Bary Berghmans

Dear Editor I would like to comment on BMJ 2020;371:m3719 The authors of this large study have performed a methodologically speaking fine job and should be recognized for this. However, I am not at all surprised by their final outcomes and conclusions that there is no statistically significant difference between the Pelvic Floor Muscle Exercises (PFME) + EMG biofeedback and PFME alone. First of all, they included women with and at the most insufficient awareness how to contract the PFM.

Aims To evaluate the role of soft tissue and ligaments damage and level of pelvic muscles activation versus intra‐abdominal pressure, on pelvic organ prolapse. Methods This was a computational modeling based on the finite element analysis. Three pelvic muscles, four pelvic ligaments, and three organs (urethra, vagina, and rectum) were simulated.

Nowadays, Pelvic Floor Muscle Training (PFMT) is a first line, level 1 evidence‐based treatment for urinary incontinence (UI), but adherence to PFMT is often problematic. Today, there are several mobile applications (mApps) for PFMT, but many lack specific strategies for enhancing adherence. To review available mApps for improvement of adherence to PFMT, and to introduce a new App so called iPelvis.