Validity study of the severity index, a simple measure of urinary incontinence in womenBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7294.1096 (Published 05 May 2001) Cite this as: BMJ 2001;322:1096
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Dear Editor- Hanley et al have correctly stated that urinary
incontinence in women is poorly evaluated and treated. There are a number
of reasons for this and chief being poor training among residents to
understand this symptom properly. Our experience in this regard was an eye
opener. Our study was a retrospective review of urinary incontinence in
patients admitted under care of the elderly department. It was felt that
patients are being put on long term urinary catheters without fully
evaluating the cause of urinary incontinence.
When a patient complains of incontinence it is essential to identify the
type before instituting any management. Diagnosis relies on history,
physical examination and non invasive investigations.
In the UK about 3million people are incontinent of urine. For many older
people full incontinence is a normal part of the ageing process and are
reluctant to talk about it.
Incontinence can sometimes be cured but mostly it can at least be
improved, it can always be better managed. Patients are often prescribed
incontinence aids before the cause of the problem has been established.
Assessment is of crucial importance -
· All patients must have documentation of their continence status.
· Physical examinations such as per-rectal exam.
· Dipstick, MSU (Midstream urine) examination, should be done in all
· As appropriate referrals to gynaecologist and urologist should be made.
Random selection of patients discharged from the care of the elderly care
department into the community. Total 50 patients were included.
Information gathered from district nurse and patient casenotes were
· Examination findings
· Results of investigations
· Any relevant interventions
Inclusion criteria- all referrals seen in community by the district nurse
for incontinence of urine and who had been inpatient in recent past.
Exclusion criteria - Patients who are long term bed ridden e.g. dense
operatively, terminally ill and severely demented patients.
Female were (60%) age group - 80 to 93 years.
Diagnosis Percentage of total Stroke 30% Congestive cardiac failure 22% Confusion (multiple cause e.g. infection) 38% Fractures 10%
Check for history of incontinence-Adequate check for history of
incontinence taken in only 40% of all patients.
Investigation of symptoms
80% of patients had a combined test of blood sugar, dip stick and MSU.
Most of the patients had at least two precipitating factors.
Cause of incontinence
The cause for incontinence was confirmed in about 76% of patients.
urinary tract infections,constipation, drugs, cerebrovascular disease,
More than one precipitating factor was noted in 74% of all cases.
Incontinence advice was not recorded in two thirds of all patients.
Patients need more detailed assessment and a physical examination
regarding their urinary incontinence.Unless fully evaluated long term
catheter should not be advised.
specialist registrar rehabilitation medicine,south thames
1. Hanley J, Capewell A, Hagen S.Validity study of the severity index, a
simple measure of urinary incontinence in women.BMJ 2001;322:1096-7(5 MAY).
Competing interests: Diagnosis Percentage of totalStroke 30%Congestive cardiac failure 22%Confusion (multiple cause e.g. infection) 38%Fractures 10%