Although urinary incontinence adversely affects most women’s health, quality of life, and function at some point in their lives, the problem has gone underdiagnosed and undertreated, according to the Women’s Preventive Services Initiative (WPSI). So the WPSI has issued a recommendation for standardized screening for urinary incontinence in routine clinical practice.
As part of a preventive health care visit, screening for urinary incontinence with a brief questionnaire could be used to identify affected women and initiate diagnostic evaluations and treatment before symptoms further affect their lives.
The recommendation is intended for all clinicians who provide preventive health care for women — particularly in primary care settings — and applies to women of all ages and adolescents.
The WPSI developed the recommendation after evaluating evidence on the benefits and harms of screening for urinary incontinence in women, including a systematic review of the accuracy of screening instruments and the benefits and harms of treatments. Also considered were the effect of screening on symptom progression and avoidance of costly and complex treatments.
Following are the key features of the recommendation:
- Screening of women for urinary incontinence should be performed annually.
- Screening should assess whether women experience urinary incontinence and whether it affects their activities and quality of life.
- If indicated, women should be referred for further evaluation and treatment.
The authors suggested that screening include the use of validated assessment instruments that include questions about whether a woman has symptoms of urinary incontinence; the type and degree of incontinence; and how symptoms affect her health, function, and quality of life. Screening instruments for urinary incontinence most applicable to screening in primary care settings are the Actionable Bladder Symptom Screening Tool, the Michigan Incontinence Symptom Index, and the Overactive Bladder Awareness Tool.
Patients’ symptoms may be treated with behavioral, nonpharmacologic, pharmacologic, and surgical interventions. Early intervention may reduce symptom progression, improve immediate- and long-term quality of life, and limit the need for more complex and costly treatment.
The authors offered the following comments about treatment:
- Weight loss improves urinary incontinence symptoms in women who are obese, particularly those who have stress rather than urge incontinence.
- Women who receive pelvic floor muscle training are more likely to report cure or symptom improvement and have better satisfaction and quality of life.
- Intravaginal and intraurethral devices for treating incontinence were not effective in trials.
- In randomized trials, medications were more effective than placebo, but the magnitude of improvement was low. Solifenacin and fesoterodine demonstrated dose–response effects on symptom improvement in treatment versus control groups.
- Surgical interventions generally are reserved for women whose symptoms do not improve sufficiently with more conservative therapies.
- The most common primary surgical treatment for stress incontinence is synthetic mid-urethral mesh slings. Other surgical options include urethral bulking agents, retropubic suspension, and fascial slings.
Last updated on 9/14/19.