We treat a growing number of people with urinary incontinence and pelvic organ prolapse, a pattern seen across the NHS. We’re a small NHS team with a big ambition, that no one waits to start getting better. While routine waits of 6–8 months to see a clinician are a reality, our aim was to develop a digital-first pathway that begins treatment immediately, enables relevant escalation to one-to-one care, and protects specialist capacity for those who need it most.

We built a structured 12-week digital self-management programme for stress urinary incontinence, overactive bladder and mild–moderate pelvic organ prolapse, building on a well-known pelvic floor muscle exercise app. We launched a pilot accessed through three GP practices, urogynaecology clinics or self-referral, with local Trust social media promotion. 

Onboarding included eligibility checks: 
•	screening for red flags
•	locality eligibility 
•	basic digital skills

Patients who were pregnant or immediately post-natal were excluded.

Patients completed a symptom screener and three-day bladder diary. Following clinician triage, one of the three treatment programmes was delivered digitally.

Suitable people can now start evidence-based self-management immediately after onboarding to the digital platform. This improves fast access to care and can build confidence and help those who require further input to “wait well” with structure and purpose.

The programmes include reminders, interactive learning and weekly content containing clear explanations of symptoms, role and importance of pelvic floor muscles and correct muscle exercises. Progressive pelvic floor strengthening challenges are encouraged, as well as relevant lifestyle changes and quizzes to embed understanding. 

By moving to a digital pathway first, designed for less complex symptoms, we have:
•	reduced contacts
•	promoted integration of self-management strategies
•	protected face to face capacity for complex cases

Eligibility screening, clear escalation criteria and oversight by the pelvic health physiotherapy team keep patients safe. 

Our service evaluation compared outcomes by referral route, and tracks change in symptom and wellbeing via specific built-in patient reported outcome measures (such as symptom specific ICIQ measures and GAD-7 anxiety scores), adherence to both exercise performance and engagement and time to start the programme after registering. Insights gained from the current pilot participants are already informing pathway refinements, such as developing information given in more modular format and including more images and videos to support written information.

At the time of submission 45 patients have adhered to the programme for 6 weeks or more.

The content given to patients is comparable to that included in one new patient and one follow up appointment with a clinician, equating to 75 minutes of contact time. Utilising the digital first approach reduces clinician contact to 15 minutes triage time, resulting in a 60 minutes per patient time saving.

This is an early stage analysis, and once patients in the pilot programme have completed the 12 weeks, we will be able to analyse the clinic outcomes.

We will continue to use the digital pathway as the default, first line route for suitable referrals. The time saved will free up one to one physiotherapy care for more complex cases and a more timely management of waiting lists. We will adapt educational content based on patient feedback and evaluation data and include more graphics to aid understanding and improve accessibility. 

The approach is transferable to other pelvic health pathways such as prostatectomy care, bowel health and maternity perinatal pelvic health services, both with and without self-referral and could offer a replicable blueprint for safe, digital first care that improves patient access and experience.