Comments on Draft NICE Guidelines CG171

Para 318.9.2

The draft recommends Supervised Pelvic Floor Muscle Training but makes no mention of the only clinically proven pelvic toning device available on the Drug Tariff. In the published clinical trial the PelvicToner™ was shown to offer considerable benefits over traditional SPFMT especially in terms of more confident identification and isolation of the pubococcygeal muscle and improved compliance.

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This area falls outside the scope of the guideline update. Therefore, we could not provide a response. Details of your comment are held on file and may be considered as part of the scope of further updates of this guideline.

Para 319.20.36

The draft recommends Supervised Pelvic Floor Muscle Training but makes no mention of the only clinically proven pelvic toning device available on the Drug Tariff. In the published clinical trial the PelvicToner™ was shown to offer considerable benefits over traditional SPFMT especially in terms of more confident identification and isolation of the pubococcygeal muscle and improved

Thank you for your comment.
This area falls outside the scope of the guideline update. Therefore, we could not provide a response. Details of your comment are held on file and may be considered as part of the scope of further updates of this guideline.

Para 320.80.2

Para 321.81.1

Key extracts from the draft

[A17] Pelvic floor muscle training

• Undertake routine digital assessment to confirm pelvic floor muscle contraction before the use of supervised pelvic floor muscle training for the treatment of UI.
• Offer a trial of supervised pelvic floor muscle training of at least 3 months’ duration as first-line treatment to women with stress or mixed UI.
• Pelvic floor muscle training programmes should comprise at least 8 contractions performed 3 times per day.

5.3.1 Pelvic floor muscle training

The rate of subjective cure or improvement was significantly higher in the intensive group in the study that considered this outcome (96% versus 66%; cure rates alone9%versus 0%).234,235 Two of three
studies in postpartum women found significantly lower UI prevalence in the intensive groups (60% versus 69% and 50% versus 76%),236,238 while the third reported no significant difference (60% versus
46%).239

General observations

Urinary incontinence is an embarrassing problem to many women and thus its presence may be significantly underreported. In a UK community study, the prevalence of UI known to the health and social service agencies was 0.2% in women aged 15–64 years

Some women may not see their UI as a major problem. For others, who do perceive a problem with which they would like help, there are often barriers to presentation. Women may take up to 10 years before seeking help.5 They may be too embarrassed to seek advice, may not wish to bother their general practitioner (GP), may believe UI to be a normal consequence of the ageing process or may not appreciate that treatments are available.

Where the most inclusive definitions have been used (‘ever’, ‘any’, ‘at least once in the last 12 months’), prevalence estimates in the general population range from 5% to 69% in women 15 years and older, with most studies in the range 25–45%.7

In adult women with UI, 60% avoid going away from home, 50% feel odd or different from others, 45% avoid public transport and 50% report avoiding sexual activity through fear of incontinence.15 Serious psychiatric morbidity has been
reported in one-quarter of women attending hospital for investigation of UI.

...this would approximate to £1.8bn annually in England and Wales, or perhaps £600 per incontinent individual.