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Urinary incontinence and pelvic organ prolapse: the care you should expect

Urinary incontinence is when you have problems controlling your bladder. This can mean you leak urine accidentally when you exercise or cough, laugh or sneeze (called ‘stress’ urinary incontinence), or you need to pass urine very suddenly and urgently, which can also cause leaks (called ‘urge’ urinary incontinence). Sometimes you can have a mixture of both.

Pelvic organ prolapse is when one or more of the pelvic organs, such as the uterus or the vagina, slips out of position and sags down. It can feel uncomfortable and cause problems passing urine.

Urinary incontinence and pelvic organ prolapse can be distressing conditions that have an impact on a woman’s quality of life, including her work, social life and relationships. They are very common, affecting millions of women of all ages. Some women have only one of these conditions, whereas others have both. They can both be treated successfully using a range of treatments, such as lifestyle changes, special exercises and medicines. Surgery may be an option too, usually if non-surgical treatments haven’t helped. The right treatment is different for each woman.

We want this guideline to make a difference to women by making sure healthcare professionals:

  • offer women the full range of treatments and explain the possible benefits and risks of each option
  • support women to make their own choice about treatments
  • are following up-to-date advice on when to consider surgery and what discussions to have with women to help them decide.

Surgery with mesh

One type of surgery that is used to treat stress urinary incontinence and pelvic organ prolapse involves inserting a piece of synthetic mesh. For a few women, surgery with mesh has led to serious complications. Some, but not all, of these complications can also happen after other types of surgery for these conditions.

NICE has recommended that doctors have an in-depth discussion with women about the risks and benefits of different types of surgery, including surgery with mesh, before they decide whether one of these could be an option for them. NICE has also said that doctors must keep detailed records about the surgery they do for these conditions, including any complications women develop after they’ve had their surgery. Doctors should give each woman a copy of her record. The guideline also includes advice on the best care for women who have complications after surgery with mesh.

Helping you decide about surgery

We’ve produced patient decision aids about surgery for stress urinary incontinence, surgery for uterine prolapse and surgery for vaginal vault prolapse to help women and their healthcare professionals discuss the different types of surgery for these conditions and make a decision that is right for each woman.

Making decisions together

Decisions about treatment and care are best when they are made together. Your healthcare professionals should give you clear information, talk with you about your options and listen carefully to your views and concerns.

To help you make decisions, think about:

  • what is most important to you at this stage in your life (for example, some treatments may not be suitable if you’re planning to get pregnant in the future)
  • whether your symptoms are making it difficult for you to live or work normally
  • whether you want treatment, and what may happen if you choose not to have it
  • how the treatment, including any side effects, may affect your day-to-day life.

If you can’t understand the information you are given, tell your healthcare professional.

Read more about making decisions about your care.

Where can I find out more?

The NHS website has more information about urinary incontinence and pelvic organ prolapse.

The organisations below can give you more advice and support.

NICE is not responsible for the content of these websites.

To share an experience of care you have received, contact your local Healthwatch.

We wrote this guideline with people who have been affected by urinary incontinence and pelvic organ prolapse and staff who treat and support them. All the decisions are based on the best research available.

ISBN: 978-1-4731-3320-4


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