GPAtlas🧭 When to suspect
Suspect urinary incontinence in any woman reporting the involuntary leakage of urine. It is common, frequently under-reported because of embarrassment, and very often treatable. The single most useful step at the first consultation is to categorise the symptom, because the subtype drives almost all subsequent management. In mixed incontinence, direct treatment at the predominant symptom.
| Subtype | Defining feature |
|---|---|
| Stress UI (SUI) | Leakage on effort or exertion – coughing, sneezing, laughing, lifting or exercise – with no preceding urge. Reflects a weak pelvic floor or urethral sphincter. |
| Urgency UI / OAB | Leakage accompanied by, or immediately preceded by, a sudden compelling urge that is hard to defer; often with frequency and nocturia. Reflects detrusor overactivity. |
| Mixed UI | Both urgency-associated and effort-associated leakage. Identify and treat whichever component predominates. |
Always remember the third pattern a GP must not miss: overflow incontinence (chronic retention), where a poorly emptying bladder causes near-constant dribbling and a palpable bladder – this needs investigation, not an overactive-bladder drug.
Source: NICE NG123
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