What is the perinatal pelvic health service?
The NHS Long Term Plan (2019) includes a commitment for NHS England to “improve access to postnatal physiotherapy to support women who need it to recover from birth”, and ensure that “all women have access to multidisciplinary pelvic health clinics and pathways across England” by March 2024 .
The PPHS is nationally driven by NHS England, to improve the prevention, identification and time to access treatment for pelvic floor dysfunction (PFD) symptoms during pregnancy and the childbearing year. PFD includes symptoms of bladder and bowel incontinence, pelvic organ prolapse and vaginal and sexual health concerns such as dyspareunia (painful sex).
Norfolk & Waveney (NW) Local Maternity & Neonatal System (LMNS) successfully bid to become an Early Implementer Site (EIS) for the launch of the NHS England’s Perinatal Pelvic Health Service in 2021.
Why is the service needed?
The service is targeted to support women or birthing people with bladder and bowel incontinence, pelvic organ prolapse and vaginal and sexual health concerns such as dyspareunia (painful sex) during pregnancy and up to 12 months following birth.
We know women or birthing people are at increased risk of developing pelvic floor dysfunction (PFD) conditions, with 1 in 3 experiencing urinary incontinence, 1 in 10 experiencing anal incontinence, and 1 in 12 can experience pelvic organ prolapse.
The taboo surrounding pelvic floor disorders is a major barrier to women receiving treatment. It is widely reported that pelvic floor dysfunction is significantly under-reported due to embarrassment, shame, or for women who have had multiple children to believe that dysfunction is ‘normal’. There is poor awareness about PFD, with some patients not realising that treatments may be available.
The National Institute for Clinical Excellence (NICE, 2021), recommends that information should be given to all pregnant women about pelvic floor exercises at booking, and offer women information and opportunity to ask questions about antenatal pelvic health problems.
A cochrane review (Woodley et al, 2020) shows that for women who were continent on starting pregnancy, early, structured pelvic floor muscle training in early pregnancy can bring about a 62% reduction in incidence of urinary incontinence in late pregnancy, and a 29% reduction at 3-6 months postpartum.
Physiotherapy is by far the most cost effective intervention for preventing and treating mild to moderate incontinence and prolapse (Barber, 2016).
What is the evidence/ key documents relating to this service?
- Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD007471. DOI: 10.1002/14651858.CD007471.pub4
- Barber, M. (2016) Pelvic organ prolapse. BMJ. 354, i3853. Available from: https://doi.org/10.1136/bmj.i3853