There is no systematic national data on perinatal pelvic floor dysfunction (PFD) in the UK, but research estimates that about one in three women experience urinary incontinence three months after pregnancy (1), one in five anal incontinence one year after pregnancy (2), and in primary care, one in 12 women report symptoms of pelvic organ prolapse (3). 

PFD is commonly underreported due to embarrassment, shame, or a belief that pelvic floor problems are ‘normal’ before or following childbirth. The impact of PFD and its ramifications for women’s lives can be devastating. PFD can affect women’s ability to work, their sexual and social relationships, and evidence has linked with poor mental health.

The NHS Long Term Plan (3.17) committed to improve access to postnatal physiotherapy to support women to recover from birth and access to multidisciplinary pelvic health clinics and pathways across England by April 2024. 

The Perinatal Pelvic Health Services (PPHS) will lead local delivery of the national Long Term Plan ambition to improve the prevention, identification, and referral to NICE-recommended treatment for ‘mild to moderate’ pelvic health problems during pregnancy and following birth, with the aim of reducing the number of women living with pelvic health problems postnatally and in later life. A local maternity and neonatal system (LMNS) were appointed to be an Early Implementer System (EIS) for the PPHS. 

To date, the LMNS had not investigated the prevalence of PFD and the women’s experiences of prevention, identification and management of PFD in the perinatal period. As part of the development and implementation of the PPHS, this study aimed to understand the prevalence of PFD and the women’s experiences of prevention, identification and management of PFD in the perinatal period across the LMNS.

The PPHS team designed a 27-question, both open and closed-ended, online questionnaire survey for this descriptive study.

The survey inquired about age, self-reported ethnicity, the type of delivery, how many times the participant had given birth, presence of PFD, how easy it was to discuss PFD with healthcare professionals and if pelvic floor muscle training (PFMT) and prevention and management of perineal trauma were provided in the antenatal and postnatal period. The survey also investigated any difficulties preventing access to specialist management, the information they would have liked to be given and how they would have liked to receive it and by whom. The survey concluded with a question about their preferences regarding the delivery of the PPHS.  

The survey was distributed via text message to women and birthing people currently pregnant or who have given birth within the last 5 years across the LMNS. The survey was open from three months from January to March 2022. 

Moreover, to address health inequalities, the PPHS team contacted 28 voluntary organisations from seldom heard groups. With the assistance of the Latin-American Women’s Rights Service (LAWRS) and the Indo-American Refugee Migrant Organisation (IRMO), 64 females attended Spanish-language pelvic health awareness meetings. During the meetings, they discussed their antenatal pelvic health experiences.

195 women and birthing people completed the anonymous survey, with the majority (171-88%) in the age range of 25-44 and ranging from 25 to 54. Out of 195, 145 self-reported their ethnicity and 116 (80%) were from a White ethnic background followed by Black (9-6%), Mixed (7-5%) and Asian (4-3%) ethnic backgrounds. Out of the 144 respondents, 63 (44%) had spontaneous vaginal deliveries, 18 (13%) had forceps deliveries, 8 (6%) had ventouse deliveries, 31 (22%) had caesarean sections, and 24 (19%) had not given birth before.

Pelvic floor dysfunction (Funnel Chart 1):
Out of 138 respondents, 72 (52%) reported Urinary Incontinence, 68 (49%) reported Flatus Incontinence, 17 (12%) reported Anal Incontinence, 37 (27%) reported a Pelvic Organ Prolapse and 43 (31%) had dyspareunia.

Prevention and Management of Pelvic floor dysfunction: 
Out of 125, only 74 (54%) have received information on PFMT. 81 (65%) had not received information on prevention of perineal trauma and 83 out of 124 (67%) had received no advice on how to manage perineal trauma.

Access to Specialist Services: 
59 out of 121 (49%) did not know that Specialist Services were available, 23 (19%) thought the PFD would ‘go away’, 17 (14%) were embarrassed to ‘talk about it’ and 54 (45%) mentioned wanting a female only clinician, the services being too far, inability to get to the services because of family/work commitments acted as a barrier to accessing specialist services.

Women’s preferences about pelvic health service delivery: 
68 out of 195 respondents had clear ideas on the information they would have liked to receive antenatally and postnatally. They mentioned PFMT, access to Physiotherapy services, advice on perineal trauma prevention and care, information about what is normal and not following birth and physical examination and pelvic floor muscle examination in the post-partum period, to name a few. Out of 121, 74 (61%) they would liked to receive face-to-face information from a Physiotherapist/Midwife/Doctor, 48 (40%) would prefer in written form, online links, specific website and/or pregnancy app and 34 (28%) would like to receive pelvic health and PFMT information via a group session in the antenatal and/or postnatal period.
26 out of the 195 respondents submitted their wishes on how the service should be developed to meet their needs (Picture 1).

This descriptive study helped us to understand the current provision and lack of antenatal education on pelvic health and PFMT. This study has also helped us to understand our local women and birthing people's preferences for how antenatal pelvic health and PFMT should be delivered.

The PPHS team educated healthcare professionals and developed a standardised antenatal education on pelvic health and PFMT using the information provided by the survey and rolled it out across the LMNS. This study will move forward by evaluating these classes to make certain they are meeting their objectives and are accessible and suitable for women and birthing people.

PFD is highly prevalent in the perinatal period. Women and birthing people and healthcare professionals need greater awareness and education about PFMT and Pelvic Health being the first line management of PFD. 

Women and birthing people presenting with PFD in the perinatal period need to be listened to by their healthcare professional and offered better information about pelvic health prevention and management options and PFMT and supported to make decisions that are right for them.

Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstetricia et Gynecologica Scandinavica 2010; 89(12): 1511-22.
Johannessen HH, Wibe A, Stordahl A, Sandvik L, Backe B, Mørkved S. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. BJOG 2016;121:269-80.
NICE Guideline – [NG123] Urinary incontinence and pelvic organ prolapse in women: management.