GPAtlas🧭 When to suspect
Suspect urinary incontinence (UI) in any patient reporting the involuntary leakage of urine. The single most important step in primary care is to classify the type from the history, because the entire management pathway diverges from that one decision. Having classified, two pieces of groundwork are mandatory before any treatment: a urine dipstick in everyone, and a bladder diary.
NICE NG123 is the cornerstone for assessing and managing UI in women, and most evidence-based primary-care UI pathways are built on it. Men whose dominant picture is lower urinary tract symptoms (hesitancy, weak stream, terminal dribbling) are assessed under the separate LUTS-in-men pathway, but the same red-flag and cancer-referral principles apply throughout.
| Type | Typical history | First-line direction |
|---|---|---|
| Stress UI | Leakage on effort or exertion – coughing, sneezing, laughing, lifting, exercise. | Supervised PFMT for at least 3 months. |
| Urgency UI / OAB | Sudden compelling urge to void, with leakage before reaching the toilet; often frequency and nocturia. | Bladder training for at least 6 weeks. |
| Mixed UI | Features of both stress and urgency. | Direct treatment at the predominant symptom first. |
| Overflow UI | Continuous dribbling, hesitancy, poor stream, sense of incomplete emptying (obstruction or underactive detrusor). | Exclude retention (post-void residual) and treat the cause – do not start an antimuscarinic blindly. |
Source: NICE NG123
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