Effect of Midwife-Led Pelvic Floor Muscle Training on Prolapse Symptoms and Quality of Life in Women with Pelvic Organ Prolapse in Ethiopia: A Cluster-Randomized Controlled Trial

Back ground Pelvic organ prolapse (POP) is a common condition that can significantly impact a woman’s quality of life. Pelvic floor muscle training (PFMT) is recommended as a first-line conservative treatment for prolapse, but evidence on its effectiveness from low-resource settings is limited. Objectives This study aimed to assess the effect of midwife-led pelvic floor muscle training on prolapse symptoms and health-related quality of life (HRQoL) among women with mild to moderate pelvic organ prolapse in Ethiopia. Methods A community-based, parallel-groups, two-arm cluster randomized controlled trial was conducted in Dale and Wonsho districts of Sidama Region, Ethiopia. Women with symptomatic POP stages I-III were randomized by cluster to receive either midwife-led PFMT plus lifestyle counseling (intervention group) or lifestyle counseling alone (control group). The primary outcomes were change in prolapse symptom score (POP-SS) and prolapse quality of life (P-QoL). Mixed-effects generalized linear model was used to determine the effect of PFMT on prolapse symptoms and P-QoL at 99% confidence level. Adjusted β coefficients were used as effect measures. The level of significance was adjusted for multiple comparisons. Results A total of 187 women were randomized to intervention (n=89) and control (n=98) arms. At sixth months, the intervention group showed significantly greater improvements both in prolapse symptoms and P-QoL with a mean change difference of -4.1 (99% CI: -5.38, -2.83) in prolapse symptoms; -11.48 (99% CI: -15.9, -7.1) in physical domain of P-QoL; -12.65 (99% CI: -19.3, -6.1) in psychological domain of P-QoL, and -9.47 (99% CI: -15.5, -3.5) in personal relationship domain of P-QoL. A significantly higher (84.2%) of women in the intervention group perceived their condition as “better” after the intervention as compared to 41.7% in control group. Women with earlier stages of prolapse (stage I and II) experienced higher benefits compared to those in stage III. Conclusions A midwife-led PFMT combined with lifestyle counseling significantly improves prolapse symptoms and quality of life in mild to moderate POP. This strategy can be integrated into the existing maternal and reproductive health programs to address POP in low-income settings where access to trained specialist is limited. Trial registration Pan African Clinical Trial Registry (PACTR202302505126575).