Female incontinence: Consultations on new treatments
5th February 2013 - Doctors treating women with urinary incontinence are to be given updated clinical guidelines in the light of new treatment options that have been developed over the past few years.
The National Institute for Health and Clinical Excellence (NICE) has published a draft version of the guidance for public consultation.
Urinary incontinence affects an estimated five million women in England and Wales over the age of 20. Types of incontinence include:
- Stress urinary incontinence - which involves urine leakage on effort or exertion or on sneezing, coughing or laughing
- Urge urinary incontinence - involuntary urine leakage accompanied or immediately preceded by urgency
- Mixed urinary incontinence - involuntary urine leakage associated by both exertion and urgency
- Overactive bladder syndrome (OAB) - where urgency to pass urine occurs with or without urge urinary incontinence, and usually with frequency
NICE says it last published guidance to health professionals on treating urinary incontinence in 2006 but that new developments mean some of the recommendations need updating.
The draft guidance says that women with overactive bladder syndrome or mixed urinary incontinence should be offered immediate release types of antimuscarinic drugs - medications that inhibit certain nerve impulses - as a first line treatment. Examples of these drugs are oxybutynin, tolterodine or propiverine.
In cases where treatment is not successful, patients should be offered trospium, oxybutynin, tolterodine or darifenacin (extended release) as a second line treatment to attempt to control the symptoms.
Women with overactive bladder syndrome who have not responded to usual treatment should be offered bladder wall injections using botulinum toxin (Botox).
This treatment should only be carried out after health professionals have discussed the risks and benefits with patients.
Women with stress urinary incontinence who have not responded to usual treatments should be offered a procedure using a synthetic mid-urethral tape - a kind of sling which supports the urethra.
These may come in the form of a tension free vaginal tape (TVT) or a tension free vaginal tape obturator (TVTO).
The NICE draft guidance also recommends that any woman embarking on a new treatment for urinary incontinence should have her treatment and progress reviewed after four weeks.
Also, before any invasive or surgical procedures are carried out, a patient should be examined by a multidisciplinary team including, at a minimum, a specialist surgeon, specialist nurse and a specialist physiotherapist.
Professor Mark Baker, director of the Centre for Clinical Practice at NICE, says in a statement: "Urinary incontinence is a distressing condition affecting the lives of millions of women of all ages. While rarely life-threatening, urinary incontinence may seriously influence the physical, psychological and social wellbeing of affected individuals.
"Over the years we have seen an increase in women needing treatment, yet many are still suffering in silence and not receiving the appropriate care for their condition.
"This draft updated clinical guideline suggests a range of treatments that women should be able to access to limit the distress that urinary incontinence can cause. These new recommendations will, when published, sit alongside the original 2006 guideline to provide women with high quality up-to-date care and support."
Consultation on the draft guidelines will run until 19th March 2013.
Information and support charity The Bladder and Bowel Foundation says it backs the draft guidelines. Debbie Stuart, clinical manager, tells us: "The Bladder and Bowel Foundation believes that raising awareness and promoting best practice amongst all health professionals is the key to improved continence care."