Implementing a training package for primary care clinicians to support women to do their Pelvic Floor Muscle Exercises for the prevention and management of incontinence: the Pflexi Study.

Accidental urine leakage (incontinence) affects the wellbeing of women throughout their lives; sometimes starting early with teenagers’ ‘giggle’ incontinence or leakage during sports. Ten percent of women aged between 19 and 30 experience incontinence, one in three during pregnancy, nearly half after childbirth and many still experience symptoms years later.

Incontinence places high burden on NHS resources and society. Pelvic floor muscle exercises (PFME) are effective yet PFME education is limited or too late, many women do not do PFME routinely. Instead they experience guilt, blaming themselves for leakage, wishing they had known about PFME. Embarrassment and assumptions that incontinence is ‘normal’ prevents help seeking.

There is a case for providing PFME education for all women throughout their life-course as these exercises help: 25,000 first time UK mums each year could be prevented from becoming incontinent and PFME is an evidence based effective treatment for existing incontinence and mild to moderate pelvic prolapse.

Two training packages have been developed by researchers, with expertise in: urogynaecology, midwifery, physiotherapy and PFME for preventing and treating pelvic floor problems, with input from young women, pregnant and post-natal women, health professionals, service stakeholders and decision makers. One training package targets midwives to support the women they see, with education and resources, to do PFME during pregnancy. This training is currently being tested in a large pilot trial. The second training package, which includes physical examination, was previously assessed as feasible for primary care.

Informed by two stakeholder events the existing packages will adapted and linked. The resultant Pflexi training package will be piloted for use by GPs and nurses interested in women’s health. A funding application for a larger implementation study will be prepared. This study aligns with the NHS 10 year plan for provision of pelvic health clinics for women across their life-course.