Treatment of urinary incontinence in women in general practice: observational study

BMJ 1996;312:1459-1462 (8 June)

General practice

Treatment of urinary incontinence in women in general practice: observational study

Arnfinn Seim, general practitioner Bjorn Sivertsen, general practitioner,^a Bjorg Sivertsen, Bjarne C Eriksen, consultant,^b Steinar Hunskaar, professor ^c

^a Medical Office of Health, Rissa, Norway, ^b Department of Gynaecology and Obstetrics, Trondheim University Hospital, Trondheim, Norway, ^c Division for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

Correspondence to: Professor S Hunskaar, Division for General Practice, Ulriksdal 8c, N-5009 Bergen, Norway. steinar.hunskar{at}isf.uib.no.

Abstract

Objective: To examine what is attainable when treating urinaryincontinence in women in general practice.
Design: Observational study with 12 months' follow up. Interviewand clinical examination before, during, and after treatmentof women seeking help for urinary incontinence in general practice.
Setting: General practice in the rural district of Rissa, Norway.
Subjects: 105 women aged 20 or more with urinary incontinence.
Interventions: Treatment with pelvic floor exercises, electrostimulation,oestrogen, anticholinergic drugs, bladder training, and protectivepads.
Main outcome measures: Subjective and objective measures ofurinary incontinence; number of patients referred to a specialist.
Results: After 12 months' follow up 70% (69/99) of the womenwere cured or much better; the mean score on a 100 mm visualanalogue scale decreased from 37 to 20 mm; and the proportionof women who were greatly bothered by their incontinence decreasedby 62%. 20% (20/98) of women became continent, and the percentageof women with severe incontinence decreased from 64% (63/99)to 28% (27/98). Mean leakage per 24 hours measured by a padtest decreased from 28 g at the start of treatment to 13 g after12 months. The number of light weight pads or sanitary towelsdecreased from 1.6 to 0.6 a day. In all, 17/105 (16%) patientswere referred to a specialist.
Conclusions: Urinary incontinence in women can be effectivelymanaged in general practice with fairly simple treatment. Mostwomen will be satisfied with the results.

Key messages

General practitioners can treat urinary inconti- nence fairly simply
Treatment options in this study were pelvic floor exercises, electrostimulation, oestrogen, anti- cholinergic drugs, bladder training, and protective pads
After 12 months' follow up most of the women were cured or much better

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