Urgency urinary incontinence

  • Urinary incontinence 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. 
  • Urgency urinary incontinence is defined as involuntary leakage of urine associated with urgency.
  • Urgency urinary incontinence is often related to over-activity of the detrusor muscle, but symptoms could be due to a urinary tract infection, so this must always be excluded. 
  • The cause is often unknown. It is more prevalent in older (post-menopausal) women, but it may be linked to a family history or childhood history of similar symptoms.
  • This type of urinary incontinence often occurs as part of group of symptoms called overactive bladder syndrome (OAB). Other OAB symptoms include urinary frequency and nocturia.
  • 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 features:

  • A sudden, intense need to empty the bladder which is often difficult to delay. 
  • The urge sensation may be linked to specific triggers, for example arrving home (latch-key urgency), a change of position or the sound of running water.
  • An associated increase in urinary frequency or nocturia.




    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.
    • Where appropriate the use of OAB drugs and/or topical oestrogen should be discussed.

    Physiotherapy management:

    If you feel that your patient has urgency 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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