- 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.
- 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
