Urinary incontinence: The management of urinary incontinence in women
This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg40
Introduction
|
This guidance replaces NICE technology appraisal 56 'The clinical effectiveness and cost effectiveness of tension-free vaginal tape for stress incontinence'. |
Urinary incontinence (UI) is a common condition that may affect women of all ages, with a wide range of severity and nature. Although rarely life-threatening, UI may seriously influence the physical, psychological and social wellbeing of affected individuals. The impact on the families and carers of women with UI may be profound, and the resource implications for the health service considerable.
UI is defined by the International Continence Society as 'the complaint of any involuntary leakage of urine'. UI may occur as a result of a number of abnormalities of function of the lower urinary tract or as a result of other illnesses, which tend to cause leakage in different situations.
-
Stress UI is involuntary urine leakage on effort or exertion or on sneezing or coughing.
-
Urge UI is involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to defer).
-
Mixed UI is involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing.
Overactive bladder syndrome (OAB) is defined as urgency that occurs with or without urge UI and usually with frequency and nocturia. OAB that occurs with urge UI is known as 'OAB wet'. OAB that occurs without urge UI is known as 'OAB dry'. These combinations of symptoms are suggestive of the urodynamic finding of detrusor overactivity, but can be the result of other forms of urethrovesical dysfunction.
This guideline focuses on the management of stress UI, OAB and urge UI, and mixed UI in women. It does not address transient or continuous UI or UI that is provoked by specific stimuli such as sexual intercourse, or laughing or giggling. Leakage in these situations may, however, be a manifestation of abnormalities of lower urinary tract function, such as detrusor overactivity or urodynamic stress incontinence, that are covered by the guideline.