Introduction

This quality standard covers the management of urinary incontinence in women aged 18 years and over. It does not cover urinary incontinence in women with neurological disease. For more information see the urinary incontinence in women overview.

Why this quality standard is needed

Urinary incontinence is the involuntary leakage of urine. It may result from a number of abnormalities of function of the lower urinary tract or from other conditions, which tend to cause leakage in different situations:

  • Stress incontinence is the involuntary leakage of urine on effort, exertion, sneezing or coughing.

  • Urgency incontinence is the involuntary leakage of urine with or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to delay).

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

  • Overactive bladder (OAB) is defined as urgency with or without urgency incontinence and usually with frequency and nocturia. When it occurs with incontinence it is known as 'OAB wet'; when it occurs without incontinence it is known as 'OAB dry'. These combinations of symptoms suggest detrusor muscle overactivity, but can result from other forms of urethrovesical dysfunction.

Urinary incontinence is an embarrassing problem for many women. It may be significantly underreported because they are too embarrassed to seek advice, they do not wish to bother their GP; they believe urinary incontinence is normal in older women or they do not know that treatments are available.

Studies have shown that urinary incontinence affects one‑third of women, with the prevalence increasing with age. Data also show that slight to moderate incontinence is more common in younger women, with moderate and severe incontinence mostly affecting older women.

The management of urinary incontinence can be conservative, pharmacological or surgical. Conservative management refers to therapies such as lifestyle interventions and physical, behavioural and non‑therapeutic interventions (such as products that collect or contain leakage).

Pharmacological treatment includes drugs with antimuscarinic action, mirabegron, desmopressin, duloxetine and oestrogens.

When conservative management and pharmacological treatment have not adequately treated the symptoms associated with overactive bladder or stress urinary incontinence, surgery or other invasive treatment may be considered.

The quality standard is expected to contribute to improvements in the following outcomes:

  • quality of life for women with urinary incontinence

  • experience of care for women with urinary incontinence.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2014–15

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measurer

1A Social care‑related quality of life*

Aligning across the health and care system

* Indicator shared with NHS Outcomes Framework (NHSOF)

Table 2 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions*

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Alignment across the health and social care system

* Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to urinary incontinence in women.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development source(s) for quality standards that impact on patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for urinary incontinence in women specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole continence care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to women with urinary incontinence.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality continence service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating women with urinary incontinence should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting women with urinary incontinence. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.