Home › Topics › Pelvic Floor Disorders

Pelvic Floor Disorders

GMJ News knowledge hub · last reviewed August 2026 · Georgian Medical Journal

SummaryStatisticsGlossaryGMJ newsFAQDocumentsOrganizationsResearch

Pelvic floor disorders — encompassing urinary incontinence (UI), pelvic organ prolapse (POP) and faecal incontinence — represent one of the most prevalent and most under-reported conditions in women: urinary incontinence affects approximately 50% of post-menopausal women and 25-45% of women overall, causing profound impact on quality of life, work participation, sexual function and mental health, yet only approximately 25% of affected women seek treatment due to stigma, normalisation (“it’s just part of being a woman”) and lack of awareness of effective treatments (WHO). Pelvic floor muscle training (PFMT) — Kegel exercises when correctly performed under physiotherapist supervision — is the first-line treatment with Grade A evidence for both stress and urgency urinary incontinence, reducing episodes by approximately 50-60% when performed correctly and consistently, and represents one of the clearest examples of a highly effective, zero-cost, zero-side-effect intervention being systematically underutilised.

Key messages

50% of post-menopausal women — the silent epidemic
Urinary incontinence (UI) affects approximately 25-45% of women overall and approximately 50% of post-menopausal women — making it one of the most prevalent conditions in women globally. Yet fewer than 25% of affected women seek treatment, due to stigma and the false belief that incontinence is an inevitable consequence of ageing or childbirth.
Pelvic floor muscle training (PFMT) — Grade A evidence, first-line for all UI types
Pelvic floor muscle training (PFMT, "Kegel exercises") correctly performed and supervised by a pelvic floor physiotherapist has Grade A evidence for stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and mixed UI — reducing episodes by approximately 50-60% in most trials. The key word is "correctly": most women who have tried Kegels are doing them incorrectly (contracting abdominals or glutes instead of the pelvic floor). Physiotherapist supervision with real-time ultrasound or biofeedback dramatically improves outcomes.
Three types of urinary incontinence — different treatments
Stress UI (SUI, most common): leakage with coughing, laughing, sneezing, exercise — from urethral sphincter weakness and poor bladder neck support. First-line: PFMT. Second-line: midurethral slings (tension-free vaginal tape — TVT, or transobturator tape — TOT). Urgency UI (UUI): sudden strong urge, leakage before reaching the toilet — overactive bladder (OAB) driving urge incontinence. First-line: PFMT + bladder training + antimuscarinics (solifenacin, oxybutynin) or mirabegron (beta-3 agonist — fewer anticholinergic side effects). Mixed: both components; PFMT first.
Pelvic organ prolapse — the grade and symptom matter
Pelvic organ prolapse (POP): descent of the pelvic organs (bladder — cystocele; rectum — rectocele; uterus — uterine prolapse; vaginal vault after hysterectomy) through the vaginal introitus. Most common in post-menopausal women, multiparous women and after vaginal delivery. Graded 0-IV (POP-Q staging). Treatment: observation for asymptomatic or minor prolapse; pelvic floor rehabilitation (PFMT); vaginal pessary (ring, Gehrung, shelf pessaries — non-surgical, highly effective first-line treatment); surgical repair (native tissue or mesh — mesh safety controversy).
Faecal incontinence — the most taboo symptom
Faecal incontinence (FI) — involuntary loss of gas or liquid or solid stool — affects approximately 7-15% of adults and up to 30-40% of patients in primary care settings when systematically asked. The most common unasked symptom in clinical practice. Causes: obstetric anal sphincter injury (OASI — 3rd and 4th degree tears); IBS; diarrhoea; rectal prolapse; neurological (MS, pudendal neuropathy). Treatment: dietary modification; loperamide; PFMT (improves sphincter function and rectal sensation); biofeedback; sacral nerve stimulation (SNS/neuromodulation — highly effective); anal sphincter repair.
Pelvic mesh controversy — patient safety history
Synthetic mesh devices implanted vaginally for SUI and POP repair were associated with serious complications: erosion through vaginal walls; chronic pain; dyspareunia; nerve damage; difficulty removing. The UK review (2018 Cumberlege Report) found mesh products were introduced without adequate safety evaluation. UK: routine use of transvaginal mesh for POP was suspended (2018); SUI mesh maintained with restrictions. Australia: several mesh products withdrawn. FDA: multiple warnings and final order for surgical mesh manufacturers to conduct post-market studies. The mesh debate underscores the need for rigorous implant device safety evaluation.

Key statistics

25-45%
of all women affected by urinary incontinence; ~50% post-menopausal
WHO/ICS
<25%
of affected women seek treatment — massive under-treatment due to stigma
ICS/WHO
50-60%
reduction in UI episodes with correctly performed PFMT (Grade A evidence)
Cochrane/NICE
Grade A
PFMT evidence for stress, urgency and mixed urinary incontinence (NICE/ICS)
NICE/ICS
7-15%
of adults have faecal incontinence — the most under-reported symptom
ICS/WHO
2018
year UK suspended routine transvaginal mesh for POP repair (patient safety)
Cumberlege Review

Urinary incontinence — treatment pathway by type (NICE/ICS)

Source: NICE/ICS. PFMT is first-line for all types; drug and surgical options are second-line for specific types.

