Katy Winters shared her knowledge and perspective on Pelvic Floor Dysfunction as a physiotherapist. Her summary included the definition of pelvic floor dysfunction, risk factors, how to assess for prolapse, symptoms and signs of pelvic floor dysfunction and conservative management options.
A few key learning points from the session are outlined below:
- Pelvic floor dysfunction is very common – encompasses urinary and faecal incontinence, pelvic pain, prolapse and symptoms of sexual dysfunction.
- Most patients who have pelvic floor prolapse will have symptoms of stress urinary incontinence too – important to check.
- Multiple risk factors for pelvic floor dysfunction – most non-modifiable!
- Pregnancy and Labour are major causes but nulliparous athletes engaging in high impact activities have an increased risk of prolapse and pelvic floor dysfunction
- Losing weight (if have high BMI) does not impact the grading /stage of a prolapse but can improve symptoms of stress urinary incontinence
- Consider possibility of familial link – some families seem to have higher incidence of prolapse, possibly related to inheriting a weaker collagen type
- Importance of pelvic floor training – evidence of benefit is for supervised training. Should be promoting pelvic floor exercises/training as a preventative measure to all but is effective as a treatment for pelvic floor dysfunction. At least 16 weeks treatment recommended. Pelvic floor muscle training can improve symptoms but may not help grade / severity of prolapse.
- Pessaries can help reduce the size /severity of a prolapse due to the fascia remodelling that occurs and so should be given serious consideration. There are various types and some can be used by sexually active women. There is an option for self management of pessaries.
- Genitourinary Syndrome of the Menopause (GSM) is very common but underdiagnosed and undertreated. GSM is a comprehensive term that includes vulvovaginal symptoms and lower urinary tract symptoms related to low oestrogen levels. It can affect women of all ages and is not solely related to the menopause. Low oestrogen states also exist in women who are breast feeding or women using progestogen-only contraceptives
- Unlike many other symptoms of the menopause, symptoms of GSM often worsen over time. It is preferable to start treatment early, rather than waiting for symptoms to worsen. The clinical response to treatment with topical oestrogen is usually rapid and sustained.
Katy also signposted the group to the following useful information resources and organisations:
International Urogynaecological Association
https://www.iuga.org
Pelvic Obstetric and Gynaecology Physiotherapy (Downloadable patient information leaflets include pelvic floor exercises for women and men, pelvic floor relaxation)
https://thepogp.co.uk
IUGA – Pelvic Floor Leaflets and Info Re Pelvic Floor Surgery
https://www.yourpelvicfloor.org
Natural Lubricants – prescribable on NHS
https://www.yesyesyes.org
For people with pelvic pain /hypertonicity:
http://pelvicrelief.co.uk
Pessary Guidelines:
https://www.ukcs.uk.net/UK-Pessary-Guideline-2021
NICE Guidance – Urinary Incontinence and Prolapse 2019:
https://www.nice.org.uk/guidance/ng123
NICE December 2021 -Pelvic Floor Dysfunction – Prevention & Management
https://www.nice.org.uk/guidance/NG210
RCOG- ‘Better for women report’ –
https://www.rcog.org.uk/better-for-women
Please note, PennineGPLearning has no affiliation with the websites/organisations above and no control over the contents or availability of the links provided.
Please be aware that information in the field of medicine changes all the time, so we cannot guarantee the accuracy of this data when you read it, it is here for General Practitioners to learn.
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