Urinary incontinence (female)

Question 1

Types of urinary incontinence

Answer 1

Stress (most common) - triggered by laughing, coughing, sneezing or exertion - due to weak or damaged pelvic floor muscles

Urge (overactive bladder) - urgent desire to pass urine, often leaking before reaching toilet - usually the result of overactivity of the detrusor muscles, which control the bladder.

Mixed - combination of stress and urge incontinence

Overflow - caused by an obstruction which prevents bladder from emptying fully for example, prostatic enlargement may
lead to outflow obstruction with overflow. Constipation can distort the bladder neck and interfere with micturition

Question 2

Red flags

Answer 2

Saddle anaesthesia/low back pain
Haematuria
Persistent UTI 
Recent pelvic surgery
Recent back trauma
Poor renal function - ask if any problems with kidneys?

Question 3

HPC questions

Answer 3

How many times do you go in the day?
How many times do you need to go at night?
How much urine are you passing each time?
Do you need to use pads to keep dry? How many?

Do you find you leak urine when coughing, sneezing at all?

Do you ever get the strong urge to go to the toilet suddenly? Have you ever not made it?

How much are you drinking in an average day?
Do you drink lots of caffeine or alcohol?

Pain on urination? Foul-smelling urine? (possible UTI)

How is this affecting your day-to-day life?

Dragging sensation in the vagina?

Any problems with bowel movements?

Question 4

Risk factors for stress incontinence to ask about

Answer 4

Multiparity - multiple vaginal deliveries
Complicated vaginal deliveries
Perineal tears or episiotomies
Obesity
Old age
Postmenopausal

Question 5

PMH questions to ask about

Answer 5

Obstetric history - deliveries

Neurological conditions e.g. DM, MS or parkinson’s

Previous pelvic surgeries

Question 6

DHx

Answer 6

Use any diuretics

Question 7

SHx

Answer 7

Do you drink much tea or coffee?
Alcohol intake
Weight - increased BMI increases risk

Has this affected your home or work life in any way?

Question 8

Investigations

Answer 8

Urine dipstick (to check for UTI and glucosuria in DM)

Bladder incontinence diary

Question 9

Stress incontinence management

Answer 9

Keep a bladder diary
- Direct the patient to bladder self-assessment tool on the NHS choices website

Lifestyle changes - e.g. maintaining healthy weight/losing weight, increasing physical activity and cutting down on caffeine and alcohol, avoid drinking more than 2L a day or restricting fluids too much

Can use incontinence pads to help manage the condition

Pelvic floor exercises to strengthen the muscles (for at least 3m)

If these do not work then further down the line:

• Referral to gynae for further investigations e.g. urodynamic studies
• Duloxetine (SSRI) - can cause dry mouth and constipation
• Surgical - tension free vaginal tape or colposuspension

Patient information leaflet as a lot of information to take in

Question 10

Urge incontinence management

Answer 10

Keep a bladder diary and NHS bladder self-assessment tool on NHS website

Lifestyle changes - increase physical activity and lose weight if overweight, avoid caffeine, avoid drinking more than 2L a day or restricting fluids too much

Can use incontinence pads to help manage the condition

Bladder retraining exercises - refer - techniques to increase the length of time between feeling the need to urinate and passing urine. The course will usually last for at least 6 weeks.

Further down the line:

• Referral to gynae for further investigations e.g. urodynamic studies
• Can use antimuscarinic medication e.g. oxybutynin - side effects may include dry mouth and constipation
• Alternative to anticholinergics is mirabegron
• Invasive procedures e.g. botox injections

Question 11

Safety netting and follow up

Answer 11

If bladder retraining/pelvic floor exercises fail to work then come back to GP

If get low back pain or loss of sensation between your legs then go to A&E

Follow up in a month