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Incontinence - urinary, in women - Management
How should I manage a woman whose symptoms are predominantly of stress urinary incontinence?

  • Refer to a gynaecologist or urogynaecologist if there is associated prolapse that is symptomatic or visible at or below the introitus.
  • Otherwise, refer to an appropriate practitioner for full assessment and consideration for a programme of supervised pelvic floor muscle training (PFMT) that should ideally last for at least 3 months. Women require an individualized programme based on assessment.
    • Digital assessment of pelvic floor muscle contraction should be done before implementation of a PFMT programme.
    • At a minimum, eight pelvic floor muscle contractions should be performed at least three times a day.
    • The woman should be reviewed after 12 weeks or as required to assess response.
    • The woman should be advised to continue taught PFMT exercises if she is experiencing sufficient benefit.
    • The use of weighted vaginal cones or multicomponent behavioural therapy (bladder training plus PFMT) may improve the outcome of PFMT, but requires specialist provision and high levels of motivation in the woman.
    • Biofeedback may assist motivation, and electrical stimulation may be of help to women who cannot initiate a pelvic floor muscle contraction.
  • If initial conservative treatments fail or if the woman expresses a preference, consider:
    • Referring to a urologist, urogynaecologist, or gynaecologist for urodynamic investigations and surgery. See Secondary care treatments for stress urinary incontinence.
    • Offering duloxetine as a second-line treatment, but only if the woman prefers pharmacological to surgical treatment or is not suitable for surgical treatment.
  • Drug treatment with alpha 1A-adrenoreceptor agonists (for example, pseudoephedrine) is not recommended.
  • In frail elderly people:
    • Treat any reversible causes or contributing factors to stress urinary incontinence (such as cognitive impairment, urinary tract infection, excess fluid intake, restricted mobility, constipation, or adverse effects of medications).
    • Take into account desire and suitability for treatment. Where appropriate, refer for full assessment and consideration of PFMT.
    • Refer where appropriate to a continence adviser, the district nursing team, or elderly care team for specialist assessment for the management of incontinence.

In depth

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