assessment of urinary incontinence in women

Last edited 05/2019

Assessing urinary incontinence

  • history taking and physical examination
    • at the initial clinical assessment, categorise the woman's urinary incontinence as stress urinary incontinence, mixed urinary incontinence or urgency urinary incontinence/overactive bladder. Start initial treatment on this basis. In mixed urinary incontinence, direct treatment towards the predominant symptom
      • if stress incontinence is the predominant symptom in mixed urinary incontinence, discuss with the woman the benefit of non-surgical management and medicines for overactive bladder before offering surgery
      • during the clinical assessment seek to identify relevant predisposing and precipitating factors and other diagnoses that may require referral for additional investigation and treatment
    • asssessing pelvic organ prolapse
      • for women presenting in primary care with symptoms or an incidental finding of vaginal prolapse:
        • take a history to include symptoms of prolapse, urinary, bowel and sexual function
        • do an examination to rule out a pelvic mass or other pathology and to document the presence of prolapse
        • for women with pelvic organ prolapse
          • do not routinely perform imaging to document the presence of vaginal prolapse if a prolapse is detected by physical examination
          • if the woman has symptoms of prolapse that are not explained by findings from a physical examination, consider repeating the examination with the woman standing or squatting, or at a different time

    • detailed history

    • examination

  • investigations

Notes (1):

  • urodynamic testing
    • do not perform multichannel filling and voiding cystometry before primary surgery if stress urinary incontinence or stress-predominant mixed urinary incontinence is diagnosed based on a detailed clinical history and demonstrated stress urinary incontinence at examination

    • after undertaking a detailed clinical history and examination, perform multichannel filling and voiding cystometry before surgery for stress urinary incontinence in women who have any of the following:

      • urge-predominant mixed urinary incontinence or urinary incontinence in which the type is unclear
      • symptoms suggestive of voiding dysfunction
      • anterior or apical prolapse
      • a history of previous surgery for stress urinary incontinence


  • ultrasound is not recommended other than for the assessment of residual urine volume

  • consider investigating the following symptoms in women with pelvic organ prolapse:
    • urinary symptoms that are bothersome and for which surgical intervention is an option
    • symptoms of obstructed defaecation or faecal incontinence
    • pain
    • symptoms that are not explained by examination findings

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