Physiotherapists also educate patients on strategies to minimize intra-abdominal pressure, such as proper lifting techniques and avoiding heavy lifting. For women with established POP, individualized PFMT programs, often combined with biofeedback, have demonstrated efficacy in improving symptoms like urinary incontinence and pelvic pressure (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Additionally, addressing modifiable risk factors, such as constipation and obesity, through lifestyle guidance further complements physiotherapy's benefits.\u003c/p\u003e \u003cp\u003eAs the global burden of POP rises, multidisciplinary approaches that integrate physiotherapy with medical and surgical options can offer effective, patient-centred care. Therefore, it is important to understand more of how physiotherapy can be effectively and in which circumstances. To better understand this relationship this systematic review and meta analysis including an examination of the impact of pelvic floor muscle training (PFMT) on perineal tears and episiotomy\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA systematic methodology was developed and published in PROSPERO (CRD42024577044).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearches and Eligibility\u003c/h2\u003e \u003cp\u003eMultiple databases of PubMed, Web of Science and ScienceDirect were used alongside of key terms of \u003cem\u003epelvic organ prolapse\u003c/em\u003e and \u003cem\u003ephysiotherapy\u003c/em\u003e. All studies reporting POP and physiotherapy, peer reviewed, and published in English from the 30th of April 1980 to the 30th of April 2024 were included.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData extraction and analysis\u003c/h3\u003e\n\u003cp\u003eThe data extraction process is illustrated in the PRISMA diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Quantitative measures, including mean, median, mode, and standard deviation, were extracted from each study. An independent reviewer refined the data, which was then pooled by two reviewers (EB and JS) using Endnote and Microsoft Excel. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated and reported.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe meta-analysis used either random-effects models or fixed-effects models based on the heterogeneity between studies. Statistical heterogeneity among studies was assessed using the Cochrane Q test and the I\u0026sup2; statistic. Due to the limited number of studies included in the meta-analysis, Egger's test was not used, and only the funnel plot was presented to demonstrate publication bias. Data analysis was performed using the meta package (version 8.0\u0026ndash;1) and the \u003cem\u003emetafor\u003c/em\u003e package (version 4.6-0) in R software (version 4.4.2).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRisk of bias\u003c/h3\u003e\n\u003cp\u003eThe Newcastle Ottawa Quality Assessment Scale (NOS) was used to assess the risk of bias. The studies were evaluated using the following criteria: selection, comparability, and exposure. A maximum of four stars was awarded for selection, two for comparability and three for outcomes, with a maximum of nine stars. NOS was used to assess the quality of cohort studies, case control and cross-sectional studies (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The studies were categorised into low risk if they scored 7\u0026ndash;9 stars, moderate risk if they scored 5\u0026ndash;6 stars and high risk if they scored 0\u0026ndash;4 stars. Cochrane Collaboration\u0026rsquo;s tool was used to assess the risk of bias in randomized control trials (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRisk of bias assessing observational study using Newcastle Ottawa Quality Assessment Scale\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"13\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAuthors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSelection (S)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eComparability (C)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eExposure/\u003c/p\u003e\n \u003cp\u003eOutcome (E/O)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal Stars\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConclusion\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN S Ali-Ross et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e*****\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate risk\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003e1. Pelvic Floor Training for Women Postpartum\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness of Perineal Massage and Pelvic Floor Muscle Training (PFMT)\u003c/h2\u003e \u003cp\u003eThe impact of perineal massage combined with PFMT on preventing perineal tears and episiotomy was evaluated. The experimental group received this combined intervention, while the control group received only relevant education. A meta-analysis of two studies, with a total of 866 pregnant women (400 from Egypt and 466 from Spain), was conducted.