NICE Releases First Pelvic Floor Dysfunction Guideline Targeting Women Aged 12 and Over

Dr Rob Hicks

December 14, 2021

The National Institute for Health and Care Excellence (NICE) has published new guidelines on the prevention and non-surgical management of pelvic floor dysfunction. The guideline is aimed at women – who for the purpose of the guideline NICE says "include those who do not identify as women but who have pelvic organs" – aged 12 and older.

This is the first guideline from NICE to address this condition, which NICE states "is a condition in which the pelvic floor muscles around the bladder, anal canal, and vagina do not work properly".

The prevalence of pelvic floor dysfunction is high with up to 1 in 2 women being identified as having some degree of pelvic organ prolapse when examined. The knock-on effect of prolapse for many women is a significant negative impact on quality of life, for example, with the ability to be physically active being limited and social interaction and engagement reduced.

Pelvic floor dysfunction can result in a range of symptoms, with urinary incontinence, faecal incontinence, and pelvic organ prolapse being the most common. Other symptoms include sexual dysfunction and chronic pelvic pain. In addition to making recommendations on the prevention of pelvic floor dysfunction, for those women who already have the condition the NICE guideline recommends interventions to help manage the specific symptoms a woman may be experiencing and to try and help prevent the condition getting worse.

Raising Awareness

With the new guideline, NICE hopes to "make a difference to women who have or are at risk of pelvic floor dysfunction", ensuring that more women know about the condition, receive better support and advice, and are offered pelvic floor muscle training, and that fewer women require specialist care or surgery.

Raising awareness is a key part to managing the condition, particularly as early intervention offers the opportunity to prevent the condition deteriorating. The guideline highlights the importance of communicating information about the condition in a variety of settings and formats, tailoring this information for women of different age groups and circumstances, for example pregnant women. In addition to helping to reach women, raising awareness of the condition, and of the steps that can be taken to address it, can help 'normalise' the condition, and in doing so help a person overcome any embarrassment they might experience, embarrassment that can get in the way of them seeking help.

NICE highlights, "Improving women’s knowledge of pelvic floor health is important because this increases the chance they will take action to prevent pelvic floor dysfunction."

As with other health conditions, risk factors exist that increase the likelihood of a woman developing pelvic floor dysfunction, or of the condition worsening. These risk factors may be non-modifiable - for example, age and a family history of urinary or faecal incontinence – but although these risk factors are unavoidable NICE explains how it is still important for a woman to be aware of these so she might be better "encouraged to reduce any modifiable risk factors", such as lack of exercise, smoking, and a body mass index over 25, and "use preventative interactions such as pelvic floor muscle training".

Positive Actions

Physical activity and a healthy diet help to prevent pelvic floor dysfunction. As part of a healthy diet highlighted is eating enough fibre as this helps achieve good stool consistency, which in turn can help avoid constipation - a significant risk factor for pelvic floor dysfunction - and helps to prevent symptoms of faecal incontinence. Along with a healthy diet physical activity helps to maintain a healthy weight. NICE emphasises that weight loss does not have to have occurred before other pelvic floor dysfunction management options are initiated.

NICE advises encouraging "women of all ages to do pelvic floor muscle training" and to continue doing this throughout life since "long-term training continues to prevent symptoms." It is important to ensure that the training is being performed correctly.

Within the guidelines the role of intravaginal devices for women with urinary incontinence, the use of pessaries for those with symptomatic pelvic organ prolapse, and the role of medication when managing specific symptoms consequent of pelvic floor dysfunction, are also covered.

For a condition that can be associated with many negatives, NICE makes it clear how important a positive approach is, as this "improves patient motivation and adherence to lifestyle changes". Moreover, making women aware of the condition from an early age helps increase awareness not only of pelvic floor dysfunction as a condition but also the lifestyle adaptations that can be made to try and prevent it in the first place, and for those women that already have the condition offer them the best opportunity to prevent it getting worse.

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