🔑 Key Learning

  • Stress incontinence = leakage on effort/sneeze/laugh
    • 1st-line = pelvic floor or bladder training
  • Urgency incontinence = sudden urge followed by leakage, often OAB
    • Step 1: Bladder training (minimum 6 weeks)
  • Mixed = combination of the above
  • Overflow = incomplete emptying → chronic leakage
  • Avoid oxybutynin in older patients

🚻 Stress Incontinence

The involuntary passage of urine associated with raised intra-abdominal pressure (e.g. sneezing, coughing, laughing).

Causes / Risk Factors

  • Pelvic floor muscle weakness
    • Age
    • Pregnancy and vaginal delivery
  • Obesity
  • Constipation

Management

  • Step 1: Supervised pelvic floor muscle training
  • Step 2:
    • Refer to urogynaecology for consideration of surgical management
    • Duloxetine may be offered if the woman prefers drug treatment instead of surgery

🚽 Urgency Incontinence

A sudden sense of the need to pass urine, followed by involuntary leakage.

Typically part of overactive bladder (OAB) syndrome, which includes urgency, frequency, and nocturia due to involuntary detrusor contractions.

Management

  • Step 1: Bladder training (minimum 6 weeks)
  • Step 2: If symptoms persist, offer either:
    • Antimuscarinics: oxybutynin, tolterodine, darifenacin
      • Avoid oxybutynin in older women due to cognitive side effects
    • Mirabegron (beta-3 agonist): alternative if antimuscarinics contraindicated

🌀 Mixed Incontinence

A combination of stress and urgency symptoms.

Management

  • Prioritise treatment based on the predominant symptom (stress vs urgency)
  • Apply the corresponding management pathway above

💧 Overflow Incontinence

Occurs due to urinary retention, often from bladder outflow obstruction or detrusor muscle underactivity, leading to involuntary ‘overflow’ leakage.

Management

  • Refer to specialist services

🔗 Useful Links and References

NICE CKS. Incontinence - urinary, in women [April 2023]. Available at URL: https://cks.nice.org.uk/topics/incontinence-urinary-in-women/