Results: 107 participants completed the study. Women selleck compound in the intervention group adhered to 89% of prescribed exercise sessions and no adverse events were reported. At 6 months, more women in the intervention group (11,

19%) compared with the control group (4, 8%) had improved POP-Q stage, (Number needed to treat [NNT] 10, 95% CI > 4.2). At 6 months, women in the intervention group had a greater elevation of the bladder (mean difference 3.0 mm, 95% CI 1.5 to 4.4) and rectum (mean difference 5.5. mm 95% CI 1.4 to 7.3) compared with the control group. At 6 months more women in the intervention group had reduced frequency (NNT 3, 95% CI 1.5 to 4.6) and bother of prolapse symptoms (NNT 4, 95% CI 2.1 to 65.0). Conclusion: Daily pelvic floor muscle training over 6 months can improve symptoms in women with pelvic organ prolapse and may help to reverse the development of the prolapse. [Number needed to

treat and 95% CIs calculated by the CAP Co-ordinator.] This is an important study for physiotherapists who treat women with pelvic organ prolapse. While physiotherapy treatment of prolapse is common (Hagen et al 2004), robust evidence to support this intervention has been lacking (Hagen et al 2006) and surgery remains the traditional treatment. This trial provides the strongest evidence yet that an effective pelvic floor muscle (PFMT) strength training program can improve prolapse PCI 32765 symptom bother – which is the ultimate goal of the patient – as well as reduce the measured anatomical descent of the prolapse. Clinicians may have confidence in these findings due to the rigorous study design. Clinicians may also easily access Rutecarpine valid and reliable prolapse symptom-bother questionnaires to verify the effect of their own intervention. By measuring anatomical prolapse before and after the intervention, the authors have demonstrated morphological changes in pelvic floor tissues

to explain the effect of the intervention, and to show that PFMT can reduce worsening of prolapse, thus demonstrating a secondary prevention effect. Access to the primary outcome measure used in this study, the POP-Q, will be problematic for physiotherapists not working with gynaecologists, as the POP-Q scoring system is currently not used routinely by physiotherapists. In addition, 3D realtime ultrasound, the other quantifiable measure of change in prolapse descent used in this study, is not in routine use by clinicians. A limitation to replication of the study design in the present Australian health care setting may be the frequency of physiotherapy treatments: in this study, participants attended up to 18 treatment sessions, higher than the average attendance in private or public settings in this country. However the intervention appears dosedependant; providing a less intensive intervention may result in a less effective outcome.