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Urinary Incontinence in Women

NICE guideline [NG123] Urinary incontinence and pelvic organ prolapse in women: management. Last updated: Jun 2019. TO BE REVIEWED!

Guidelines

Approach:

1st line: conservative management + bladder retrianing
2nd line: pharmacological management
3rd line: invasive management

Regulate fluid intake
Avoid bladder stimulants
Bladder retraining for 6 weeks

1st line: anti-cholinergic (e.g. oxybutynin, darifenacin, tolterodine)
2nd line: beta-3 receptor agonist (e.g. mirabegon, vibegron)

Common reasons to avoid anti-muscarinics are:

Glaucoma
Patient of old age / at risk of cognitive impairment / with cognitive impairment
Known myasthenia gravis

Options:

Botulinum toxin A injection - if there is proven detrusor overactivity
Percutaneous sacral nerve stimulation
Augmentation cystoplasty
Urinary diversion via ileal conduit

Approach:

1st line: conservative management + pelvic floor muscle training for at least 3 months
2nd line: pharmacological or invasive management

Weight loss
Regulate fluid intake
Avoid bladder stimulants

Pelvic floor muscle training for at least 3 months (at least 8 contractions, 3 times per day)

Consider duloxetine, if patients prefers pharmacological management over invasive management.

Options:

Colposupension
Autologous rectus fascial sling
Retropubic mid-urethral mesh sling

Consider intramural bulking agents if the above are not suitable / acceptable.

References

NICE Urinary incontinence and pelvic organ prolapse in women: management

Author: Adams Lau
Reviewer:
Last edited: 25/04/25

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