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Urinary Incontinence

Urinary Incontinence. NICE Guidance. Urinary incontinence. Involuntary leakage of urine Common condition Affects women of different ages Physical/psychological/social impact. Types of incontinence. Stress Urge Mixed Overactive bladder. Initial Assessment. Bladder diary Urinalysis

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Urinary Incontinence

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  1. Urinary Incontinence NICE Guidance

  2. Urinary incontinence • Involuntary leakage of urine • Common condition • Affects women of different ages • Physical/psychological/social impact

  3. Types of incontinence • Stress • Urge • Mixed • Overactive bladder

  4. Initial Assessment • Bladder diary • Urinalysis • Post-void residual urine

  5. Lifestyle changes • Modify fluid intake • Lose weight • Reduce caffeine

  6. Stress incontinence • Pelvic floor exercises • Duloxetine

  7. Stress incontinence • Retropubic mid-urethral tape • Intramural bulking agents • Colposuspension • Artificial urinary sphincter

  8. Urge incontinence/OAB • Bladder training • Antimuscarinic drugs • Intravaginal oestrogens • Desmopressin

  9. Urge incontinence/OAB • Botulinum toxin A • Sacral nerve stimulation • Augmentation cystoplasty

  10. Urgent referral • Microscopic haematuria >50 • Macroscopic haematuria • Recurrent/persisting UTI with haematuria >40 • Suspected pelvic mass arising from urinary tract

  11. Routine referral • Symptomatic prolapse seen at or below introitus • Palpable bladder after voiding

  12. Consider referral • Persisting bladder or urethral pain • Clinically benign pelvic masses • Associated faecal incontinence • Suspected neurological disease • Voiding difficulty • Suspected urogenital fistula • Previous continence surgery • Previous pelvic surgery or radiation

  13. Catheterisation • Persistent urinary retention causing incontinence, symptomatic infections, renal dysfunction • Urine contamination of wounds, pressure sores • Distress/disruption caused by bed/clothing changes • Patient preference

  14. A anticholinergic B blood tests C desmopressin D HRT E Intermittent catheterisation F long term Abx G MSU H PFE I prolapse J reassurance K refer L sibutramine M USS N weight loss Incontinent woman Abnormal 1 Normal 2 Treat Incontinence persists Resolved? Predominantly stress Predominantly urge 3 4 5 No better 6

  15. Answers • 1 G • 2 N • 3 J • 4 H • 5 A • 6 K

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