Urinary incontinence

Current situation?

  • Urinary incontinence affects one woman in three but is underdiagnosed and undertreated.
  • Continence services in the UK are scattered and varied.
  • A questionnaire survey showed that more than 70 per cent of women with urinary incontinence said that they did not think it warranted consultation (Int J Urol 2005; 12: 621).


What is the evidence?

  • A recent trial has shown that the combination of duloxetine and pelvic floor muscle training results in the greatest improvement of symptoms for women with stress urinary incontinence (J Urol 2005; 173: 1,647).
  • One study has shown that women with moderate to severe urinary incontinence have an increased risk of depression (Obstet Gynecol 2005; 106: 585).
  • Patients with more severe incontinence were more likely to suffer with depression. The authors of this study even suggest that depression should be screened for in women with urinary incontinence.
  • Only a small proportion of older people with urinary incontinence seek help, despite the availability of treatment (Br J Gen Pract 2005; 55: 776).
  • Women with diabetes have been shown to have a 28 per cent greater risk for incontinence than those without (J Am Geriatr Soc 2005; 53: 1,851).
  • Data from the Women’s Health Initiative study has shown that hormone replacement therapy does not decrease the risk of urinary incontinence in postmenopausal women (JAMA 2005; 293: 935).

Implications for practice

  • Continence nurses are often very important in the management of patients with urinary incontinence. A recent study has shown that nurse practitioner-led interventions are effective in reducing the symptoms of incontinence at both three and six months (Br J Gen Pract 2005; 55: 696). They also seem to be cost-effective.
  • In practice it can often be very difficult to distinguish between stress and urge incontinence in women. One study has shown that asking three simple questions to women can reliably distinguish between the two conditions (Ann Intern Med 2006; 144: 715).

Available guidelines

  • SIGN guidance aims to reduce barriers to care and wants all people with incontinence to be offered assessment, treatment and referral.
  • Patients should be offered information and advice about treatment options, and GPs should be proactive in identifying incontinence in people at increased risk.
  • NICE produced provisional guidelines for urinary incontinence earlier this year.

Useful websites

 

 

- Dr Louise Newson is a GP in the West Midlands and author of ‘Hot Topics for MRCGP and General Practitioners’, Pas Test 2006

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