Guidelines for preventive activities in general practice


The Red Book
13. Urinary incontinence
☰ Table of contents


Age range chart

0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

No evidence for screening general population


There is no evidence for screening for urinary incontinence in the general population. Instead, GPs should case-find those at higher risk (B).

Within the general population, up to 19% of children,1 13% of men and 37% of women may be affected by some form of urinary incontinence.2 While urinary incontinence is most common in women and increases with age, bedwetting (enuresis) is common in children (5.5% of children also report daytime wetting).1 In men, uncomplicated lower urinary tract symptoms do not appear to be associated with an increased risk of prostate cancer.3 Of those sitting in a GP waiting room, 65% of women and 30% of men report some type of urinary incontinence, yet only 31% of these people report having sought help from a health professional.4Primary care professionals are in a position to take a more proactive approach to incontinence treatment by asking about urinary symptoms in at-risk groups during routine appointments. There remains considerable health decrement due to urinary incontinence in those not receiving help in a population readily accessible to primary care services.5

 

Table 13.1. Urinary incontinence: Identifying risk

Who is at risk?

What should be done?

How often

Average risk

 

There is no evidence to support screening (IV)

N/A

Higher risk2

  • Prenatal and postnatal women
  • Women who have had children
  • Women who are overweight
  • Women reporting constipation
  • People with respiratory conditions, diabetes stroke, heart conditions, recent surgery, neurological disorders
  • Frail elderly people or long-term care residents

Case finding (IV, B) 

Ask about the occurrence of urinary incontinence 





In residential aged care facilities, residents are automatically assessed

Every 12 months

 

Table 13.2. Urinary incontinence: Preventive interventions

Test

Technique

Case finding

Probing questions such as ‘Other people with … [state conditions of higher risk here] have had problems with their waterworks [bladder control] …’6 

Simple patient survey assessment tools have been shown to be valid and reliable (A)

Assessment

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 dipstick and culture, if indicated. A post-void residual may be required in the assessment of possible retention and/or overflow 

There are four common types of incontinence:

  1. Stress incontinence is the leaking of urine that 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
  2. 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 over-active or unstable bladder, neurological condition, constipation, enlarged prostate or history of poor bladder habits
  3. Mixed incontinence is a combination of stress and urge incontinence, and is most common in older women
  4. Overflow incontinence as a result of bladder outflow obstruction or injury. Its symptoms may be confused with stress incontinence

Because treatments differ, urge incontinence should be distinguished from stress incontinence (A) 

To make this distinction, the International Continence Society guidelines recommend an extensive evaluation that is too time-consuming for primary care practice 7 

However, the 3 Incontinence Questions (3IQ) questionnaire is a simple, quick, and non‑invasive test with acceptable accuracy for classifying urge and stress incontinence, and may be appropriate for use in primary care settings (A). The questionnaire is provided in Appendix 13A in the PDF version8, 9


The Continence Foundation of Australia (CFA) has a helpline available for consumers and healthcare professionals at 1800 33 00 66. Consumers can ask for specific help or for contact details of their nearest continence professional. The CFA website has many evidence-based resources available for consumers


Redbook







 
  1. Bower W, editor. An epidemiological study of enuresis in Australian children. Sydney: Wells Medical, 1995.
  2. Continence Foundation of Australia. What is incontinence: Key statistics. Brunswick, Vic: CFA, 2015.  [Accessed 2015 September].
  3. Martin RM, Vatten L, Gunnell D, Romundstad P, Nilsen TI. Lower urinary tract symptoms and risk of prostate cancer: The HUNT 2 Cohort, Norway. Int J Cancer 2008;123(8):1924–28.
  4. Byles J, Chiarelli P, Hacker A, Bruin C. Help seeking for urinary incontinence: A survey of those attending GP waiting rooms. Aust Continence J 2003;9(1):8–15.
  5. Shawa C, Gupta RD, Bushnell DM, Passassa R, Abrams P, Wagg A. The extent and severity of urinary incontinence amongst women in UK GP waiting rooms. Fam Pract 2006;23(5):497–506.
  6. Martin JL, Williams KS, Sutton AJ, Abrams KR, Assassa RP. Systematic review and meta-analysis of methods of diagnostic assessment for urinary incontinence. Neurourol Urodyn 2006;25(7):674–83.
  7. Staskin D, Kelleher C, Avery K, et al, editors. Committee 5: Initial assessment of incontinence. Proceedings of the fourth international consultation on incontinence. Paris: Health Publication Ltd, 2009.
  8. Brown J, Bradley C, Subak L, Richter H, Kraus S, Brubaker L. The sensitivity and specificity of a simple test to distinguish between urge and stress incontinence. Ann Intern Med 2006;144:715–23.
  9. Hess R, Huang AJ, Richter HE, et al. Long-term efficacy and safety of questionnaire-based initiation of urgency urinary incontinence treatment. Am J Obstet Gynecol 2013;209(3):244, e1–9.