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Lancet. 2014 Mar 1;383(9919):796-806. doi: 10.1016/S0140-6736(13)61977-7. Epub 2013 Nov 28.

Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial.

Author information

  • 1Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK. Electronic address:
  • 2Clinic 2, Balmoral Building, Leicester Royal Infirmary, Leicester, UK.
  • 3Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen, UK.
  • 4Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
  • 5Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow, UK.
  • 6Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia.
  • 7Department of Medicine-Royal Melbourne Hospital, University of Melbourne, VIC, Australia.
  • 8Centre for Healthcare Randomised Trials, Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen, UK.
  • 9Pelvic Floor and Bladder Unit, Department of Urogynaecology, St George Hospital, NSW, Australia.
  • 10Department of Obstetrics and Gynaecology, Dunedin School of Medicine, Dunedin, New Zealand.

Erratum in

  • Lancet. 2014 Jul 5;384(9937):28.



Pelvic organ prolapse is common and is strongly associated with childbirth and increasing age. Women with prolapse are often advised to do pelvic floor muscle exercises, but evidence supporting the benefits of such exercises is scarce. We aimed to establish the effectiveness of one-to-one individualised pelvic floor muscle training for reducing prolapse symptoms.


We did a parallel-group, multicentre, randomised controlled trial at 23 centres in the UK, one in New Zealand, and one in Australia, between June 22, 2007, and April 9, 2010. Female outpatients with newly-diagnosed, symptomatic stage I, II, or III prolapse were randomly assigned (1:1), by remote computer allocation with minimsation, to receive an individualised programme of pelvic floor muscle training or a prolapse lifestyle advice leaflet and no muscle training (control group). Outcome assessors, and investigators who were gynaecologists at trial sites, were masked to group allocation; the statistician was masked until after data analysis. Our primary endpoint was participants' self-report of prolapse symptoms at 12 months. Analysis was by intention-to-treat analysis. This trial is registered, number ISRCTN35911035.


447 eligible patients were randomised to the intervention group (n=225) or the control group (n=222). 377 (84%) participants completed follow-up for questionnaires at 6 months and 295 (66%) for questionnaires at 12 months. Women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the pelvic organ prolapse symptom score [POP-SS]) at 12 months than those in the control group (mean reduction in POP-SS from baseline 3.77 [SD 5.62] vs 2.09 [5.39]; adjusted difference 1.52, 95% CI 0.46-2.59; p=0.0053). Findings were robust to missing data. Eight adverse events (six vaginal symptoms, one case of back pain, and one case of abdominal pain) and one unexpected serious adverse event, all in women from the intervention group, were regarded as unrelated to the intervention or to participation in the study.


One-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms. Long-term benefits should be investigated, as should the effects in specific subgroups.


Chief Scientist Office of the Scottish Government Health and Social Care Directorates, New Zealand Lottery Board, and National Health and Medical Research Council (Australia).

Copyright © 2014 Elsevier Ltd. All rights reserved.

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