Quality standard

Quality statement 4: Supervised pelvic floor muscle training

Quality statement 4: Supervised pelvic floor muscle training

Quality statement

Women with stress or mixed urinary incontinence are offered a supervised pelvic floor muscle training programme of at least 3 months' duration as first-line treatment.

Rationale

Women with stress or mixed urinary incontinence are often given a leaflet on pelvic floor muscle training but are not given additional support. As a result, many women who attend for specialist treatment have been incorrectly performing pelvic floor muscle exercises for many years with no improvement in their symptoms. Supervised pelvic floor muscle training programmes with trained healthcare professionals can improve symptoms significantly, avoiding surgery or other invasive treatment.

For women with mixed urinary incontinence, a supervised pelvic floor muscle training programme is a first-line treatment alongside bladder training.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that a supervised pelvic floor muscle training programme of at least 3 months' duration is available as first-line treatment for women with stress or mixed urinary incontinence.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

Proportion of women with stress or mixed urinary incontinence who have a supervised pelvic floor muscle training programme of at least 3 months' duration as first-line treatment.

Numerator – the number in the denominator who have a supervised pelvic floor muscle training programme of at least 3 months' duration as first-line treatment.

Denominator – the number of women with stress or mixed urinary incontinence.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as GP practices, community continence services and hospitals) ensure that a supervised pelvic floor muscle training programme of at least 3 months' duration is available as first-line treatment for women with stress or mixed urinary incontinence. Those delivering the training should be suitably trained to do so.

Healthcare professionals ensure that they offer a supervised pelvic floor muscle training programme of at least 3 months' duration as first-line treatment for women with stress or mixed urinary incontinence.

Commissioners (such as integrated care systems and clinical commissioning groups) ensure that they commission services that offer women with stress or mixed urinary incontinence a supervised pelvic floor muscle training programme of at least 3 months' duration as first-line treatment.

Women with leakage of urine caused by conditions called stress or mixed urinary incontinence are offered at least 3 months of training in pelvic floor exercises with a healthcare professional as a first treatment. This can lead to big improvements in symptoms and can mean that surgery or other invasive treatment is avoided.

Definitions of terms used in this quality statement

Pelvic floor muscle training programme

Pelvic floor muscle training is exercise to improve pelvic floor muscle strength, endurance, power, relaxation, or a combination of these. Women should be offered the choice of group or individual sessions.

Pelvic floor muscle training programmes should be supervised by a physiotherapist or other healthcare professional with the appropriate expertise in pelvic floor muscle training. Supervision should involve:

  • assessing the woman's ability to perform a pelvic floor contraction and relaxation

  • tailoring the pelvic floor muscle training programme to the woman's ability to perform a pelvic floor contraction and relaxation, any discomfort felt, and her individual needs and training goals

  • encouraging the woman to complete the course, because this will help to prevent and manage symptoms.

[NICE's guideline on pelvic floor dysfunction, recommendations 1.3.15, 1.3.16, 1.6.16 and terms used in this guideline]

Equality and diversity considerations

Pregnant women with stress urinary incontinence or mixed urinary incontinence should be offered a programme of supervised pelvic floor muscle training for at least 3 months.

Women with physical disabilities may have difficulty accessing the service so provision needs to be made for a home visit if necessary.

Women with learning disabilities may need to be accompanied by a support worker or family member and may need to receive information about the condition in a way that is easy for them to understand.

Some women, including those from certain ethnic groups, religious or cultural backgrounds, may prefer a female healthcare professional to supervise their pelvic floor muscle training. Provision for this should be made, if possible.