Urinary urge incontinence - Allied Health Professionals

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.

Assessment Treatment

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