NICE has published the first guideline for prevention and non-surgical management of pelvic floor dysfunction, which emphasises the importance of raising awareness and early intervention

elenavolf pelvic organ prolapse exercise woman

NICE has published a new guideline 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. 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 prevent the condition getting worse. Pelvic floor dysfunction can result in a range of symptoms, the most common being urinary incontinence, faecal incontinence, and pelvic organ prolapse. Other symptoms include sexual dysfunction and chronic pelvic pain. 

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 of 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 and tailoring this information for women of different age groups and circumstances, for example, pregnant women. In addition to helping to reach women who need help, raising awareness of the condition and the steps that can be taken to address it can help to ‘normalise’ the condition, and in doing so help a person overcome any embarrassment they might experience that could get in the way of them seeking help.

NICE emphasises: ‘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 and unavoidable—for example, a family history of urinary or faecal incontinence—but NICE explains that it is still important for a woman to be aware of these so that 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. One part of the healthy diet highlighted in the guideline 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 prevent symptoms of faecal incontinence. Along with a healthy diet, physical activity helps to maintain a healthy weight.

NICE advises encouraging ‘women of all ages to do pelvic floor muscle training’ and to continue doing this throughout life, as ‘long-term training continues to prevent symptoms’. 

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 in the guideline.

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 of the lifestyle adaptations that can be made to try and prevent it in the first place, or prevent it from getting worse.

The prevalence of pelvic floor dysfunction is high, with up to one in two 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, with the ability to be physically active, for example, being limited and social interaction and engagement reduced.

This article was originally published on Medscape, part of the Medscape Professional Network.


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