Assessment of urinary incontinence in women

Assessing urinary incontinence

• history taking and physical examination
  • at the initial clinical assessment, categorise the woman's urinary incontinence as stress urinary incontinence, mixed urinary incontinence or urgency urinary incontinence/overactive bladder. Start initial treatment on this basis. In mixed urinary incontinence, direct treatment towards the predominant symptom
    • if stress incontinence is the predominant symptom in mixed urinary incontinence, discuss with the woman the benefit of non-surgical management and medicines for overactive bladder before offering surgery
    • during the clinical assessment seek to identify relevant predisposing and precipitating factors and other diagnoses that may require referral for additional investigation and treatment
  • asssessing pelvic organ prolapse
    • for women presenting in primary care with symptoms or an incidental finding of vaginal prolapse:
      • take a history to include symptoms of prolapse, urinary, bowel and sexual function
      • do an examination to rule out a pelvic mass or other pathology and to document the presence of prolapse
      • for women with pelvic organ prolapse
        • do not routinely perform imaging to document the presence of vaginal prolapse if a prolapse is detected by physical examination
        • if the woman has symptoms of prolapse that are not explained by findings from a physical examination, consider repeating the examination with the woman standing or squatting, or at a different time
          
          
  • detailed history
    
    
  • examination
    
    
• investigations

Notes (1):

• urodynamic testing
  • do not perform multichannel filling and voiding cystometry before primary surgery if stress urinary incontinence or stress-predominant mixed urinary incontinence is diagnosed based on a detailed clinical history and demonstrated stress urinary incontinence at examination
    
    
  • after undertaking a detailed clinical history and examination, perform multichannel filling and voiding cystometry before surgery for stress urinary incontinence in women who have any of the following:
    • urge-predominant mixed urinary incontinence or urinary incontinence in which the type is unclear
    • symptoms suggestive of voiding dysfunction
    • anterior or apical prolapse
    • a history of previous surgery for stress urinary incontinence
      
      
      
• ultrasound is not recommended other than for the assessment of residual urine volume
  
  
• consider investigating the following symptoms in women with pelvic organ prolapse:
  • urinary symptoms that are bothersome and for which surgical intervention is an option
  • symptoms of obstructed defaecation or faecal incontinence
  • pain
  • symptoms that are not explained by examination findings

Reference:

• 1) NICE (April 2019). Urinary incontinence: The management of urinary incontinence in women