Excerpt

Urinary incontinence (UI) is a common symptom that can affect women of all ages, with a wide range of severity and nature. While rarely life-threatening, incontinence may seriously influence the physical, psychological and social wellbeing of affected individuals. The impact on the families and carers of women with UI may be profound, and the resource implications for the health considerable.

The International Continence Society (ICS) has standardised terminology in lower urinary tract function: UI is defined as ‘the complaint of any involuntary urinary leakage’. This may occur as a result of a number of abnormalities of function of the lower urinary tract, or as a result of other illnesses, and these tend to cause leakage in different situations. Definitions for stress, mixed and urge UI and overactive bladder (OAB) are given in the glossary. Other types of UI may be described by the situations that provoke urine loss, for example during sexual intercourse, or on laughing or giggling. Some patients may simply report being ‘wet all the time’. This may be a reflection of the severity of their condition, although may on occasions be due to other pathologies, for example fistula. There are currently approximately 80 cases of fistula between the urinary tract and genital tract treated each year in England and Wales and this condition is not considered further in this guideline. It is recognised that UI may be of a transient nature on occasion, reflecting acute health or environmental factors.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1 Urinary incontinence
  • 1.2 Aim of the guideline
  • 1.3 Areas outside the remit of the guideline
  • 1.4 For whom is the guideline intended?
  • 1.5 Who has developed the guideline?
  • 1.6 Other relevant documents
  • 1.7 Guideline method
  • 1.8 Schedule for updating the guideline
• 2. Summary of recommendations and practice algorithm
  • 2.1 Key priorities for implementation (key recommendations)
  • 2.2 Summary of recommendations
  • 2.3 Research recommendations
  • 2.4 Algorithm
• 3. Assessment and investigation
  • 3.1 Introduction
  • 3.2 History taking and physical examination
  • 3.3 Pelvic floor muscle assessment
  • 3.4 Assessment of prolapse
  • 3.5 Urine testing
  • 3.6 Assessment of residual urine
  • 3.7 Referral
  • 3.8 Symptom scoring and quality of life assessment
  • 3.9 Bladder diaries
  • 3.10 Pad testing
  • 3.11 Urodynamic testing
  • 3.12 Other tests of urethral competence
  • 3.13 Cystoscopy
  • 3.14 Imaging
  • 3.15 Information provision
• 4. Conservative management
  • 4.1 Lifestyle interventions
  • 4.2 Physical therapies
  • 4.3 Behavioural therapies
  • 4.4 Drug therapies
  • 4.5 Non-therapeutic interventions
  • 4.6 Complementary therapies
  • 4.7 Preventive use of conservative therapies
  • 4.8 Optimal sequence and timescales for conservative therapies
• 5. Surgical management
  • 5.1 Procedures for overactive bladder
  • 5.2 Procedures for stress urinary incontinence
• 6. Competence of surgeons performing operative procedures for urinary incontinence in women
  • 6.1 Introduction
  • 6.2 Achieving competence
  • 6.3 Maintaining and measuring expertise and standards for practice
• Appendix A Declarations of interest
• Appendix B Guideline questions
• Appendix C Findings of urinary history taking compared with urodynamics
• Appendix D Economic evidence for urodynamics
• Appendix E Costing first-line conservative treatments for urinary incontinence
• Appendix F Cost effectiveness analysis for duloxetine
• Appendix G A partial cost–consequence analysis for surgical treatment options for OAB
• References
• Evidence tables for included studies
• Excluded studies

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.