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REVIEW ARTICLE
The following phrases are used to classify diagnostic tests . Previous conservative, medical and surgical treatment in
and studies: particular, as they affect the genitourinary tract and lower
. A highly recommended test is a test that should be done on bowel. The effectiveness and side effects of treatments
every patient. should be noted.
. A recommended test is a test of proven value in the . Coexisting diseases may have a profound effect on incon-
evaluation of most patients and its use is strongly tinence and prolapse sufferers, for example asthma patients
encouraged during initial evaluation. with stress incontinence will suffer greatly during attacks.
. An optional test is a test of proven value in the evaluation of Diseases may also precipitate incontinence, particularly in
selected patients; its use is left to the clinical judgment of frail older persons.
the physician. . Patient medication: it is always important to review every
. A not recommended test is a test of no proven value. patient’s medication and to make an assessment as to
whether current treatment may be contributing to the
patient’s condition.
This section primarily discusses the Evaluation of Urinary . Obstetric and menstrual history.
Incontinence with or without Pelvic Organ Prolapse (POP) and . Physical impairment: individuals who have compromised
Anal Incontinence. mobility, dexterity, or visual acuity may need to be managed
The recommendations are intended to apply to children differently.
and adults, including healthy persons over the age of 65.
These conditions are highly prevalent but often not
reported by patients. Therefore, the Consultation strongly Social History:
recommends case finding, particularly in high-risk groups. . Environmental issues: these may include the social, cultural
and physical environment.
Highly Recommended Tests During Initial Evaluation . Lifestyle: including exercise, smoking and the amount and
type of food/fluid intake.
The main recommendations for this consultation have been
abstracted from the extensive work of the 23 committees of
the 4th International Consultation on Incontinence (ICI, 2008). Other Treatment Planning Issues:
Each committee has written a report that reviews and
evaluates the published scientific work in each field of interest . Desire for treatment and the extent of treatment that is
in order to give Evidence Based recommendations. Each report acceptable.
ends with detailed recommendations and suggestions for a . Patient goals and expectations of treatment.
program of research. . Patient support systems (including carers).
. Cognitive function: all individuals need to be assessed for
their ability to fully describe their symptoms, symptom
a
To date, these definitions are not included in the current ICS terminology. bother and quality of life impact, and their preferences and
Further symptom and health-related QoL assessment. In . When initial testing suggest other pathologies, for example,
patients with urinary symptoms the use of a simple frequency hematuria.
- The algorithms for initial management are intended for use Use of Continence Products
by all clinicians including health care assistants, nurses, The possible role of continence products should be considered
physiotherapists, generalist doctors and family doctors as at each stage of patient assessment, treatment and, if treatment
well as by specialists such as urologists and gynecologists. is not (fully) successful, subsequent management.
The consultation has attempted to phrase the recommenda-
tions in the basic algorithms in such a way that they may be . Firstly, intermittent catheterization or indwelling catheter
readily used by clinicians in all countries of the world, both drainage often have a role to play in addressing urinary
in the developing and the developed world. retention.
- The specialized algorithms are intended for use by specialists. . Secondly, assisted toileting using such devices as commodes,
The specialized algorithms, as well as the initial manage- bedpans, and handheld urinals may help to achieve dependent
ment algorithms are based on evidence where possible and continenceb where access, mobility and/or urgency problems
on the expert opinion of the 600 healthcare professionals undermine a patient’s ability to maintain independent
who took part in the Consultation. In this consultation, continence(see footnote b), be it urinary and/or fecal.
committees ascribed level of evidence to the published work . Finally, containment products (to achieve contained incon-
on the subject and devised grades of recommendation to tinenceb) for urine and/or feces find an essential role in
inform patient management. enhancing the quality of life of those who:
It should be noted that these algorithms, dated December - Elect not to pursue treatment options.
2008, represent the Consultation consensus at that time. Our - Are awaiting treatment.
knowledge, developing from both a research base and because - Are waiting for treatment to take effect.
of evolving expert opinion, will inevitably change with time. - Are unable to be (fully) cured.
The Consultation does not wish those using the algorithms to
believe they are ‘‘carved in tablets of stone’’: there will be Further guidance and care algorithms on which products
changes both in the relatively short term and the long term. might be suitable for a given patient are given in Chapter 20.
Essential components of basic assessment
CHILDREN
Each algorithm contains a core of recommendations in
addition to a number of essential components of basic Initial management Children produce specific management
assessment listed in sections I–III. problems for a variety of reasons: assessment requires help
from their parents and carers; consent to treatment may be
problematic; and cooperation in both assessment and
. General assessment.
treatment may be difficult (Fig. 1).
. Symptom assessment.
