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Practice Guidelines

Management of urinary incontinence in women: summary of updated NICE guidance

BMJ 2013; 347 doi: (Published 10 September 2013) Cite this as: BMJ 2013;347:f5170

This article has a correction. Please see:

  1. Antony Smith, chair of the Guideline Development Group1,
  2. David Bevan, project manager2,
  3. Hannah Rose Douglas, associate director, health economics2,
  4. David James, clinical codirector2
  1. 1University of Manchester, Manchester M13 9PL, UK
  2. 2National Collaborating Centre for Women’s and Children’s Health, Royal College of Obstetricians and Gynaecologists, London NW1 4RG, UK
  1. Correspondence to: D Bevan dbevan{at}

Urinary incontinence has substantial implications for the individual and family and has considerable resource implications for the health service. Monthly data in the UK show that 46% of women attending a primary care clinic report having urinary incontinence.1 Women with urinary incontinence can present with either stress urinary incontinence, urgency urinary incontinence, or mixed urinary incontinence (see box for definitions), each of which has a different care pathway based on the predominant symptom. As new treatments (such as botulinum toxin A and surgical tapes for mid-urethral procedures) have become available, and as new variations periodically arrive on the market, updated guidance is needed to reflect these changes.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on the care for women with urinary incontinence,2 and replaces previous NICE clinical guideline 40 (published October 2006).

Definitions of terms

  • Urinary incontinence is defined by the International Continence Society as “the complaint of any involuntary leakage of urine.”3 Urinary incontinence may occur as a result of various abnormalities of lower urinary tract function or as a result of other illnesses, which tend to cause leakage in different situations.

    • Stress urinary incontinence is involuntary urine leakage on effort or exertion or on sneezing or coughing

    • Urgency urinary incontinence is involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to delay)

    • Mixed urinary incontinence is involuntary urine leakage associated with both urgency and exertion, effort, sneezing, or coughing.

  • Overactive bladder syndrome is defined as urgency that occurs with or without urge urinary incontinence and usually with frequency and nocturia. Overactive bladder that occurs with incontinence is known as “overactive bladder wet,” while overactive bladder without incontinence is “overactive bladder dry.” These combinations of symptoms are suggestive of the …

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