Pelvic floor dysfunction - assessment in primary care

Assessment in primary care

A focused history is important for identifying the likely cause of any symptoms, because many of the symptoms of pelvic floor dysfunction can be caused by other conditions as well.

At initial assessment in primary care (which may include assessments by physiotherapists, bladder and bowel team members and continence advisors), take a general history from the woman about current and past symptoms or disorders associated with pelvic floor dysfunction, such as:

• urinary incontinence
• emptying disorders of the bladder
• faecal incontinence
• emptying disorders of the bowel
• pelvic organ prolapse
• sexual dysfunction
• chronic pelvic pain.

Depending on the symptoms described, carry out a focused history, clinical examination and investigations to exclude other causes, such as:

• pelvic masses
• neurological disease
• urinary tract infection
• adverse effects of medication
• diabetes
• cancer (for further information, see the NICE guideline on suspected cancer: recognition and referral)
• fistula
• inflammatory bowel or bladder conditions
• endometriosis
• mobility and cognitive impairment.

Ask women who have recently given birth about symptoms of pelvic floor dysfunction during routine postnatal care, in hospital and in the community.

Medication review:

• ".. many medications can impact on symptoms of pelvic floor dysfunction. In addition, this impact is often larger for people who are taking multiple medicines. Because of this, a medication review is important " (1)

Depending on the symptoms and the woman's preferences and circumstances, consider other clinical examinations. For example:

• inspecting the woman's vulva and vagina for atrophy
• asking them to bear down, to check for visible vaginal or rectal prolapse
• rectal examination to check for impaction, for women who are at risk of this and who cannot give an accurate history of their symptoms (for example, women with cognitive impairments or dementia).

For more guidance on assessing urinary incontinence and pelvic organ prolapse, see the NICE guideline on urinary incontinence and pelvic organ prolapse in women. (The recommendations in this guideline may also be relevant for women under 18.)

If the woman has symptoms of faecal incontinence, follow the recommendations on baseline assessment in the NICE guideline on faecal incontinence. (The recommendations in this guideline may also be relevant for women under 18.)

For more details then consult the full NICE guideline.

Reference:

• NICE (December 2021). Pelvic floor dysfunction: prevention and non-surgical management