Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
GP Pathway for the Management of Adult Female Urinary Incontinence and Prolapse pathway

Urogynaecology - Female Incontinence and Prolapse

NB: Unless there are red flags all referrals are to be sent via urogynacology triage (the bladder and bowel service, using urogynacology referral form) DO NOT send directly to gynaecology

Check for red flags (see pathway).  If incontincence perform urine dipstick.  Manage blood/ leucocytes/ nitrites as per pathway (to exclude bladder TCC or UTI)

The following patients need to be referred directly to urogynaecology triage (they will ascertain the correect first contact for patient).  Use the urogynaecology triage form and send to the bladder and bowel service for:

  • Prolapse, assess severity
    • 1st degree (mild): cervix visible when the perineum is depressed - prolapse is contained within the vagina.
    • 2nd degree (moderate): cervix prolapsed through the introitus with the fundus remaining in the pelvis.
    • 3rd degree (severe): complete prolapse - entire uterus is outside the introitus.
    • Pessaries can be offered for  prolapse but may not help incontinence
    • Advise weight loss if BMI>30
  • Urinary incontinence with associated faecal incontinence, susptect urogenital fistula, previous continence surgery, previous pelvic cancer surgery or previous pelvic radiation therapy

If no prolapse and dip stick negative (including after treating UTI)

  • Ask patient to keep voiding diary - minimum three days, include fluid intake, caffine intake and other irritants.  Use baseline ICIQ questionnaire
  • Advise on coping strategies (see pathway)
  • On review assess if stress, mixed incontinence or over active bladder (OAB) and manage accordingly:
    • Pure stress incontinence - advise weightloss if BMI >30, refer to urogynae triage (bladder and bowel service using the urogynaecology triage form)
    • If mixed picture - treat as over active bladder initially.  If OAB improves but stress incontinence ongoing/ develops refer to to urogynae triage (bladder and bowel service using the urogynaecology triage form)
    • If predominently urge or over active bladder - advise wieght loss if BMI >30, stop caffine and bladder irritantes, offer advice for self-guided bladder training
    • Review all patients with urge incontinence or mixed picture at 8 weeks, if symptoms ongoing, decide whether to:
      • Commence pharmacological treatment (see pathway for options) , OR
      • Refer to urogynae triage (bladder and bowel service using the urogynaecology triage form)