Effect of pelvic floor muscle training on pelvic floor muscle morphometry in subjects with pelvic organ prolapse: a systematic review and meta-analysis.

BACKGROUND: Pelvic organ prolapse (POP) is common among women and is associated with bladder, bowel, and sexual dysfunction, reducing quality of life. Pelvic floor muscle training (PFMT) is recommended as a first-line conservative therapy, but its effects on pelvic floor muscle (PFM) morphometry remain unclear. This is the first systematic review and meta-analysis to evaluate the effects of PFMT on PFM morphometric parameters in women with POP. METHODS: A comprehensive search of PubMed/MEDLINE, Scopus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) was conducted. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy covered all records from database inception to July 9, 2025. Randomized controlled trials (RCTs) and clinical trials assessing PFMT effects on PFM morphometry were included. Methodological quality was assessed using the PEDro scale. Meta-analyses were performed using random-effects and fixed-effects models. RESULTS: Eight studies with 579 women (POP stages I-III) were included. Meta-analyses based on excellent to low quality evidence demonstrated significant reductions in levator hiatus area (LHA) at rest (MD = - 1.97; 95% CI: -2.79 to - 1.15; p < 0.0001; 3 studies) and, based on good to low quality evidence, during the Valsalva maneuver (MD = - 2.30; 95% CI: -3.36 to - 1.25; p < 0.0001; 2 studies). Furthermore, excellent to low quality evidence indicated that PFMT improved bladder neck position (MD = 0.16; 95% CI: 0.08 to 0.23; p < 0.0001; 3 studies). Narrative synthesis suggested improvements in PFM strength, while effects on the POP stage were inconsistent across studies. Based on PEDro ratings, the included studies comprised three excellent, one good, two moderate, and two low-quality trials. CONCLUSION: PFMT may improve PFM morphometry, POP stage, and muscle strength in women with POP. However, the evidence remains limited due to the small number of studies, the low quality of some studies, and the inclusion of women with POP stages I-III. High-quality RCTs are needed to address these limitations and identify patient subgroups most likely to benefit. TRIAL REGISTRATION: PROSPERO registration number CRD420251021705.