The conservative (non-pharmacological) management of female urinary incontinence

Key content Urinary incontinence (UI) affects up to 69% of the female population at some point in their lives but remains under-reported. There are three main types of UI: stress, urgency and mixed. It is recommended to try conservative approaches as first-line measures in the management of all types of UI. These include lifestyle interventions such as adjustment of fluid intake and weight loss, physical and behavioural therapies (pelvic floor muscle training, electrical stimulation, vaginal cones and bladder training programmes) and occasionally containment devices. Initial management of UI, in most cases, renders itself to primary care settings: this involves appropriate assessment of women's symptoms, including quality of life (QOL) assessment, appropriate simple investigations (such as urine analysis) and conservative treatment. Appropriate referral pathways to secondary and tertiary levels of care are necessary. Regular audit should take place to assess the efficacy of management options and referral pathways. UI has significant adverse affects on women's QOL. Hence patient reported outcome measures (PROMs) have been highlighted in recent NHS reports as a means of assessing effectiveness of care from the patient's perspective by gauging patient health status or health-related QOL. Learning objectives To gain an understanding of the assessment and various conservative management options for common types of UI in women. To explore the existing evidence base for such conservative management modalities and to analyse the effect of the current economic climate and reorganisation of services on the conservative management approach. To recognise the important role of patient reported outcome measures as well as service and user involvement, in the assessment of clinical and cost-effectiveness of various treatment options of UI in women. Ethical issues Should conservative measures such as weight loss and smoking cessation be a pre-requisite for offering further management options? In the present climate of scarce health resources should more emphasis be placed on the active role of patients in their own management? Will reorganisation of the NHS pose any threat to the conservative measures for treating UI in women? Is it acceptable to take a 'one size fits all' approach to management of common types of UI?