Stress urinary incontinence

  • 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.

     

    Stress

     

    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.

    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
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