Guidelines for preventive activities in general practice 7th edition

• Peri- and post-natal women
• Younger women who have had children
• Women who are overweight
• Those with diabetes, stroke, heart conditions, neurological disorders, recent surgery, respiratory conditions, and prostate problems
• The frail, elderly or long term care residents

Ask about the occurrence of urinary incontinence

Every 12 months

IV B 460,461

Question patients about the occurrence of urinary incontinence, eg. ‘Do you have trouble with your bladder?’ ‘Do you ever lose your urine or get wet?’

Effectiveness of self reported scales, professional assessment of clinical history and ultrasound to detect urinary incontinence in women is comparable to urodynamic testing and consistent across race, age, and socioeconomic groups

History taking for a patient with urinary incontinence should include questions about leakage such as precipitating factors, amount and frequency of urine loss, and protective measures (eg. pads or change of clothing)

Patients with urinary incontinence should be assessed to determine the diagnostic category as well as underlying aetiology. This can usually be determined on the basis of history, physical examination and urinary culture and microscopy. There are four common types of incontinence:

• Stress incontinence is the leaking of small amounts of urine which may occur during exercise, coughing, sneezing, laughing, walking, lifting or playing sport. This is more common in women, although it also occurs in men, especially after prostate surgery. Pregnancy, childbirth and menopause are the main contributors
• Urge incontinence is a sudden and strong need to urinate. It is often associated with frequency and nocturia and is often due to having an overactive or unstable bladder, neurological conditions, constipation, enlarged prostate or history of poor bladder habits
• Mixed incontinence is a combination of both stress and urge incontinence and is most common in older women
• Overflow incontinence as a result of bladder obstruction or injury and often occurs in an atonic bladder with overfilling. It often masks stress incontinence