Guidelines help PCPs evaluate urinary incontinence

September 26, 2012

New guidelines from the University of Michigan Health System, Ann Arbor, offer family physicians a step-by-step guide for the evaluation of urinary incontinence.

New guidelines from the University of Michigan Health System, Ann Arbor, offer family physicians a step-by-step guide for the evaluation of urinary incontinence.

"I think a lot of physicians don’t realize that this problem can be successfully treated without surgery or other major interventions, and there are some pretty simple things they can do in the office to make a big difference for a lot of women," said lead author Abigail Lowther, MD. "We hope to give primary care providers a framework for how to evaluate and treat different many forms of incontinence without the need for referral to a specialist."

Studies have found that 10% to 40% of women older than 18 years of age-and as many as 53% of those over 50-are affected by urinary incontinence, the authors wrote in the Journal of Family Practice (2012; 9:544-51).

The authors suggest three simple, immediate steps a physician can take to address the problem while keeping the appointment on track: Collecting a urine sample, asking the patient to keep a 3-day voiding diary, and scheduling a follow-up visit.

By the second visit, the authors say, the physician will have more information for further evaluation and a management plan. Also recommended are high-yield questions to classify the type of incontinence being experienced. Examples include asking how worried patients are that coughing will lead to a leak, how quickly patients need to find a bathroom when their bladder is full, and whether washing hands or the sound of running water leads to leakage.

Dr. Lowther says some women don’t broach the subject with doctors because they think loss of bladder control is a normal part of aging.

"We want to emphasize to women that this is not something they have to live with, that they should tell their primary care physicians about their symptoms," Dr. Lowther said. "We also want to remind physicians that simple interventions can go a long way towards improving this problem for patients."

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