Researchers to work with NHS to implement prolapse prevention training

21 October 2016

Following a large-scale trial showing that pelvic floor muscle training is an effective treatment for women with prolapse, researchers at Glasgow Caledonian University (GCU) are working with the NHS to understand how the training can be put into practice.

Pelvic organ prolapse – when the bladder, womb or bowel moves downward from its normal position into the vagina – is associated with childbirth and increasing age, and can affect up to half the female population aged over 40. Surgery has been the main treatment option for most women but many women end up with an additional prolapse and around 30% of women have repeat surgery.

Yet the condition, which leads to discomfort, pain and poor quality of life for thousands of women in Scotland every year, can be improved using a simple set of pelvic floor muscle exercises.

A recent trial by researchers in the Nursing, Midwifery & Allied Health Professions Research Unit (based at GCU and the University of Stirling) has shown that when taught individually, pelvic floor muscle training (PFMT) is an effective and potentially cost-effective treatment and should be recommended as the first treatment option. It showed that using PFMT improved prolapse symptoms and also that women who used PFMT had less requirement for further treatment.

Funded with a National Institute for Health Research grant of over £500,000, researchers are now implementing an evidence-based PFMT intervention for women with pelvic organ prolapse into routine care.

GCU’s Professor Suzanne Hagen is working with Professor Margaret Maxwell of the University of Stirling, who is leading the three-year project, to recruit over 100 women who will receive PFMT across three NHS areas in Glasgow, Leicester and the Highlands. Different sites will have access to different resources and their care pathways may be different, allowing each site to determine how they can best deliver PFMT and what specialist training would be required for clinical staff.

The research team will study the outcomes for each NHS service, and most importantly for the women receiving PFMT.  This will include an analysis of women's perceptions of their prolapse symptoms and how it affects their quality of life before and after PFMT; whether the severity of their prolapse has changed; and whether they need further prolapse treatment. In addition, by going back to the women in the original trial, the researchers will also find out if PFMT has prevented surgery in the longer term.

Professor Suzanne Hagen said: “We know that running a trial can be different from real life practice. We also know that having evidence that something works does not always mean that it is put into practice. There can be many reasons for this within the NHS. PFMT is currently not consistently available across the NHS and there are a limited number of physiotherapists specialising in women’s health and prolapse. 

“To provide PFMT to the large numbers of women who would benefit from it, we need to try out other ways of delivering it. This could involve training other healthcare professionals to deliver PFMT; and seeing how many sessions a woman needs with a PFMT specialist to be able to continue exercising correctly by herself. We want to understand how PFMT can be provided in the real world of the NHS and in the context of local services.”