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.1 Demographic Characteristics of the Studied Groups\u003c/h3\u003e\n\u003cp\u003eThe baseline demographic characteristics of the participants are summarised in the table below:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.87\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.61\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e1.2 Meta-Analysis\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e1.2.1 Duration of the Second Stage of Labor\u003c/h2\u003e \u003cp\u003eThe impact of the duration of the second stage duration of labour between the experimental group and the control group was compared.\u003c/p\u003e \u003cp\u003eThe pooled mean difference in the second stage of labour was \u0026minus;\u0026thinsp;9.95 (95% CI: [-28.73, 8.83]), which was not statistically significant. These findings indicate no difference between the experimental and control groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e1.2.2 Apgar Score at 1 Minute\u003c/h2\u003e \u003cp\u003eThe pooled mean difference was 0.17 (95% CI: [-0.23, 0.15]), showing no statistically significant difference between the groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e1.2.3 Apgar Score at 5 Minutes\u003c/h2\u003e \u003cp\u003eThe pooled mean difference was 0.22 (95% CI: [-0.13, 0.56]), which was not statistically significant, indicating no difference in Apgar scores at 5 minutes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e1.2.4 Severe Perineal Trauma (Grades III \u0026amp; IV)\u003c/h2\u003e \u003cp\u003eThe pooled odds ratio (OR) was 0.33 (95% CI: [0.19, 0.59]), indicating a significantly lower risk of severe perineal trauma in the experimental group compared to the control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e1.2.5 Episiotomy\u003c/h2\u003e \u003cp\u003eThe pooled OR for episiotomy was 0.50 (95% CI: [0.26, 0.56]), demonstrating that the risk of episiotomy in the experimental group was half that of the control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e1.2.6 Pain Severity (Moderate or Severe Pain)\u003c/h2\u003e \u003cp\u003eThe pooled OR was 0.50 (95% CI: [0.36, 0.71]), indicating that the risk of moderate or severe pain was halved in the experimental group compared to the control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e1.2.7 Postpartum Analgesia Requirement\u003c/h2\u003e \u003cp\u003eThe pooled OR was 0.49 (95% CI: [0.28, 0.86]), showing a significantly lower need for postpartum analgesia in the experimental group than in the control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e2. Pelvic Floor Muscle Training for Women with Pelvic Organ Prolapse (POP)\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eEffectiveness of PFMT in Alleviating POP Symptoms\u003c/h2\u003e \u003cp\u003eThe effectiveness of PFMT was evaluated in three studies conducted in Denmark, India, and the UK/Australia, involving a total of 676 women with pelvic organ prolapse. The experimental group received PFMT, while the control group received no intervention.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Demographic Characteristics of the Studied Groups\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity (Mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Meta-Analysis\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Symptom Assessment Using the POP-SS (24-Week Follow-Up)\u003c/h2\u003e \u003cp\u003eThe POP-SS scale is a questionnaire tool used to assess symptoms of pelvic organ prolapse in women.\u003c/p\u003e \u003cp\u003eA comparison of changes in the POP-SS scores between the experimental group and the control group over a 24-month follow-up period were conducted. The pooled mean difference in POP-SS scores was \u0026minus;\u0026thinsp;2.76 (95% CI: [-4.19, -1.32]), which was statistically significant. Women in the experimental group experienced greater reductions in POP symptoms compared to the control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Symptom Assessment Using the PFIQ-7 (24-Week Follow-Up)\u003c/h2\u003e \u003cp\u003eThe PFIQ-7 consists of 7 questions that need to be answered 3 times each considering symptoms related to the bladder or urine, vagina or pelvis, and bowel or rectum and their effect on function, social health, and mental health in the past 3 months.\u003c/p\u003e \u003cp\u003eThe pooled mean difference in PFIQ-7 scores was \u0026minus;\u0026thinsp;1.17 (95% CI: [-2.24, -0.10]), indicating a significant reduction in prolapse symptoms in the experimental group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e3. Pelvic Floor Muscle Training for Women Undergoing Pelvic Organ Prolapse Surgery\u003c/h2\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eEffectiveness of PFMT in Surgical Outcomes\u003c/h2\u003e \u003cp\u003eA meta-analysis of two studies (one from Norway and one from Brazil) involving 241 women undergoing POP surgery was conducted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003e3.1 Demographic Characteristics of the Studied Groups\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (Mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity (Mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoker (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003e3.2 Meta-Analysis\u003c/h2\u003e \u003cdiv id=\"Sec28\" class=\"Section4\"\u003e \u003ch2\u003e3.2.1 Symptom Assessment Using the UDI-6\u003c/h2\u003e \u003cp\u003eThe Urogenital Distress Inventory-6 (UDI-6) is a short-form questionnaire designed to assess the impact of lower urinary tract symptoms and genital prolapse on a woman\u0026rsquo;s quality of life.