Offer women training and advice to manage incontinence and pelvic organ prolapse, says NICE

Women should receive pelvic floor muscle training and lifestyle advice as a first step, before surgery for stress urinary incontinence or pelvic organ prolapse is considered.

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Specialist pelvic health physiotherapists can offer advice about first line treatment options

This is one of the recommendations from the National Institute for Health and Clinical Excellence (NICE) in draft guidance on the management of urinary incontinence and pelvic organ prolapse in women, published today.

In its new recommendations, NICE suggests that women with pelvic organ prolapse should be offered as a first option:

  • a programme of supervised pelvic floor muscle training for at least 16 weeks
  • advice about lifestyle interventions, including information about exercising and its effect on symptoms

Katie Mann, chair of the CSP Pelvic, Obstetric and Gynaecological Physiotherapists (POGP) professional network, welcomed the guidance.

She said specialist pelvic health physiotherapists were in an ideal position to offer advice on many of the first line treatment options recommended by NICE.

‘Pelvic floor muscle training, supervised by a specialist physiotherapist, has been well researched as a successful treatment option for these conditions, though sadly this approach is often overlooked or under resourced,’ she said.

‘After thorough clinical assessment, specialist physiotherapists can tailor individual exercise programmes focused on the woman's life and exercise goals, as well as support a woman through the holistic health and lifestyle changes needed too.’

POGP member Rebecca Bennett added that NICE had historically recommended that physiotherapy and conservative options should be available before surgical options for stress urinary incontinence are considered.

‘It is a further positive step forward that this new guidance supports their use as a first line treatment strategy,’ she said.

New advice about the use of mesh 

The draft guideline also contains new recommendations about how mesh/tape surgery should be assessed and managed.

It advises that if mesh is used for prolapse surgery, women should be made aware that there is uncertainty about associated long-term complications.

In addition, details of any prolapse surgery that uses mesh should be collected in a national registry, along with details of its subsequent short- and long-term outcomes, NICE says.

In July, the government announced a pause on NHS use of surgical mesh/tape to treat stress urinary incontinence and urogynaecological prolapse.

Amanda Savage, spokesperson for the POGP, said: ‘We have just had a two day conference celebrating the 70th anniversary of POGP, attended by 80 of our 700 members.

‘There was a good debate about how we can step up to deal with the unexpected events of the year, especially the mesh pause.'

The draft guideline is open for consultation until 19 November 2018.

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by Robert Millett

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