Effectiveness of Pelvic Floor Rehabilitation and Conservative Therapies for Female Pelvic Organ Prolapse and Urinary Incontinence: A Systematic Review

Abstract

Background: Pelvic organ prolapse (POP) and urinary incontinence (UI) are prevalent conditions significantly impairing women’s quality of life (QoL). First-line management includes pelvic floor muscle training (PFMT) and other conservative therapies, but an updated synthesis of their comparative effectiveness is needed. The aim of this review was to systematically review the effectiveness of pelvic floor rehabilitation and conservative therapies on symptom severity and QoL in adult women with POP or UI. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. Databases (MEDLINE, Embase, CINAHL, CENTRAL) were searched. Included studies compared PFMT, biofeedback, or pessary management to control conditions in women with symptomatic POP or UI. Primary outcomes were symptom severity and QoL. Results: Eight RCTs (total n=2,406) were included. For POP, PFMT consistently demonstrated statistically and clinically significant reductions in symptom severity (Pelvic Organ Prolapse Symptom Score [POP-SS] mean difference -1.01 to -1.52) and improved condition-specific QoL compared to lifestyle advice or watchful waiting. Vaginal pessary was non-inferior to PFMT for symptom relief and QoL. For UI, biofeedback-mediated PFMT provided no significant additional benefit over basic PFMT for symptom severity or QoL. Improvements in condition-specific outcomes did not consistently translate to measurable gains in generic QoL (12-item Short Form Health Survey [SF-12], Quality-Adjusted Life Years [QALYs]). The overall risk of bias was “some concerns,” primarily due to lack of blinding. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessments indicated moderate-certainty evidence for improvements in POP symptoms and condition-specific QoL. Conclusion: PFMT is an effective first-line conservative treatment for improving symptoms and condition-specific QoL in women with POP. Pessary use is a comparable alternative. For UI, standard PFMT is effective, with no clear added value from biofeedback for the general population. Treatment decisions should integrate patient preference, as benefits are primarily condition-specific.