- Urinary incontinence (UI) is a symptom that can affect women of all ages, with a wide range of severity and impact on quality of life. It is common but not normal.
- Stress urinary incontinence is defined as involuntary leakage of urine on effort or physical exertion (e.g. sporting activities) or on sneezing or coughing.
- Stress incontinence is often related to weakness of, or damage to, the pelvic floor muscles although women with a strong active contraction of these muscles could also have symptoms if they’re not using them correctly.
- Risk factors include vaginal (particularly forceps) delivery, increased parity, older age, obesity, and family history
- There are many barriers to seeking advice/treatment for symptoms of UI. We also know that many women are not able to contract their pelvic floor muscles effectively, so if a woman reports symptoms please refer for further assessment.
Main presenting feature:
- Leakage of urine on effort or exertion or on sneezing or coughing.
- Urine dipstick screening to detect the presence of blood, glucose, protein, leucocytes and nitrites in the urine.
- Vaginal examination to identify evidence of pelvic organ prolapse or pelvic mass. May also include pelvic floor muscle assessment, if within your scope of practice.
Physiotherapy management:
If you feel that your patient has stress urinary incontinence refer her to physiotherapy. The physiotherapist will complete a detailed assessment, following which she will work with your patient, with the aim of resolving or reducing her symptoms. This may include:
- Advice on an individualised pelvic floor muscle exercise programme
- Advice on fluid intake (following completion/analysis of a bladder diary)
- Education on daily activities, general exercise, diet, weight loss and smoking cessation
- Referral to the community continence services, for further tests or assessment of containment products, if required
If conservative management fails the physiotherapist may discuss referral to the urological/gynaecological consultant.
Referrals to consultant-led services:
If your patient describes any of the following symptoms they should be referred urgently, following locally-agreed pathways, to the appropriate consultant-led service.
- Microscopic haematuria in women aged 50 years and older
- Visible haematuria
- Recurrent or persisting UTI associated with haematuria in women aged 40 years and older
- Suspected malignant mass arising from the urinary tract
Further indications for consideration for referral to a consultant-led service include:
- Persisting bladder or urethral pain
- Clinically benign pelvic masses
- Associated faecal incontinence
- Suspected neurological disease
- Symptoms of voiding difficulty
- Suspected urogenital fistulae
- Previous continence surgery
- Previous pelvic cancer surgery
- Previous pelvic radiation therapy
