Clinical Education

Urinary Stress 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.
  • 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