Urgency / Urge Urinary Incontinence

Screening Questions
Contributing Factors
Management

ICS Definitions:

Urgency: sudden and compelling desire to pass urine.
Urge urinary incontinence: is a complaint of involuntary loss of urine associated with urgency.

Screening Questions:

Sudden, overwhelming desire to pass urine with or without leakage?
Difficulty getting to the toilet on time?

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

Persistent or recurring urinary tract infections.
Dysuria, persisting bladder or urethral pain.
Haematuria, glycosuria or persistent proteinuria.
Inability to empty bladder or straining to empty.
Post void residual volume >200ml.
Nocturnal enuresis.
Rectal bleeding or unexplained vaginal bleeding.
Recent sudden alteration of bowel habits with no obvious explanation.
Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.
Pelvic organ prolapse (POP) past introitus causing difficulty emptying bladder.
Pelvic masses, unexplained weight loss or unremitting night pain.
Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.
Suspected urogenital fistulae.

Side Effects of Medication
UTI
Defaecation Dysfunction
Neurological Co-morbidities

Consideration:

Some medications may have side effects which affect bladder function.

Medical Intervention:

Review of medications which may impact on bladder and bowel health.
Consider alcohol consumption.

Consideration:

Urinary urgency is a common symptom of a UTI.

Medical Intervention:

Assess for and treat UTI as required.

Consideration:

Constipation and repetitive straining to evacuate bowels may cause pelvic floor dysfunction and impact on the bladder and potentially contribute to urgency.

Medical Intervention:

Basic advice on diet, exercise and fluid intake.
Advice on aperients.
Refer to Dietician.
Refer to Continence and Women's Health Physiotherapist for review of pelvic floor and defaecation function.

Consideration:

Some neurological conditions, such as Parkinson's Disease, MS, CVA and dementia may cause urinary urgency and/or affect both bladder emptying or containment.

Medical Intervention:

Review of medications.
Specialist review.

Initial Testing / Examination

Pelvic examination.
Urinalysis.
Diagnostic imaging may be appropriate to rule out outlet obstruction.

1^st Line Treatment

Refer to an appropriate health professional:

Continence and Women's Health Physiotherapist:

3 day bladder diary.
Bowel diary.
Lifestyle modifications: reduce caffeinated drinks, carbonated drinks and other bladder irritants.
Addressing urgency triggers/bladder calming/bladder re-training strategies.
Bowel management strategies and defaecation dynamics.
TENS to assist bladder training.

Continence Nurse Advisor.
In some cases it may be appropriate to refer to both Continence Nurse Advisor and Continence and Women's Health Physiotherapist. These roles may compliment and work together to help the patient achieve optimal management.

2^nd Line Treatment

Pharmacological management:

Beta-3 Agonist.
Antimuscarinic.

3^rd Line Treatment

The following referral to medical specialty is appropriate if patient shows Red Flag signs or is non-responsive to Conservative Management:

Urologist/Urogynaecologist:

Urodynamic studies.
Botox (requires ability to self-catheterize after treatment).
Neuromodulation.

ICS Definitions:

Urgency: sudden and compelling desire to pass urine.

Urge urinary incontinence: is a complaint of involuntary loss of urine associated with urgency.

Screening Questions:

Sudden, overwhelming desire to pass urine with or without leakage?

Difficulty getting to the toilet on time?

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

Persistent or recurring urinary tract infections.

Dysuria, persisting bladder or urethral pain.

Haematuria, glycosuria or persistent proteinuria.

Inability to empty bladder or straining to empty.

Post void residual volume >200ml.

Nocturnal enuresis.

Rectal bleeding or unexplained vaginal bleeding.

Recent sudden alteration of bowel habits with no obvious explanation.

Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.

Pelvic organ prolapse (POP) past introitus causing difficulty emptying bladder.

Pelvic masses, unexplained weight loss or unremitting night pain.

Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.

Suspected urogenital fistulae.

Consideration:

Some medications may have side effects which affect bladder function.

Medical Intervention:

Review of medications which may impact on bladder and bowel health.

Consider alcohol consumption.

Consideration:

Urinary urgency is a common symptom of a UTI.

Medical Intervention:

Assess for and treat UTI as required.

Consideration:

Constipation and repetitive straining to evacuate bowels may cause pelvic floor dysfunction and impact on the bladder and potentially contribute to urgency.

Medical Intervention:

Basic advice on diet, exercise and fluid intake.

Advice on aperients.

Refer to Dietician.

Refer to Continence and Women's Health Physiotherapist for review of pelvic floor and defaecation function.

Consideration:

Some neurological conditions, such as Parkinson's Disease, MS, CVA and dementia may cause urinary urgency and/or affect both bladder emptying or containment.

Medical Intervention:

Review of medications.

Specialist review.

Initial Testing / Examination

Pelvic examination.

Urinalysis.

Diagnostic imaging may be appropriate to rule out outlet obstruction.

1st Line Treatment

Refer to an appropriate health professional:

Continence and Women's Health Physiotherapist:

3 day bladder diary.

Bowel diary.

Lifestyle modifications: reduce caffeinated drinks, carbonated drinks and other bladder irritants.

Addressing urgency triggers/bladder calming/bladder re-training strategies.

Bowel management strategies and defaecation dynamics.

TENS to assist bladder training.

Continence Nurse Advisor.

In some cases it may be appropriate to refer to both Continence Nurse Advisor and Continence and Women's Health Physiotherapist. These roles may compliment and work together to help the patient achieve optimal management.

2nd Line Treatment

Pharmacological management:

Beta-3 Agonist.

Antimuscarinic.

3rd Line Treatment

The following referral to medical specialty is appropriate if patient shows Red Flag signs or is non-responsive to Conservative Management:

Urologist/Urogynaecologist:

Urodynamic studies.

Botox (requires ability to self-catheterize after treatment).

Neuromodulation.

1^st Line Treatment

2^nd Line Treatment

3^rd Line Treatment