Clinical Education

Urinary urge 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.
  • 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