Login

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 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

Bladder Re-Training;
https://www.yourpelvicfloor.org/conditions/bladder-training

Referral forsupervised PFE to the pelvic floor nurses. Pts can self refer via CFT website:
https://www.cornwallft.nhs.uk/physiotherapy


 

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

Author: Dr S Burns GP

Contributors: Farah Lone, Constultant Uro-gynaecologist RCHT

Version: 1.2

Date: December 2020

Review date: December 2021