\u003c/p\u003e \u003cp\u003eThis study compared the changes in UDI-6 scores between the experimental group and the control group before and after surgery. The pooled mean difference in UDI-6 scores was 3.24 (95% CI: [0.49, 5.99]), which was statistically significant. This indicates better outcomes in the control group compared to the experimental group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e3.2.2 Symptom Assessment Using the CRADI-8\u003c/h2\u003e \u003cp\u003eThe Colorectal-Anal Distress Inventory-8 (CRADI-8) is a short-form questionnaire designed to assess the distress and impact of colorectal and anal symptoms in women with pelvic floor disorders.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe pooled mean difference in CRADI-8 scores was 2.63 (95% CI: [-1.97, 7.24]), which was not statistically significant, indicating no difference between the groups.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePublication bias\u003c/h3\u003e\n\u003cp\u003eThe following funnel plots illustrate the publication bias for all outcomes. Due to the limited number of studies included in the meta-analysis, it is not possible to use Egger's test to assess the symmetry of the funnel plot.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the effectiveness of pelvic floor muscle training (PFMT) in improving pelvic health outcomes across postpartum recovery, pelvic organ prolapse (POP) management, and surgical contexts. The results support the therapeutic role of PFMT, emphasizing its potential to reduce symptoms, prevent complications, and improve overall quality of life for women.\u003c/p\u003e \u003cp\u003eGiven its widespread impact, addressing POP requires comprehensive public health strategies. These should prioritize education on preventive measures, increasing access to healthcare, and promoting conservative management approaches, particularly in underserved regions. Awareness campaigns to reduce stigma and encourage early consultation could significantly improve outcomes. Additionally, expanding access to affordable physiotherapy services and training healthcare providers in conservative management techniques could bridge the gap in low-resource settings.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003ePostpartum Pelvic Floor Training\u003c/h2\u003e \u003cp\u003eThe combination of perineal massage and PFMT was found to significantly reduce the incidence of severe perineal trauma and episiotomies in postpartum women compared to education-only controls. Pain severity and the need for postpartum analgesia were also significantly lower in the treatment group. These findings reinforce previous evidence that targeted pelvic floor interventions enhance tissue resilience and muscle function, reducing trauma and facilitating postpartum recovery (Hagen \u0026amp; Stark, 2011).\u003c/p\u003e \u003cp\u003eDespite these benefits, there were no significant differences in the duration of the second stage of labour or neonatal Apgar scores. This suggests that while PFMT is instrumental in maternal recovery, it does not directly influence neonatal outcomes, highlighting its primary utility as a maternal health intervention.\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003ePelvic Floor Muscle Training for Women with Pelvic Organ Prolapse\u003c/h2\u003e \u003cp\u003eThe results provide robust evidence of PFMT\u0026rsquo;s effectiveness in reducing POP symptoms, as demonstrated by significant improvements in Pelvic Organ Prolapse Symptom Score (POP-SS) outcomes. The pooled mean difference of -2.76 (95% CI: [-4.19, -1.32]) at the 24-week follow-up represents a clinically meaningful reduction in symptoms in the treatment group compared to the control. The negative value confirms that the intervention group experienced lower symptom scores, further emphasizing PFMT's benefit in alleviating prolapse-related distress.\u003c/p\u003e \u003cp\u003eHowever, only three studies were included in this meta-analysis, and their geographical diversity\u0026mdash;spanning Denmark, India, the UK, and Australia\u0026mdash;may not fully represent broader populations. Differences in healthcare systems, cultural practices, and patient characteristics could influence the generalizability of these findings. For instance, demographic differences in age and parity between the treatment (mean age 54.61 years) and control groups (mean age 57.95 years) may have introduced bias. Older age is associated with greater symptom severity in POP, potentially skewing outcomes in favour of the treatment group. Additionally, the reliance on self-reported symptom severity via the POP-SS tool, while validated, introduces potential subjective bias.