Intended for healthcare professionals

Practice Guidelines

Prevention and non-surgical management of pelvic floor dysfunction: summary of NICE guidance

BMJ 2022; 376 doi: (Published 06 January 2022) Cite this as: BMJ 2022;376:n3049
  1. Nicola Adanna Okeahialam, clinical fellow and urogynaecology research fellow1 2 3,
  2. Katharina Dworzynski, guideline lead1,
  3. Paul Jacklin, senior health economist1,
  4. Doreen McClurg, topic adviser and professor of physiotherapy and pelvic floor rehabilitation4
  5. on behalf of the Guideline Committee
  1. 1National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
  2. 2Croydon University Hospital, UK
  3. 3St George’s University, London, UK
  4. 4Glasgow Caledonian University, Glasgow, UK
  1. Correspondence to N Okeahialam nicola.okeahialam{at}

What you need to know

  • Modifications to lifestyle, such as increasing physical activity, having a healthy diet, losing weight, stopping smoking, and controlling diabetes can help prevent and treat symptoms of pelvic floor dysfunction

  • Encouraging women to start and continue training of the pelvic floor muscles in the long term can help prevent and treat symptoms

  • Pelvic floor muscle training is an effective option to treat symptoms of pelvic floor dysfunction in women with pelvic organ prolapse, urinary incontinence, and faecal incontinence

Pelvic floor dysfunction is a complex condition that is associated with urinary incontinence, emptying disorders of the bladder, pelvic organ prolapse, sexual dysfunction, chronic pelvic pain, faecal incontinence, and emptying disorders of the bowel.12 Approximately five million women in the UK have experienced pelvic floor dysfunction.3 Age has an important effect, as 6% of women in their 20s experience symptoms, with this increasing to 40% of women in their 60s.4 These symptoms can have a notable impact on quality of life. In July 2020, the Independent Medicine and Medical Devices Safety Review highlighted the major complications women faced after surgical management with pelvic mesh.5 Preventive and non-surgical strategies can reduce the number of women developing severe symptoms and needing invasive treatment.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) guideline on pelvic floor dysfunction: prevention and non-surgical management. The guideline applies to women aged 12 and older.6 It uses the term “women” throughout, but this should be taken to include those who do not identify as women but who have female pelvic organs.

What’s covered in the guideline?

  • Strategies to prevent pelvic floor dysfunction

  • Non-specialist care options for the management of pelvic floor dysfunction

  • Symptom based referral criteria for supervised pelvic floor muscle training


NICE recommendations are based on systematic reviews of best …

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