Addressing the need for a simpler algorithm for the management of women with urinary incontinence

Urinary incontinence (UI) is a prevalent and bothersome condition for many women. However, few women convey the problem to primary care physicians (PCPs), and few PCPs proactively ask about it. One reason may be that available UI recommendations are too complex and difficult to implement. Simplification may encourage greater adaptation as long as a simplified algorithm does not compromise patient safety. I review the opportunity to develop a simpler UI algorithm based on the 3rd edition 2005 International Consultation of Incontinence (ICI) guidelines for the initial management of UI in women.

A literature search for scientific evidence supporting simplification was performed using PubMed, the Cochrane Database, the Agency for Health Care Policy and Research's (AHCPR) 1996 recommendations, and the ICI's 2005 Incontinence Book / CD-ROM. Each level in the ICI algorithm for initial assessment and treatment was evaluated to develop an updated and less complex management strategy.

A simpler UI algorithm for PCPs should focus on considering reversible risk factors and identifying those who need specialized management. A short questionnaire may be sufficient to assess type and severity of UI, whereas a standard neurologic or comprehensive abdominal and pelvic examination seems unnecessary. Treatment should be restricted to a few evidence-based options.

In conclusion, a simpler UI algorithm allows the initiation of evidence-based treatment after a simplified assessment in primary care.