Management of urinary incontinence in women

Urinary incontinence is defined by the International Continence Society as an involuntary loss of urine that is objectively shown and a social and hygiene problem.1 Urinary incontinence not only causes considerable personal discomfort but is also of economic importance to the NHS, costing around £424m per annum.2 In a survey of 10 226 adults aged over 40, the prevalence of incontinence in women was reported as 20.2%.3

Table 1 summarises the prevalence of urinary incontinence from a variety of studies.4 It is likely that about 3 million people are regularly incontinent in the United Kingdom, a prevalence of around 40 per 1000 adults.5

Incontinence can be broadly divided into genuine stress incontinence and an overactive bladder (detrusor instability) (fig 1). Bladder symptoms often do not correlate with the underlying diagnosis. Thus urge incontinence often but not always results from an overactive bladder. Emphasis must be placed on the management of urinary incontinence in primary care, as this is effective in both the short term and the long term and benefits secondary care by ensuring that only patients who cannot be managed in primary care are referred. 6 7 Urodynamic studies can be reserved for when conservative treatment has failed, surgery is intended, there are voiding difficulties, or a neuropathy is present.