\u003c/p\u003e \u003cp\u003eThese limitations notwithstanding, the findings underscore PFMT\u0026rsquo;s promise as a conservative management strategy for POP, particularly in settings where surgical interventions may not be readily accessible.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003ePelvic Floor Muscle Training and Pelvic Organ Prolapse Surgery\u003c/h2\u003e \u003cp\u003eThe role of PFMT in women undergoing POP surgery yielded mixed outcomes. While the intervention group did not exhibit better Urogenital Distress Inventory-6 (UDI-6) scores compared to controls, no significant differences were observed in colorectal-anal distress (CRADI-8) scores between groups. The better UDI-6 outcomes in the control group raise questions regarding the timing, intensity, and focus of PFMT protocols in the perioperative period. These results suggest that surgical recovery may require tailored interventions to complement PFMT.\u003c/p\u003e \u003cp\u003eThe lack of significant differences in CRADI-8 scores suggests that PFMT may have limited utility in addressing colorectal symptoms following POP surgery. This finding warrants further exploration into specific symptom domains that PFMT can effectively target postoperatively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Implications\u003c/h3\u003e\n\u003cp\u003eThe evidence supports the integration of PFMT into routine care for postpartum women and those with POP, emphasizing its role as a non-invasive, cost-effective intervention. For postpartum women, combining PFMT with perineal massage could prevent significant complications, while for women with POP, PFMT offers a viable strategy to reduce symptom burden and delay surgical intervention.\u003c/p\u003e \u003cp\u003eHowever, the mixed results in surgical cohorts highlight the need for further research to optimize PFMT protocols in perioperative settings. Efforts to standardize interventions, improve adherence, and evaluate their long-term impact are critical for advancing pelvic health management.\u003c/p\u003e\n\u003ch3\u003ePublic Health Perspective\u003c/h3\u003e\n\u003cp\u003eThese findings have important public health implications, particularly for underserved populations where access to surgical care is limited. Expanding access to PFMT through community-based programs and training healthcare providers to deliver consistent guidance can reduce the burden of POP and improve maternal health outcomes. Moreover, promoting awareness of PFMT\u0026rsquo;s benefits through education and public health campaigns could empower women to seek early intervention, reducing stigma and improving quality of life.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations and Future Directions\u003c/h2\u003e \u003cp\u003eThe primary limitations include the small number of studies included in the POP analysis and the potential demographic and subjective biases in the data. Variability in healthcare practices and patient characteristics across study sites may limit the broader applicability of findings.\u003c/p\u003e \u003cp\u003eFuture research should focus on standardizing PFMT protocols across clinical contexts and evaluating their efficacy in larger, more diverse populations. Additionally, exploring adjunctive therapies, such as biofeedback or electrical stimulation, could further enhance PFMT outcomes. Long-term studies are also needed to assess the durability of PFMT\u0026rsquo;s benefits and its role in preventing symptom recurrence or progression.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePFMT is a cornerstone intervention for postpartum recovery and POP management, offering significant symptom relief and prevention of complications. While its role in surgical recovery requires further clarification, PFMT represents a critical component of women\u0026rsquo;s pelvic health care. Addressing disparities in access to care and fostering awareness at the community level remain critical for improving the quality of life for women affected by POP worldwide. Efforts to improve access and adherence to PFMT programs have the potential to transform outcomes for women globally, addressing an unmet need in pelvic health management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNot funded\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u0026nbsp;\u003c/strong\u003eAll authors report no conflict of interest. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the Academic institutions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eThe data shared within this manuscript is publicly available.