urinary incontinence in women

Last edited 05/2019

Urinary incontinence (UI) is a common cause of referral to gynaecology clinics

• although it is rarely life-threatening, urinary incontinence can be very detrimental to the physical, psychological and social wellbeing of the women it affects
  • impact on families and carers can also be profound, and the resource implications for the health service are considerable
  • urinary incontinence is defined by the International Continence Society as 'the complaint of any involuntary leakage of urine'
    
    
• prevalence of pelvic organ prolapse is high; in primary care in the UK, 8.4% of women reported vaginal bulge or lump, and on examination prolapse is present in up to 50% of women
• pelvic organ prolapse is defined as symptomatic descent of 1 or more of: the anterior vaginal wall, the posterior vaginal wall, the cervix or uterus, or the apex of the vagina (vault or cuff)
  • symptoms include a vaginal bulge or sensation of something coming down, urinary, bowel and sexual symptoms, and pelvic and back pain. These symptoms affect women's quality of life
    
    
• one in 10 women will need at least 1 surgical procedure, and the rate of re-operation is as high as 19%
  • there is likely to be an increasing need for surgery for urinary incontinence and pelvic organ prolapse because of the ageing population (1)

This is probably a gross underestimate. It is suggested that there are about 3 million incontinent women in the UK of which, less than 20% receive any investigation other than an MSU, and a similarly small proportion receive help from health or social services.

UI may occur as a result of a number of abnormalities of function of the lower urinary tract or as a result of other illnesses, which tend to cause leakage in different situations.

• stress UI is involuntary urine leakage on effort or exertion or on sneezing or coughing
• urge UI is involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to defer)
• mixed UI is involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing

Overactive bladder syndrome (OAB) is defined as urgency that occurs with or without urge UI and usually with frequency and nocturia. OAB that occurs with urge UI is known as 'OAB wet'. OAB that occurs without urge UI is known as 'OAB dry'.

• these combinations of symptoms are suggestive of the urodynamic finding of detrusor overactivity, but can be the result of other forms of urethrovesical dysfunction

Reference:

1. NICE (April 2019). Urinary incontinence - The management of urinary incontinence in women