NICE issues new guidance on urinary incontinence in womenBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7574.876-c (Published 26 October 2006) Cite this as: BMJ 2006;333:876
Doctors in England and Wales have been given new guidance to improve the care and treatment of millions of women who have urinary incontinence.
But surgeons should have specific competences before they perform surgery in cases of urinary incontinence, says the guidance, which was issued this week by the clinical standards body the National Institute for Health and Clinical Excellence (NICE).
The guidelines on how to manage urinary incontinence in women contain around 100 recommendations and advise on diagnosis, treatment, and training in this area, which NICE says is still regarded by many as a “hidden” subject.
Experts believe that the condition affects five million women in England and Wales aged over 20 and one in three women aged over 40, but this may be an underestimate, because embarrassment stops many women seeking help.
Paul Hilton, a consultant gynaecologist and chairman of the guideline development group, said at the launch of the guidelines: “It's the problem we just don't talk about. Incontinence is one of the last taboo subjects in health care, which patients have often been reluctant to discuss and the medical profession slow to address.” Some women have the condition for years before seeking help and avoid exercise, sex, and even laughing, because those activities could trigger incontinence.
The guidance has a section on assessment and investigation in which it says that women should be categorised as having stress urinary incontinence, mixed incontinence, or urge incontinence (overactive bladder syndrome).
Treatment recommendations include:
Lifestyle changes, such as changing how much a person drinks and losing weight
At least three months of pelvic floor muscle training
At least six weeks of bladder training.
The guidance recommends that only surgeons who are trained in the management of urinary incontinence or who work in a multidisciplinary team with this training and who regularly do this kind of surgery should undertake it.
When asked whether there were enough surgeons with these skills, Malcolm Lucas, consultant urologist and member of the development group, said: “We have looked at the competences that we think should underpin someone carrying out surgery, the training, and how people maintain their expertise—and how we monitor that.
“There are enough surgeons out there with the necessary competences. The issue is more to do with making sure people's skills are maintained.”
The guidance would be particularly helpful for GPs, said the authors, because as patients were now able to choose which hospital they were treated in GPs were increasingly unlikely to know the specialists they were referring their patients to.
The estimated annual cost for the NHS to treat urinary incontinence is £233m (€350m; $440m).
The guidance is available at www.nice.org.uk/CG40.