Mixed urinary incontinence:
Main presenting features:
As well as
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.
If you feel that your patient has mixed 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. Where appropriate the use of OAB drugs and/or topical oestrogen should be discussed.
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
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