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eGD developed the evidence synthesis methodology. GD, ME, and SE conceptualised the study. First draft was written by ES and GD and furthered by all other authors. JS completed data collection, whilst JQS and GD conducted the analysis. All authors critically appraised, reviewed and commented on all versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eNo participants were involved within this paper\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll authors consented to publish this manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAjayi O, Chilaka VN (2021) Pelvic Organ Prolapse. Contemporary Obstetrics and Gynecology for Developing Countries. :497\u0026ndash;505\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE et al (2014) Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstet Gynecol 123(1):141\u0026ndash;148\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker GJ, Gunasekera P (2011) Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J 22:127\u0026ndash;135\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160\u0026ndash;1166\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M et al (2013) Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 309(19):2016\u0026ndash;2024\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagen S, Stark D Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Reviews. 2011(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiedel A, Tegerstedt G, M\u0026aelig;hle-Schmidt M, Nyr\u0026eacute;n O, Hammarstr\u0026ouml;m M (2009) Nonobstetric risk factors for symptomatic pelvic organ prolapse. Obstet Gynecol 113(5):1089\u0026ndash;1097\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKammerer-Doak D, Rogers R (2021) Female sexual dysfunction. Pelvic Floor Disorders: A Multidisciplinary Textbook. :909\u0026thinsp;\u0026ndash;\u0026thinsp;21\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhandi S, Sand P (2005) History and physical examination of pelvic floor disorders. Taylor \u0026amp; Francis Group, Boca Raton, FL, pp 119\u0026ndash;139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDumoulin C, Cacciari LP, Hay-Smith EJC Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane database Syst reviews. 2018(10).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026oslash; K, M\u0026oslash;rkved S, Frawley H, Sherburn M (2009) Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. Neurourol Urodynamics: Official J Int Cont Soc 28(5):368\u0026ndash;373\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarber MD, Maher C (2013) Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 24:1783\u0026ndash;1790\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"Table 2 is available in the Supplementary Files section."}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Birmingham","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pelvic organ prolapse, Physiotherapy, Pelvic floor, Womens Health","lastPublishedDoi":"10.21203/rs.3.rs-6073673/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6073673/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003ePelvic organ prolapse impacts millions globally, causing discomfort and reduced quality of life. Physiotherapy offers a potential non-invasive solution, strengthening pelvic muscles and appearing to offer an effective means of effectively improving symptoms. To better understand this relationship, we conducted a systematic review and meta-analysis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic methodology was designed before gathering eligible data from PubMed, ScienceDirect and Web of Science. All randomised clinical trials and non-clinical trials that were peer reviewed and published were included.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 7 studies were included in the final sample. Pelvic floor muscle training (PFMT) was a common technique to support the evaluation of perineal tears and episiotomy. A meta-analysis was conducted using symptom assessment scale over a 24-month period where the pooled mean difference showed \u0026minus;\u0026thinsp;2.76% (95% CI: [-4.19, -1.32]) statistically significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIt is evident limited research has been conducted within this field, and long-term studies are required to improve the care offered to women with pelvic organ prolapse.\u003c/p\u003e","manuscriptTitle":"Systematic Review and Meta-analysis Exploring Outcomes linked to the use of Physiotherapy in managing Pelvic Organ Prolapse","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-27 03:40:33","doi":"10.21203/rs.3.rs-6073673/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2dfb9641-a5b4-436a-a94f-4459d06dc6e4","owner":[],"postedDate":"February 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44642948,"name":"Women's studies"}],"tags":[],"updatedAt":"2025-02-27T03:40:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-27 03:40:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6073673","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6073673","identity":"rs-6073673","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}