Glossary of key terms

Stress urinary incontinence (SUI)
ICS/NICEInvoluntary leakage of urine on effort or exertion (exercise, lifting) or on sneezing or coughing — the most common type of UI in younger women. Caused by inadequate urethral sphincter closure mechanism and/or hypermobility of the bladder neck (usually from childbirth trauma, surgery or intrinsic sphincter deficiency). The urethral pressure momentarily drops below bladder pressure during the intra-abdominal pressure spike of a cough or sneeze → leakage. PFMT strengthens the pelvic floor and improves urethral sphincter support. Surgery (midurethral sling — TVT or TOT) has approximately 80-90% cure rates for SUI not responding to PFMT.
Overactive bladder (OAB) and urgency incontinence
ICSOAB is characterised by urinary urgency (a sudden, compelling desire to pass urine that is difficult to defer), usually with frequency (≥8 voids/24h) and nocturia (≥1 void/night). Urgency incontinence (UI) occurs when urgency leads to leakage before reaching the toilet. Pathophysiology: inappropriate detrusor (bladder muscle) contractions during filling — "detrusor overactivity." Management: first-line: PFMT + bladder training (scheduled voiding, urgency suppression techniques); antimuscarinics (solifenacin, tolterodine, oxybutynin — avoid in elderly: cognitive impairment risk) or mirabegron (beta-3 agonist — safer in elderly). Second-line: intravesical botulinum toxin (100 units onabotulinum toxin A, 3-6 monthly); sacral neuromodulation (implant).
Midurethral sling (TVT/TOT)
NICE/ICSTension-free vaginal tape (TVT) — retropubic route; transobturator tape (TOT) — transobturator route. Both are minimally invasive synthetic mesh slings placed under the mid-urethra to provide support and increase urethral closure pressure during coughing/activity. Procedure: day surgery; short recovery. Cure rates for SUI: approximately 80-90% at 5 years. Unlike transvaginal mesh for POP (suspended in UK 2018), midurethral slings for SUI were maintained (with restrictions) due to their favourable risk-benefit profile. Complications: urinary retention (usually temporary); de novo OAB; mesh erosion (approximately 1-2%).
Vaginal pessary for POP
RCOG/ICSA non-surgical option for symptomatic pelvic organ prolapse — a silicone or rubber device inserted into the vagina to mechanically support the prolapsed organs. Types: ring pessary (most common — for cystocele/uterine prolapse); shelf/Gehrung pessary (for larger prolapse). Highly effective as first-line management — approximately 60-80% of women use pessaries long-term successfully. Advantages: reversible; no surgery; can be used while awaiting surgery or as lifelong management. Requirements: regular review (every 3-6 months); cleaning and reinsertion by patient or clinician; topical oestrogen (post-menopausal women) to prevent epithelial erosion.
Sacral nerve stimulation (SNS) / neuromodulation
ICS/NICEAn implantable device (similar to a pacemaker) that stimulates the sacral nerves (S2-S4) with low-level electrical impulses — modulating the neural control of bladder and bowel function. FDA-approved and NICE-recommended for: OAB (urgency, frequency, urge incontinence) refractory to medication; faecal incontinence refractory to conservative treatment. Success rates: approximately 70-80% improvement in UI episodes; 40-50% complete continence. Implanted under local anaesthesia; reversible (device can be removed); MRI-conditional. Trial period (4-week external test stimulation) before permanent implant.
Obstetric anal sphincter injury (OASI)
RCOG/WHOPerineal trauma during vaginal delivery involving the external and/or internal anal sphincter (3rd degree — involving external sphincter; 4th degree — involving anal mucosa). Affects approximately 3-5% of vaginal deliveries (higher with instrumental delivery). A major preventable cause of faecal incontinence — with up to 60% of women with unrecognised OASI developing faecal incontinence later in life. Prevention: RCOG Care Bundle (OASI-CB): warm perineal compresses; manual perineal protection technique. Repair: primary surgical repair (end-to-end or overlap technique) immediately after delivery by experienced surgeon. All OASIs should be documented and women followed up with specialist pelvic floor physio.

Latest GMJ coverage

Sleep Disturbances in Pregnancy Linked to Gestational Diabetes Risk
20/05/2026

Frequently asked questions 12 Q&A — structured for Google featured snippets and AI discovery

Knowledge hub: guidelines, conventions and reports

Organizations working in migration and health

Related health topics

Menopause (GSM, prolapse risk)Women's healthUterine conditionsObesity (PFD risk)Ageing (PFD prevalence)UTI (OAB differential)

About this hub. Produced by the GMJ News Editorial Team as a public-good service. Every statistic is linked to its primary source. Documents are preserved in the GMJ Repository with full attribution. Georgian Medical Journal · Contact the editorial team
GMJ BriefsView all →
●From Emergency Response to Durable Policy: Three Actionable Lessons from the 2026 Migrant Health Review2 hours ago●400 Million Cases of Atopic Dermatitis: Nature Reviews Confirms Massive Global Burden2 hours ago●Announcement: The 20 Amino Acids: The Chemical Alphabet of Life and What Every Patient Should Know2 hours ago●What Healthcare Providers Need to Know About Sandwich Generation Caregivers6 minutes ago●New Data: Unstable Connectivity Amplifies Loneliness More Than No Internet at All6 minutes ago●Announcement: Magnesium deficiency linked to multiple chronic diseases: what clinicians need to know6 minutes ago●Ultra-Processed Foods Account for Majority of Calories in Latin American Retail2 hours ago●What Clinicians Must Know: Screening and Managing Immigration-Related Family Separation Trauma2 hours ago●Announcement: Vitamin C May Reverse Skin Aging at the Genetic Level, New Research Suggests2 hours ago●Three Clinical Advances in the UK's Updated Influenza Vaccine Framework4 hours ago