Women of all ages should be advised to start pelvic floor muscle training and to continue throughout their life, according to a NICE draft guideline on pelvic floor dysfunction prevention and non-surgical management. 

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 guideline stated. 

As part of the key recommendation advising pelvic floor muscle training for women of all ages, the draft guideline recommended schools teach girls aged between 12 and 17 about pelvic floor anatomy and pelvic floor muscle exercises, potentially as an addition to sex and relationship education. 

Meanwhile, older women could be given information about pelvic floor dysfunction when they ask for advice about menopause, as part of general health assessments or comprehensive geriatric assessments. 

Women who are pregnant or have just given birth should also be advised that pelvic floor muscle training helped prevent pelvic floor dysfunction, the draft guideline recommended. 

Pregnant women who have a mother or sister with pelvic floor dysfunction should be offered a three-month programme of supervised pelvic floor muscle training from week 20 of pregnancy. Women who experienced certain risk factors during birth (assisted vaginal delivery) should be offered the same programme postnatally. 

Professor Gillian Leng, chief executive of NICE, said the draft guideline aimed 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,’ she said. 

Women might feel embarrassed discussing their symptoms and might not know the precise technical terms for their pelvic anatomy, making it important for healthcare professionals to tailor information and terminology to each woman’s level of understanding. 

Women should know the risk factors for pelvic floor dysfunction, including non-modifiable risk factors like increasing age, as well as modifiable risk factors including a BMI over 25, smoking, lack of exercise, constipation and diabetes. 

‘Advise women that exercise and a healthy diet can help prevent pelvic floor dysfunction,’ the document stated, emphasising the importance of eating enough fibre to improve stool consistency. 

When discussing lifestyle changes with affected women, discussions should focus on how the changes will improve symptoms, the draft guideline advised.  

‘Give them regular encouragement to keep up the changes, because it may take weeks or months before they notice a benefit,’ it recommended.  

The consultation on the draft guidelines is open until 9 August 2021.