Introduction

Introduction

This guideline updates and replaces the previous NICE guidance on urinary incontinence in women: NICE guideline CG40 (published October 2006). The recommendations are labelled according to when they were originally published (see update information for details).

Urinary incontinence (UI) is a common symptom that can affect women of all ages, with a wide range of severity and nature. While rarely life‑threatening, incontinence may seriously influence the physical, psychological and social wellbeing of affected individuals. The impact on the families and carers of women with UI may be profound, and the resource implications for the health service considerable.

UI is defined by the International Continence Society as 'the complaint of any involuntary leakage of urine'. UI may occur as a result of a number of abnormalities of function of the lower urinary tract or as a result of other illnesses, which tend to cause leakage in different situations.

  • Stress UI is involuntary urine leakage on effort or exertion or on sneezing or coughing.

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

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

  • Overactive bladder (OAB) is defined as urgency that occurs with or without urgency UI and usually with frequency and nocturia. OAB that occurs with incontinence is known as 'OAB wet'. OAB that occurs without incontinence is known as 'OAB dry'. These combinations of symptoms are suggestive of the urodynamic finding of detrusor overactivity, but can be the result of other forms of urethrovesical dysfunction.

Since the publication of the 2006 guideline, new methods of managing urinary incontinence have become available on the NHS. Botulinum toxin A and sacral nerve stimulation are also now more commonly used for treating OAB symptoms. Synthetic tape procedures have become increasingly popular for the treatment of stress urinary incontinence, and there have been reported improvements in the effectiveness and advances in the types of procedure offered since 2006. Updated guidance is needed to reflect these changes.

New recommendations for 2013 sit alongside the original recommendations from the 2006 guideline. It is important to emphasise that all of the 2006 recommendations are just as relevant and important now as they were when they were originally published.

Urinary incontinence in neurological disease is outside the scope of this guideline but is covered in urinary incontinence in neurological disease (NICE guideline CG148).

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or those with authority to give consent on their behalf) should provide informed consent, which should be documented. See the General Medical Council's Good practice in prescribing medicines – guidance for doctors for further information. Where recommendations have been made for the use of drugs outside their licensed indications ('off‑label use'), these drugs are marked with a footnote in the recommendations.

  • National Institute for Health and Care Excellence (NICE)