Your assessment before referral:
- 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.
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