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Urinary incontinence in women NICE guideline - CG171 by Karen Kiernan

Urinary incontinence in women NICE guideline - CG171 by Karen Kiernan. Types of incontinence. Stress UI - involuntary urine leakage on effort or exertion or on sneezing or coughing. Incompetent sphincter +/- Prolapse Urgency UI - involuntary urine leakage

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Urinary incontinence in women NICE guideline - CG171 by Karen Kiernan

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  1. Urinary incontinence in womenNICE guideline - CG171by Karen Kiernan

  2. Types of incontinence Stress UI - involuntary urine leakage on effort or exertion or on sneezing or coughing. Incompetent sphincter +/- Prolapse Urgency UI - involuntary urine leakage accompanied or immediately preceded by urgency Infection, neurological disorders Mixed UI – both! Overactive bladder (OAB) – frequency and nocturia +/- leakage Often detrusor overactivity

  3. Basic approach History taking (incl. obstetric) Urine testing Assessment of pelvic floor muscles Assessment of prolapse Bladder diaries Rule out – UTI or Signs of malignancy

  4. Urgent referral Microscopic haematuria if aged 50+ Visible haematuria Recurrent or persisting UTI with haematuria if aged 40+ Pelvic mass

  5. 1st line - Lifestyle Caffeine, Fluids Weight (BMI 30+) Pelvic floor At least 8 contractions 3 times per day over 3 months

  6. Pharmacological treatment Works best in OAB, urge & mixed (not stress…) Antimuscarinic - oxybutynin - not for frail, older women tolterodine darifenacin Note – Regurin / Trospium Chloride not on list…. Side effects - dry mouth, dry eyes, constipation and blurred vision

  7. Follow up • Review after 4 weeks • If continuing on drug treatment review annually or 6 monthly if <75 • Refer to secondary care if drug treatment doesn’t work

  8. Where to refer? • Urologist? • Gynecologist?? • Urogynecologist??? • The Continence Service - based at Eccleshill Clinic, Bradford The female urinary incontinence referral pathway Seen by specialist nurse Ensures conservative treatments have been tried Will refer to urology or Gyne as appropriate

  9. Specialist treatment • Further investigations Urodynamic studies Multi-channel filling and voiding cystometry Ambulatory urodynamics or videourodynamics • Potential treatmetns Bladder wall injection with botox if proven detrusor overactivity not responding to conservative Percutaneous sacral nerve stimulation Synthetic tapes +/- Prolapse repair Tapes provides support to keep the urethra closed

  10. Thank you for listening! Any questions??

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