referral criteria from primary care - urinary incontinence in women

Last edited 05/2019

During the clinical assessment seek to identify relevant predisposing and precipitating factors and other diagnoses that may require referral for additional investigation and treatment.

• women with UI who have any of the following should receive an urgent referral :
  • microscopic haematuria if aged 50 years and older
  • visible haematuria
  • recurrent or persisting UTI associated with haematuria if aged 40 years and older
  • suspected malignant pelvic mass
    
    
• in women with UI, further indications for consideration for referral to a specialist service include:
  
  
  • persisting bladder or urethral pain
    
    
  • clinically benign pelvic masses
    
    
  • associated faecal incontinence
    
    
  • suspected neurological disease
    
    
  • symptoms of voiding difficulty
    
    
  • suspected urogenital fistulae
    
    
  • previous continence surgery
    
    
  • previous pelvic cancer surgery
    
    
  • previous pelvic radiation therapy

Offer referral to secondary care if the woman does not want to try another drug treatment for overactive bladder (OAB) (after initial drug therapy failed or was stopped after adverse effects), but would like to consider further treatment (1).

Offer referral to secondary care if OAB drug treatment is not successful (1).

With respect to stress urinary incontinence:

• if the woman's chosen procedure for stress urinary incontinence is not available from the consulting surgeon, refer her to an alternative surgeon (1).

Reference:

1. NICE (April 2019). Urinary incontinence - The management of urinary incontinence in women