National Institute for Health and Clinical Excellence (NICE)
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NICE opens consultation on draft pelvic floor dysfunction guideline recommendations

NICE recently (28 June 2021) published its draft guideline on the prevention and non-surgical management of pelvic floor dysfunction and is seeking stakeholder comments on the draft recommendations.

Women doing pelvic floor exercises

The draft guideline covers the prevention, assessment, and non-surgical management of pelvic floor dysfunction in women aged 12 and over. Pelvic floor dysfunction covers a variety of symptoms including urinary and faecal incontinence, emptying disorders of the bladder or bowel, pelvic organ prolapse, sexual dysfunction, and chronic pelvic pain.

The draft recommendations advise that women of all ages should be encouraged to do pelvic floor muscle training to help prevent the symptoms of pelvic floor dysfunction.

The draft guideline advises that a three-month programme of supervised pelvic floor muscle training to help prevent pelvic floor dysfunction should be offered to women from week 20 of pregnancy if they have a mother or sister with pelvic floor dysfunction. Women who have experienced certain risk factors during birth should also be offered this programme during postnatal care. These programmes should be supervised by a qualified physiotherapist or healthcare professional who can tailor exercises to the individual woman and monitor their progress. Up to 140,000 women per year could benefit from this preventative strategy.

Prof Gillian Leng, chief executive of NICE, recently said:

“Pelvic floor dysfunction is a common and often debilitating set of symptoms that can result in many issues for women. This draft guideline aims to raise awareness of non-surgical management options so that women are better informed about effective options to address pelvic floor dysfunction.

“Improving women’s awareness of pelvic floor health and encouraging them to practise pelvic floor muscle exercises throughout their lives is the most effective way to prevent pelvic floor dysfunction. We are keen to hear views from stakeholders and the wider community on these draft recommendations and would encourage as many organisations and people as possible to contribute to the consultation.”

The draft recommendations also advise that educating women about pelvic floor health will increase the chances that they take action to prevent pelvic floor dysfunction. Women should be advised of risk factors for pelvic floor dysfunction, which range from modifiable risk factors such as a lack of exercise to non-modifiable risk factors such as age. The draft guideline also outlines risk factors relating to pregnancy, such as an assisted vaginal birth.  

Information on pelvic floor dysfunction, including causes, symptoms and management options, should be made available to women across different healthcare settings and tailored to different age groups and characteristics.

The draft guideline also recommends that young women, aged between 12 and 17, should be taught about pelvic floor anatomy and pelvic floor muscle exercises as part of school curriculums, potentially as an addition to sex and relationship education classes.

Women should also be advised that exercise and a balanced diet can help prevent pelvic floor dysfunction.

The committee highlighted that NICE currently has three guidelines with recommendations relevant to this draft guideline. NICE will align these recommendations at consultation.

NICE is aware that some of these recommendations may require additional local capacity. NICE is working with NHS England and other system partners to consider an approach to gradual roll out.

The consultation is open until 9 August 2021. You can read the draft guideline and take part in the consultation here.


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