MRCGP exam update - Urinary incontinence

Dr Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners' PasTest, 2006

Current situation

  • Urinary incontinence is very common. It affects one in three women aged over 40 years, but it is still underdiagnosed and undertreated.
  • Continence services in the UK have developed at different rates within differing care models. This has resulted in inconsistent services.

What is the evidence?

  • A combination of duloxetine treatment and pelvic floor muscle training was found to improve symptoms in women with stress urinary incontinence more than either treatment alone (J Urol 2005; 173: 1,647-53).
  • Women with moderate to severe urinary incontinence have been shown to have an increased risk of depression. Patients with severe incontinence were more likely to suffer from depression (Obstet Gynecol 2005; 106: 585-92).
  • Risk of developing incontinence is 28 per cent higher in women with diabetes (J Am Geriatr Soc 2005; 53: 1,851-7).
  • The Women's Health Initiative study showed that HRT does not decrease the risk of urinary incontinence in postmenopausal women (JAMA 2005; 293: 935-48). Researchers concluded that it should not be prescribed for the prevention or relief of urinary incontinence.
  • A US study found that women with a BMI over 35 were more than twice as likely as normal weight women to develop urinary incontinence (Obstet Gynecol 2007; 110: 346-53).

Implications for practice

  • A study found that nurse-led interventions were effective in reducing the symptoms of incontinence at both three and six months (Br J Gen Pract 2005; 55: 696-703).
  • GPs should initiate discussion of urinary symptoms. One study found that urinary incontinence in middle-aged women was high, but only 38 per cent mentioned it to their GP (Am J Obstet Gynecol 2007; 197: 167.e1-167.e5).
  • Data from the STAR trial showed that solifenacin is superior to tolterodine at reducing urinary incontinence episodes (Eur Urology 2005; 48: 464-70.

Guidelines

  • SIGN guidance recommends that patients should be offered information and advice about treatment options, and GPs should be proactive in identifying incontinence in people at increased risk.
  • NICE guidelines advise on the treatments and expectant competencies of surgeons performing procedures. It recommends that GPs should take an active role in identifying and treating incontinence.

Useful websites

 

Key points

  • Urinary incontinence affects 30 per cent of women.
  • Duloxetine has a role in the management of urinary incontinence.
  • Depression is more common in patients with urinary incontinence.
  • Continence nurses have a very important role.

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