1. Urinary Incontinence NICE Guidance

2. Urinary incontinence  Involuntary leakage of urine  Common condition  Affects women of different ages  Physical/psychological/social impact

3. Types of incontinence  Stress  Urge  Mixed  Overactive bladder

4. Initial Assessment  Bladder diary  Urinalysis  Post-void residual urine

5. Lifestyle changes  Modify fluid intake  Lose weight  Reduce caffeine

6. Stress incontinence  Pelvic floor exercises  Duloxetine

7. Stress incontinence  Retropubic mid-urethral tape  Intramural bulking agents  Colposuspension  Artificial urinary sphincter

8. Urge incontinence/OAB  Bladder training  Antimuscarinic drugs  Intravaginal oestrogens  Desmopressin

9. Urge incontinence/OAB  Botulinum toxin A  Sacral nerve stimulation  Augmentation cystoplasty

10. Urgent referral  Microscopic haematuria >50  Macroscopic haematuria  Recurrent/persisting UTI with haematuria >40  Suspected pelvic mass arising from urinary tract

11. Routine referral  Symptomatic prolapse seen at or below introitus  Palpable bladder after voiding

12. Consider referral  Persisting bladder or urethral pain  Clinically benign pelvic masses  Associated faecal incontinence  Suspected neurological disease  Voiding difficulty  Suspected urogenital fistula  Previous continence surgery  Previous pelvic surgery or radiation

13. Catheterisation  Persistent urinary retention causing incontinence, symptomatic infections, renal dysfunction  Urine contamination of wounds, pressure sores  Distress/disruption caused by bed/clothing changes  Patient preference

14.  A anticholinergic  B blood tests  C desmopressin  D HRT  E Intermittent catheterisation  F long term Abx  G MSU  H PFE  I prolapse  J reassurance  K refer  L sibutramine  M USS  N weight loss Incontinent woman AbnormalNormal Treat Resolved? Incontinence persists Predominantly stress Predominantly urge No better 1 2 4 5 3 6

15. Answers  1 G  2 N  3 J  4 H  5 A  6 K