Improving the management of urinary incontinence

Area of Science:

• Urology
• Geriatrics
• Women's Health

Background:

• Urinary incontinence (UI) is a prevalent, under-reported condition, especially in the elderly.
• Prevalence in the UK ranges from 17-40%, with higher rates in women and increasing frequency with age, parity, high BMI, and comorbidities.
• Common types include stress UI, overactive bladder (OAB), and mixed UI.

Purpose of the Study:

• To outline the epidemiology and common types of urinary incontinence.
• To detail the recommended initial assessment and diagnostic steps for UI.
• To describe management strategies and referral criteria for UI.

Main Methods:

• Review of the clinical presentation and diagnostic criteria for UI.
• Description of initial assessment including history, urine dipstick, and physical examination (abdominal, vulval-vaginal).
• Outline of management pathways including conservative measures, pharmacological treatment, and referral criteria.

Main Results:

• UI is common, particularly in older women, and influenced by various factors.
• Initial assessment involves detailed history, urine tests, and physical examination.
• Management progresses from conservative measures to pharmacological treatment and specialist referral based on response.

Conclusions:

• Effective management of UI requires a thorough initial assessment and tailored treatment approach.
• Involving continence nurses and pelvic physiotherapists can optimize care and reduce secondary care referrals.
• Referral to secondary care is indicated for persistent OAB unresponsive to two drugs or stress UI unresponsive to pelvic floor muscle training.