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.


METHODS
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 authors' opinions and experience.


RESULTS
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 care. Women with more complex problems, such as severe prolapse or failed continence surgery, require referral.


CONCLUSIONS
Urinary incontinence is a common condition in women. In most cases, it can be diagnosed and managed effectively by family physicians.
O'Neil
Barbara
B
Department of Family Medicine, Dalhousie University, Halifax, NS.
Gilmour
Donna
D
D000368:Aged; D015444:Exercise; D005194:Family Practice; D005260:Female; D006801:Humans; D008487:Medical History Taking; D010353:Patient Education as Topic; D017773:Pelvic Floor; D010570:Pessaries; D010808:Physical Examination; D012017:Referral and Consultation; D014549:Urinary Incontinence / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*