This factsheet covers 10 Top Tips for managing female urinary incontinence in primary care. It is intended for use in your multi-disciplinary practice education sessions as a resource to stimulate discussion and learning.
1. Promote self care measures including:
- Avoid bladder irritants (i.e. caffeine, carbonated drinks, alcohol)
- Manage constipation
- Fluid intake of 1.5 litres fluid/day
2. Take a focused history to determine predominant symptom and focus initial management on this i.e. stress incontinence or overactive bladder symptoms (OAB)
3. All women require an abdominal/pelvic examination and urine dip
4. Offer vaginal oestrogens to peri/post- menopausal women.
Reassure them about the safety of long-term use.
5. Anticholinergic medication – assess choice of product, including transdermal, on individual risk/benefit basis (remember to consider anticholinergic load). Change product after 4 weeks if no improvement or significant side effects.
6. If insufficient improvement after trial of 2 or 3 anticholinergics change
to/add mirabegron before referral.
7. If treatment successful review after 6-12 months and consider reducing
or stopping treatment.
8. STRESS DOMINANT Stress or mixed incontinence refer for 12 weeks supervised pelvic floor exercises. (Recommend use of on-line exercises/Squeezy app in addition)
9. Consider use of ring pessary if incontinence associated with pelvic organ prolapse
10. MESH Currently no role for vaginally placed mesh. If a woman presents with symptoms suggestive of mesh related problem refer to secondary care.