Clinical guidelines on urinary incontinence in women

The National Institute for Clinical Excellence has published a quality standard on urinary incontinence in women, including It assessment, care and treatment options. It covers managing urinary incontinence in women (aged 18 and over).

The contents of the standard include quality statements on:

• Initial assessment
• Bladder diaries and lifestyle changes
• Containment products
• Supervised pelvic floor muscle training
• Bladder training
• Indwelling catheters
• Multidisciplinary team review before surgery or invasive treatment.

1. Urinary incontinence is the involuntary leakage of urine. It may result from a number of abnormalities of function of the lower urinary tract or from other conditions, which tend to cause leakage in different situations:
2. Stress incontinence is the involuntary leakage of urine on effort, exertion, sneezing or coughing.
3. Urgency incontinence is the involuntary leakage of urine with or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to delay).
4. Mixed urinary incontinence is the involuntary leakage of urine associated with both urgency and exertion, effort, sneezing or coughing.
5. Overactive bladder (OAB) is defined as urgency with or without urgency incontinence and usually with frequency and nocturia. When it occurs with incontinence it is known as 'OAB wet'; when it occurs without incontinence it is known as 'OAB dry'. These combinations of symptoms suggest detrusor muscle overactivity, but can result from other forms of urethrovesical dysfunction.

Urinary incontinence is an embarrassing problem for many women. It may be significantly underreported because they are too embarrassed to seek advice, they do not wish to bother their GP; they believe urinary incontinence is normal in older women or they do not know that treatments are available.

Studies have shown that urinary incontinence affects one‑third of women, with the prevalence increasing with age. Data also show that slight to moderate incontinence is more common in younger women, with moderate and severe incontinence mostly affecting older women.

The management of urinary incontinence can be conservative, pharmacological or surgical. Conservative management refers to therapies such as lifestyle interventions and physical, behavioural and non‑therapeutic interventions (such as products that collect or contain leakage).

Pharmacological treatment includes drugs with antimuscarinic action, mirabegron, desmopressin, duloxetine and oestrogens.

When conservative management and pharmacological treatment have not adequately treated the symptoms associated with overactive bladder or stress urinary incontinence, surgery or other invasive treatment may be considered.

The quality standard is expected to contribute to improvements in the following outcomes:

• quality of life for women with urinary incontinence
• experience of care for women with urinary incontinence.