Quality statement 4: Supervised pelvic floor muscle training

Quality statement

Women with stress or mixed urinary incontinence who are able to contract their pelvic floor muscles are offered a trial of supervised pelvic floor muscle training 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 exercise programmes with trained healthcare professionals can improve symptoms significantly, avoiding surgery or other invasive treatment.

For women with mixed urinary incontinence, supervised pelvic floor training is first‑line treatment alongside bladder training.

Quality measures

Structure

Evidence of local arrangements to ensure that a trial of supervised pelvic floor muscle training of at least 3 months' duration is available as first‑line treatment for women with stress or mixed urinary incontinence who are able to contract their pelvic floor muscles.

Data source: Local data collection.

Process

a) Proportion of women with stress or mixed urinary incontinence who can contract their pelvic floor muscles who have a trial of supervised pelvic floor muscle training of at least 3 months' duration as first‑line treatment.

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

Denominator – the number of women with stress or mixed urinary incontinence who can contract their pelvic floor muscles.

Data source: Local data collection.

b) Proportion of women with urinary incontinence who have a digital vaginal assessment to confirm correct pelvic floor muscle contraction before referral for supervised pelvic floor muscle training.

Numerator – the number in the denominator who have a digital vaginal assessment to confirm correct pelvic floor muscle contraction before referral.

Denominator – the number of women with urinary incontinence who are referred for supervised pelvic floor muscle training.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

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

Healthcare professionals ensure that they offer supervised pelvic floor muscle training of at least 3 months' duration as first‑line treatment for women with stress or mixed urinary incontinence who can contract their pelvic floor muscles.

Commissioners (such as clinical commissioning groups) ensure that they commission services that offer women with stress or mixed urinary incontinence who can contract their pelvic floor muscles supervised pelvic floor muscle training of at least 3 months' duration as first‑line treatment.

What the quality statement means for patients, service users and carers

Women with leakage of urine caused by conditions called stress or mixed urinary incontinence who can contract their pelvic floor muscles 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.

Source guidance

Definitions of terms used in this quality statement

Pelvic floor muscle training

Training in repetitive selective voluntary contraction and relaxation of specific pelvic floor muscles that is delivered and evaluated by a trained healthcare professional. [Adapted from urinary incontinence (NICE guideline CG171)]

Equality and diversity considerations

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 escorted 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 exercises. Provision for this should be made, if possible.