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Management of incontinence in general practice

Incontinence is largely a "hidden" condition. Patients do not readily admit to symptoms, and many doctors are unaware of their prevalence. Within the general population, up to 19% of children and at least 20% of women and 10% of men may be affected by some form of urinary incontinence. Rates of faecal incontinence in the adult population are also thought to be high, with recent Australian statistics highlighting a 12-month incidence of 11.2%. These largely under-reported conditions often have a significant negative influence on quality of life and mental health and are usually a major influence on decisions to place an elderly person in long-term institutionalisation.

A large proportion of incontinence can be cured or improved, often through simple pelvic floor exercises and other behavioural strategies such as bladder training. General Practitioners are ideally placed within the Australian Health System to provide and coordinate care for persons affected by incontinence. GPs are the leading providers of health-care to the Australian community, averaging 6000 consultations each per year. Up to 90% of Australians visit a GP each year.

The cost of incontinence to patients and the wider community is difficult to estimate due to its lack of visibility. An Australian study estimated that the median personal cost per week is A$5.61 and the total annual treatment cost of medical treatments is A$462 on average. Total direct cost (median) was found to be A$12.89 per week. Financial cost is more than matched by the social cost of the condition. Incontinence may be described as a social death, due to its debilitating effect on the ability of sufferers to travel and interact with other community members.

It is clear that a large amount of incontinence remains unmanaged. A major barrier to patients' help-seeking behaviour is certainly embarrassment. Many patients, however, simply lack knowledge of their condition and of the available treatments. Others believe that incontinence is a normal part of ageing or childbirth or that it is not a "medical" condition. A growing body of research and clinical opinion suggests that incontinence should not be considered either normal or untreatable.

These guidelines provide sufficient information to enable GPs to feel confident in their ability to identify and manage incontinence within their own practices. Effective treatment may take time, however, and management can often be optimised by appropriate referral to other health providers such as nurse continence advisors, physiotherapists, occupational therapists, pharmacists, and specialists. Links to such professionals are provided in the package that accompanies these guidelines.

These guidelines represent a summary of the strongest available data and management recommendations for urinary and faecal incontinence, contextualised to the particular needs of Australian General Practice. Information is presented in three levels, providing detailed background, summarised guidelines, and an assessment and management algorithm that provides a convenient visual representation of the major decision points and preferred management pathways. We encourage GPs to use these resources and are confident that their use will assist in uncovering and managing a substantial amount of previously unreported incontinence.

Publication Date: 11 April 2007
Authorised By: Quality care and research