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Understanding pelvic organ prolapse and urinary incontinence in women

02 June 2022
Clinical Focus
02 June 2022
Volume 33 · Issue 6

Abstract

Pelvic organ prolapse and urinary incontinence are common but under-treated conditions in women. Lucy Dwyer explains how to assess and manage the conditions in primary care

Pelvic organ prolapse (POP) and urinary incontinence (UI) are extremely common yet under-reported and, therefore, under-treated conditions. Women may disclose symptoms of POP or UI to practice nurses and other healthcare professionals working in primary care. Therefore, this article aims to provide a background to both conditions and explain how to assess and manage POP and UI in primary care, utilising NICE guidelines to ensure practice nurses feel confident in their provision of evidence-based care.

The pelvic organs are supported by a complex system of muscle, ligaments and nerves (DeLancey, 2005) (Figure 1). Injury or damage to the pelvic support system results in pelvic floor dysfunction (DeLancey, 2005). Two of the most common and definable conditions of pelvic floor dysfunction are pelvic organ prolapse (POP) and urinary incontinence (UI) (National Institute for Health Care Excellence (NICE), 2021), which – despite being extremely common – remain taboo subjects for many (Shaw et al, 2006; Nygaard et al, 2008; Drennan et al, 2011; Ghetti et al, 2015). Many women believe that POP or UI are an inevitable consequence of ageing or following childbirth and, therefore, cannot be treated other than via containment, or are simply too embarrassed to report and seek help for their symptoms (Tinetti et al, 2018). Conversely, there are various treatments and management options available for both conditions, and practice nurses are well situated to identify symptoms and commence management, or signpost patients with POP and UI to appropriate services. Two recent guidelines from NICE (2019; 2021) provide evidence-based recommendations for the assessment and management of POP and UI; they also provide strategies to raise awareness and prevent pelvic floor dysfunction.

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Pelvic organ prolapse
Urinary incontinence
Primary care
Urogynaecology
Pelvic floor