This guideline covers assessing and managing urinary incontinence and pelvic organ prolapse in women aged 18 and over. It also covers complications associated with mesh surgery for these conditions.
In June 2019, we withdrew recommendations 1.8.21 and 1.8.22 on the use of synthetic polypropylene or biological mesh insertion for women with recurrent anterior vaginal wall prolapse. We have replaced them with a link to the NICE interventional procedures guidance on transvaginal mesh repair of anterior or posterior vaginal wall prolapse. For further details see update information.
In July 2018, the Government announced a period of ‘high vigilance restriction’ on the use of a group of procedures to treat stress urinary incontinence and pelvic organ prolapse, in England. This followed a recommendation by Baroness Cumberlege, who is chairing an independent review of surgical mesh procedures and has heard from women and families affected by them. For details, see the letter from NHS England and NHS Improvement to trust medical directors. The high vigilance restriction period was extended in March 2019.
This guideline includes new and updated recommendations on:
- organisation of specialist services
- collecting data on surgery and surgical complications
- urodynamic testing to assess urinary incontinence
- pelvic floor muscle training and absorbent containment products for urinary incontinence
- medicines and botulinum toxin type A injections for overactive bladder
- surgical management of stress urinary incontinence
- assessing pelvic organ prolapse
- non-surgical and surgical management of pelvic organ prolapse
- surgery for women with both stress urinary incontinence and pelvic organ prolapse
- assessing and managing complications associated with mesh surgery
These supplement the existing recommendations on:
Who is it for?
- Healthcare professionals
- Service commissioners
- Women with urinary incontinence, pelvic organ prolapse, or complications associated with surgery for urinary incontinence or pelvic organ prolapse, their families and carers
Guideline development process
This guideline updates and replaces NICE guideline CG171 (September 2013), NICE guideline CG40 (October 2006), NICE technology appraisal guidance 56 (February 2003), NICE interventional procedures guidance 154 (2006) and NICE advice ESNM2 (September 2012).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.