Urinary Incontinence

History:

Identify whether symptoms suggestive of 1) Stress incontinence (SUI)

2) Overactive bladder (OAB) and urge incontinence

3) Mixed Incontinence (SUI and OAB)

Consider using the Bladder Symptom Profile/Bladder Diary in the link here (https://www.cornwallft.nhs.uk/bladder-and-bowel-service/) over minimum of 3 days

Consider and treat:

· UTI

· pelvic mass

· neurological problems

· medication effects

· constipation

· atrophic vaginitis

· obesity

· fluid intake

· chronic cough

Investigations:

· Urinalysis

· Assess pelvic floor muscle contraction using Muscle Grading System

(0 = no contraction, 1 = flicker, 2 = weak, 3 = moderate, 4 = good (with lift), 5 = strong)

· Arrange a bladder pre/post voiding ultrasound scan if :

- Symptoms suggestive of voiding dysfunction

(hesitancy, Poor stream, Straining, Incomplete emptying, terminal dribbling) OR

- Recurrent UTI

Red flags

· Micro (60yrs+) & macro (45yrs+) haematuria – 2ww urology referral

· Recurrent UTI with haematuria (40yrs+)- 2ww referral urology

· Suspected pelvic mass - 2ww gynae if suspected malignancy

Management:

Pelvic Floor Exercises:
https://www.yourpelvicfloor.org/conditions/pelvic-floor-exercises

Referral for supervised PFE to the pelvic floor nurses.
https://www.cornwallft.nhs.uk/physiotherapy

NOTE in women with mixed ui start both conservative/medical treatments for SUI and OAB

Bladder Re-training advice: https://yourpelvicfloor.org/conditions/bladder-training

References: NICE Guideline [NG123] Publish date: 02 April 2019 Last Updated: 24 June 2019

Author:Dr S Burns GP

Contributors:Farah Lone, Consultant Uro-gynaecologist RCHT

Version:1.3

Date:January 2022

Review date: December 2023