Women's health toolkit

Pelvic floor health

Pelvic organ prolapse is common, affecting 10% of women over the age of 50, but many will be asymptomatic. Presentation may be with a feeling of heaviness/dragging, or with urinary or faecal incontinence. Risk factors include multiparity, vaginal or instrumental deliveries, raised BMI, persistent constipation or cough and being post-menopausal. Management may be entirely in primary care, using pessaries and vaginal oestrogen, or may involve referral for consideration of surgery. Some women may have concerns relating to publicity around complications related to the previous use of vaginal mesh devices in prolapse surgery – they can be reassured that this is no longer routinely used in the UK. Any woman presenting with complications from previous mesh use should be referred to a regional MDT centre to assess the risks and benefits of partial or complete removal of the mesh.

More information can be found in the following resources:

• NICE guidance on urinary incontinence and pelvic organ prolapse in women.

• UK consensus clinical guidance on the use of vaginal pessaries for pelvic organ prolapse.

• Patient information on prolapse from the RCOG and the NHS website and patient information on mesh from the RCOG and the British Society of Urogynaecology.

• NHS England information on vaginal mesh, including the interim and final working group reports.

• Primary care women’s health forum competency framework, which may be useful for commissioning GPs considering setting up a service in this area.

• First Do No Harm – the report of the independent medicines and medical devices safety review, which covered vaginal mesh.