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Pelvic Floor Physiotherapy

Pelvic Floor Physiotherapy should be offered before stress incontinence surgery. Any reasonable urologist or gynaecologist would be aware that conservative non-surgical therapy should be offered by way of pelvic floor exercises.

The guideline on management of urinary incontinence was originally published by NICE in 2006. It stated that:

  1. Routine digital assessment of pelvic floor muscle contraction should be undertaken before the use of supervised pelvic floor muscle training for the treatment of UI
  2. A trial of supervised pelvic floor muscle training of at least 3 months duration should be offered as a first-line treatment
  3. Pelvic floor muscle training programmes should comprise at least eight contractions performed three times per day
  4. If pelvic floor muscle training is beneficial an exercise programme should be continued.

Any patient being assessed for stress urinary incontinence should have an assessment of the pelvic floor either by the gynaecologist or urologist attending if they have the requisite skills. If not, then by a suitably qualified physiotherapist. The assessment will determine pelvic floor muscle strength and contraction technique.

If pelvic floor exercises have not been performed, muscle strength was weak or technique was poor, a firm recommendation for Pelvic Floor Physiotherapy should be made prior to offering surgery.

Pelvic Floor Physiotherapy is risk free.

Even if a woman reports practicing self-taught pelvic floor exercise the pelvic floor requires assessment to determine muscle strength or pelvic floor technique. Some women can correctly contract their pelvic floor, but others cannot. Many women have no idea how to initiate contraction of the levator ani muscles and need to be taught it.

Self-taught pelvic exercises, without physiotherapy input, are not beneficial if pelvic contraction technique is incorrect or the woman cannot initiate an adequate pelvic floor contraction.

Offering continence surgery for urinary stress incontinence without checking the pelvic floor for muscle strength and correct pelvic floor exercise technique breaches NICE Guidelines and is substandard.

Failure to refer a woman with weak pelvic floor muscles for supervised physiotherapy prior to proceeding with surgery breaches NICE Guidelines and is substandard.

If you have been affected by incontinence and not offered the recommended pelvic Floor Physiotherapy then contact Dr Victoria Handley today on 0800 470 2009 or email



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