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.
• At the first consultation, categorise the symptom: 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 or overactive bladder (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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