Behavioural changes and physical therapies

The behavioural changes and physical therapies recommended by NICE for urinary incontinence in women are pelvic floor muscle training (PFMT) and bladder training. 

Pelvic floor muscle training is an effective intervention, particularly for stress and mixed incontinence. NICE recommends it as first‑line treatment for women who can contract their pelvic floor muscles (if they try to stop urination midstream and they can feel the muscles contracting to at least some degree). 

PFMT aims to strengthen the urethral sphincter mechanism. It involves the voluntary contraction and relaxation of the levator ani muscle, which supports the vagina, bladder and urethra, and contributes to the skeletal muscle component of an effective urethral sphincter mechanism. Increasing the strength and endurance of the levator muscle enhances the force of urethral closure including in response to a sudden increase in abdominal pressure.

NICE recommends at least eight pelvic floor muscle contractions performed three times a day for a minimum of 12 weeks. The stomach, leg and buttock muscles should remain relaxed while contracting pelvic floor muscles. If PFMT is beneficial the exercises should be sustained after the initial 12 weeks. 

The key to successful results from PFMT exercises is practice. NICE advises that PFMT is supervised as part of a local NHS commissioned service, probably because this offers inbuilt monitoring and conversations to sustain motivation and make a successful outcome more likely. However, some women will want to try PFMT without being referred into the formal health system and pharmacists can signpost to appropriate information and emphasise the importance of practice and continuing for 12 weeks. 

Several apps are available including the NHS “Squeezy” app and pharmacy teams should make themselves familiar with these so they can recommend one where appropriate.