|
Minimum
history
- when started
- frequency, amount of leakage
- current management, fluid intake
- effect on lifestyle
Minimum examination
- abdomen: PR, PV; relevant neurological assessment
Minimum investigation
- frequency/volume chart
- residual urine estimation (scan or in/out catheterisation)
- dipstick/MSSU
| Causes
and Symptoms |
Possible
underlying problems |
Treatment
|
Referral
options |
*
Stress incontinence:
leaking with coughing, laughing, exercise |
Urethral
sphincter incompetence, pelvic floor weakness |
Pelvic
floor therapy, urethral appliances, surgical intervention |
Continence
specialist nurse, physio-therapist, uro-gynaecologist, urologist |
| Voiding
inefficiency, continual dribbling, weak flow, hesitancy, incomplete
emptying , intermittent stream, straining to void |
Bladder
outlet obstruction (prostatic enlargement, urethral stricture, faecal
impaction) |
Clear
any impaction; otherwise, surgical referral required |
Prostate
assessment clinic, urologist |
| Detrusor
failure (secondary to neurological disease) |
Clean
intermittent catheterisation if post-micturition residual >150ml. |
Continence
specialist nurse, specialist continence service |
| Detrusor
overactivity, urinary urgency, frequency (>8/24h), urge incontinence,
latchkey morning urgency |
Idiopathic
detrusor overactivity |
Check
residual volume, advice on fluid intake, bladder retraining programme,
anticholinergic drugs |
Continence
specialist nurse, specialist continence service |
| Detrusor
overactivity secondary to neurological disease (eg, MS) |
| Cystitis,
classical (internal) dysuria secondary to UTI |
Appropriate
antibiotic therapy. Refer if recurrent |
Urologist,
urogynaecologist, continence specialist nurse |
| Atrophic
urethritis or vaginitis, external dysuria |
Topical
oestrogen replacement or systemic HRT |
Gynaecologist,
specialist continence service |
| Bladder
calculus |
Surgical
referral |
Urologist |
| Cognitive
impairment |
CNS
disease (dementia, delirium) |
Exclude
iatrogenic causes; appropriate toiletting programme; minimise handicap |
Community
nurse, community psychiatric nurse, specialist continence service |
| Physical
impairment |
Impaired
dexterity/mobility |
Physiotherapist,
occupational therapist |
| Enuresis
- bed-wetting |
Detrusor
instability, prostatism, immobility, primary nocturnal enuresis |
As
for underlying condition. Antidiuretic in some cases. |
Specialist
continence service |
Possible
confounding factors: anticholinergics, diuretics, alpha adrenoreceptor
blockers, calcium channel blockers, sedatives
Always review environment, e.g. ease of access to WC
Containment during investigation or if problem regarded as intractable:
-
body worn and bed pads
-
urethral appliances
-
timed voiding programmes
-
sheaths and urinals
-
indwelling catheter (last resort)*
Other
possible referrals: geriatrician; physician
|
