Making Best Practice, Every Day Practice
Urinary incontinence and related conditions have a high prevalence and a major impact on a patient’s quality of life. Drug therapy can be very effective and forms an important part of the treatment armoury when managing women with incontinence. Unfortunately, medication can be associated with adverse effects, but there are approaches that can be used to maximise a drug’s effectiveness and limit problems that reduce adherence to treatment.
Over the past 30 years a wealth of research has proved the benefits of pelvic floor muscle exercises (PFME) in treating both urinary incontinence and pelvic organ prolapse. However, patients in some areas may have to wait some time for an appointment with specialist continence services. So it makes sense for primary care professionals to know how to teach PFME to their patients.
Urinary continence problems are common in women, and result in significant costs to patients, carers and the NHS, both for treatment and coping strategies such as pads and appliances. Despite this, continence rarely gets the attention that some other, less prevalent conditions receive, and there is evidence of both under-diagnosis and inadequate management.
Urinary incontinence (UI) – the complaint of any involuntary leakage of urine – is common and affects women of all ages. Most patients present in primary care, and require a thorough initial assessment to ensure that they receive appropriate treatment and, where necessary, referral.
Women presenting with urinary incontinence can often be successfully treated in primary care with bladder retraining, pelvic floor muscle exercises and anticholinergic medication as appropriate. But some do not respond to conservative treatment and need referral to secondary care for investigation with urodynamics.
All too many women with urinary incontinence are referred to secondary care when they could be assessed and successfully treated by their GP, practice nurse or local primary care continence advisor. This article explains how one PCT introduced a local pathway that has changed professional behaviour, and proved popular with both professionals and patients.
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