1. Urinary Symptoms in the Female
 Most urinary symptoms in the female are functional disorders  Management is directed towards improvement of quality of life  If symptoms are of sudden onset or atypical, especially in the elderly, bladder malignancy should be considered with early referral to secondary care.
Presentation
Stress Urinary Incontinence (SUI) : Leakage on physical activity
Overactive Bladder (OAB) symptoms : urgency, frequency, urge incontinence, nocturia, enuresis
Mixed Urinary Incontinence: Both SUI and OAB symptoms
Complicated Symptoms
Haematuria Bladder pain Recurrent UTIs Voiding dysfunction Retention Suspected fistula
Assessment
History & Examination - Prev incontinence or prolapse surgery / Prev pelvic irradiation Significant and/or Symptomatic prolapse / Pelvic mass Atrophic changes in postmenopausal women  Treat with topical oestrogen Post-void residual if indicated – If significant
Urinalysis +/- MSSU - Positive for blood  Follow Haematuria Pathway UTI  Treat with antibiotics
Frequency-Volume-Chart
Clinical Diagnosis
Early Referral to Secondary Care
SUI
OAB + / - Incontinence
Mixed Incontinence
Primary Management
Lifestyle interventions - Review fluid intake ( 1-1.5l per day ) - Reduce caffeine intake Normalize weight / Stop smoking / Treat constipation
Supervised and targeted pelvic floor muscle training/Physiotherapy for weeks (See link to Referral Pathway below)
Supervised bladder re-training for weeks for OAB
Drug therapy for OAB (see Prescribing Guidance)/Consider Duloxetine for SUI
If symptoms persist
Referral to Secondary Care for Specialised Management

2. Referral Pathway to Women’s Health Physiotherapists
in the Community across Edinburgh and the Lothians
(West/Mid/East)
Referrals via SCI Gateway – Option:
AHP – Physiotherapy. Edinburgh – Community MSK HUB (Slateford)
AHP – Physiotherapy. East Lothian – Roodlands Hospital (East Lothian)
AHP – Physiotherapy. Midlothian – Roodlands Hospital (Midlothian)
AHP – Physiotherapy. St Johns Hospital (West Lothian)
Referrals will be directed to one of the Community Physiotherapy Services MSK Outpatient Clinics.
Referrals will be triaged appropriately to a Women’s Health Physiotherapist.