Approach to urinary incontinence in women. Diagnosis and management by family physicians

Objective. To outline an approach to diagnosis and management of the types of urinary incontinence seen by family physicians. Sources of Information. Recommendations for diagnosis are based on consensus guidelines. Treatment recommendations are based on level I and II evidence. Guidelines for referral are based on the author's opinions and experience. Main Message. Diagnoses of stress, urge, or mixed urinary incontinence are easily established in family physicians' offices by history and gynecologic examination and sometimes a urinary stress test. There is little need for formal diagnostic testing. Management by family physicians (without need for specialist referral) includes lifestyle modification, pelvic floor muscle strengthening, bladder retraining, and pharmacotherapy with muscarinic receptor antagonists. Patients with pelvic organ prolapse might require specialist referral for consideration of pessaries or surgery, but family physicians can provide follow-up. Women with more complex problems, such as severe prolapse or failed continence surgery, require referral. Conclusion. Urinary incontinence is a common condition in women. In most cases, it can be diagnosed and managed effectively by family physicians.