Incontinence in Women
Advice: Conservative measures can be tried in straightforward cases before referral. However, Nick can liaise with the expert Calvary continence nurses if necessary.
Look for ‘red-flag’ signs/symptoms and refer urgently if present.
Refer To: Urologist or Bladder Physiotherapists
Causes of incontinence to consider
Stress incontinence
Urgency incontinence
Mixed urge and stress incontinence
Overflow incontinence
Post-micturition dribbling
Causes of incontinence to consider
- Urinary tract infection
- Weak pelvic floor muscles
- Pelvic organ prolapse
- Atrophy of hormone-sensitive tissue
- Detrusor muscle dysfunction
- Obstruction
- Incompetent sphincter
- Urethral diverticulum
- Fistula
- Cognitive impairment
- Neurological impairment
Stress incontinence
If incontinence is associated with haematuria, an urgent referral is needed.
Other ‘red flag’ signs that require urgent referral if associated with incontinence include:
- Palpable bladder
- Bladder or pelvic pain
- Failed previous stress incontinence treatment
- Continuous incontinence (fistula)
- Neurological disease/abnormal neurological findings
Urgency incontinence
This common symptom can be managed in primary care with bladder physiotherapy and training, followed by, or complemented with, medical treatment. If recalcitrant or difficult to manage, please refer.
If urgency incontinence is associated with haematuria, an urgent referral is needed.
Other ‘red flag’ signs that require urgent referral if associated with incontinence include:
- Palpable bladder
- Bladder or pelvic pain
- Failed previous stress incontinence treatment
- Neurological disease/abnormal neurological findings
Mixed urge and stress incontinence
It is common to find both entities in combination. The principle is to treat the most concerning symptom or form of incontinence first, and reassess the second after. This may be an oversimplification in some patients, but is a reasonable initial approach.
Overflow incontinence
This may be a symptom of chronic retention of urine, so referral is needed. Examine for new neurological signs; if present, an emergency referral is required.
Post-micturition dribbling
This may (rarely) be a symptom of urethral diverticulum or urethral stricture, so warrants referral. However, often a cause is not found.
