HNY Policy and Pathway Repository - York

Urinary Incontinence can be divided into three types:

• Stress Incontinence: leakage on coughing, sneezing, associated with pelvic floorweakness.
• Urge Incontinence: leakage associated with a strong desire to void (with frequent smallvoids throughout the day and night).
• Mixed Incontinence: a combination of the above

• Acute urinary retention is a rare complication, but sometimes a presenting feature ofcomplete uterine prolapse and requires admission.
• Persistent Haematuria - please follow 2ww referral guidance.

• History: Establish nature of leakage and request patient completes a 3-day bladder diary Bladder Diary
• Examination: Pelvic examination to include: assessment for presence of leakage on coughing/straining, pelvic floor tone.
• Review bladder diary and offer Bladder Drill if small frequent voids present in keeping with urge incontinence.
• Urine dipstick- Treat UTI
• Lifestyle intervention- e.g. reduce weight if BMI>30, reduce caffeine intake and modify fluid intake
• Review medication- (e.g. diuretics,/antihypertensives, anti-depressants)
• Manage constipation
   
• Therapeutic Management of Overactive Bladder: click here
• Treat underlying atrophy:
  • Vagifem 10mcg pessaries or Ovistin 10mcg cream (Daily for 2w, then twice weekly) for 3m or Estring leave in situ 3m
• Cystocele/ Uterine Prolapse present: consider fitting a ring pessary
• Pelvic floor exercises: click here
• Women’s Health physio: all women with prolapse should be referred first for gynae physio prior to considering surgery, to improve success of surgery.
• Continence Products/ Support: consider referral to the Continence serviceor DNs if housebound

 

Investigations prior to referral

• Bladder diary
• Gynae physiotherapy- refer via MSK form

Indications for referral

• Women who have tried bladder training and medications for OAB but have not been successful

 

Information to include in referral letter

• Reason for referral: Incontinence/Urgency/Possible Interstitial Cystitis
• Examination findings
• Treatment to date:
  • Gynae physiotherapy completed
  • Atrophy treated
  • Bladder drill/urinary symptoms addressed
  • Trial with anti-cholinergic for 3m (details to confirm; detrusitol/solifenacin, time-frame)
  • Bladder diary completed and attached
  • For possible Interstitial Cystitis: MSU results
  • Past medical/surgical history
  • Drug history
  • BMI
  • Smoking cessation

Please note: pelvic floor surgery is usually only considered for women who have completed their family.

Patient information leaflets/ PDAs

• Prolapse patient information
• Incontinence patient information
• Pelvic floor exercises
• Surgical Procedures
• Urethral sling surgery information
• Bladder Drill: useful patient information
• Bladder Diary (file should download)

 

References

• NICE Clinical Knowledge Summary Incontinence - urinary, in women