. Assessment of quality of life impact. Initial assessment should involve a detailed investigation of
. Assessment of the desire for treatment. voiding and bowel habits using a micturition diary and
. Physical examination.
structured questionnaires The child’s social environment and
. Urinalysis.
the child’s general and behavioral development should also be
formally assessed and recorded. Physical examination should
Joint decision making be done to detect a palpable bladder and exclude anatomic
The patient’s desires and goals for treatment: Treatment is and neurogenic causes. Urine analysis and culture is sufficient
a matter for discussion and joint decision making between the to exclude the presence of infection. If possible, the child
patient and his or her health care advisors. This process of should be observed voiding.
consultation includes the specific need to assess whether or Referrals for specialist treatment are recommended for a
not the sufferer of incontinence wishes to receive treatment group of children who have complicated incontinence asso-
and, if so, what treatments he or she would favor. Implicit in ciated with:
this statement is the assumption that the health care provider . recurrent urinary infection;
will give an appropriate explanation of the patient’s problem . voiding symptoms or evidence of poor bladder emptying;
and the alternative lines of management, and the indications . urinary tract anomalies;
and the risks of treatment. The assumption that patients . previous pelvic surgery;
almost always wish to have treatment is flawed, and the need . neuropathy.
to consult the patient is paramount.
In each algorithm, treatments are listed in order of b
Useful terms suggested by Fonda & Abrams (Cure sometimes, help always—a
simplicity, the least invasive being listed first. This order does ‘‘continence paradigm’’ for all ages and conditions. Fonda D and Abrams P,
not imply a scale of efficacy or cost, two factors which need to Neurology & Urodynamics 25: 290–292, 2006).
Initial treatment is recommended for the remaining - antimuscarinics may be used if there are symptoms that
patients who have: suggest detrusor overactivity (Grade C).
. Nocturnal enuresis without other symptoms (mono-symp-
tomatic enuresis). Should initial treatment be unsuccessful for either enuresis
. Daytime symptoms of frequency, urgency, urgency incon- or daytime symptoms, then after a reasonable period of time
tinence with or without night-time wetting. (8–12 weeks), referral for a specialist’s advice is highly
recommended.
Treatment
Specialized management Two groups of children with
. Initial treatment for mono-symptomatic nocturnal enuresis ‘‘complicated’’ incontinence should have specialist management
should include: from the outset (Fig. 2).
- parental counseling and motivation;
- a choice between either alarm (Grade A) and anti-diuretic . Children whose incontinence is due to, or associated with,
hormone analogues desmopressin (Grade A).c It may be a urinary tract anomalies and neuropathy.
parental choice if advantages and disadvantages are well . Children without urinary tract anomalies, but with recur-
explained. rent infection and, proven or suspected, voiding dysfunction.
. Daytime incontinence should be managed holistically Those children who failed the basic treatment, but who
including: have neither Neurogenic nor anatomical problems, should
- counseling, bladder training (timed voiding), behavior also receive specialist management.
modification and bowel management when necessary Assessment. As part of further assessment, the measure-
(Grade B); ment of urine flow (in children old enough), together with the
ultrasound estimate of residual urine and the upper urinary
tracts is highly recommended.
c Those who fail treatment and have neither neurogenic nor
A regulatory warning exists for the danger of overhydration in children on
desmopressin. anatomical problems should be reassessed using micturition
charts, symptom scores, urinalysis, Uroflowmetry and resid- and severity of the problem (please see Children’s Committee
ual urine determination. Report).
If there are recurrent infections, upper tract imaging and Care should be given by specialist children’s nurses and
possibly a VCUG should be considered. However, endoscopy is therapists.
rarely indicated. Initial treatment should be non-surgical.
Urodynamics should be considered:
. For stress urinary incontinence (SUI): pelvic floor muscle
. If the type and severity of lower tract dysfunction cannot be training (Grade C).
explained by clinical findings. . For suspected detrusor overactivity (DO): bladder training
. If invasive treatment is under consideration, for example, and antimuscarinics (Grade C).
stress incontinence surgery, if there is sphincteric incom- . For voiding dysfunction: timed voiding, biofeedback to teach
petence, or bladder augmentation if there is detrusor pelvic floor relaxation, intermittent catheterization (when
overactivity. PVR >30% of bladder capacity) (Grade B/C).
. If upper tract dilatation exists and is thought to be due to . For bowel dysfunction: as appropriate.
bladder dysfunction.
The child’s progress should be assessed and, if quality of life
Urodynamic studies are not recommended if the child has is still significantly impaired, or if the upper urinary tracts are
normal upper tract imaging and is to be treated by non- at risk, surgical treatment is likely to be necessary.
invasive means. If surgical treatment is required, then urodynamics is
Spinal Imaging (US/X-ray/MRI) may be needed if a bony recommended to confirm the diagnosis.
abnormality or neurological condition is suspected.
. For SUI, sling surgery, bulking agent injection and AUS may
Treatment. The treatment of incontinence associated with
be considered.
urinary tract anomalies is complex and cannot easily be dealt
. For DO/poor compliance, botulinum toxind and bladder
with in an algorithm. In many children, more than one
augmentation may be performed.
pathophysiology demands treatment. If there are complex
congenital abnormalities present, the treatment is mostly d
At the time of writing, botulinum toxin is being used ‘‘off label’’ for refractory
surgical and it should be individualized according to the type DO and must be used with caution.
Specialized management. The specialist may first reinstitute (Grade B). Botulinum toxin continues to show promise in
initial management if it is felt that previous therapy had been the treatment of symptomatic detrusor overactivity unre-
inadequate (Fig. 4). sponsive to other therapies.e
- When incontinence has been shown to be associated with
Assessment poor bladder emptying and detrusor underactivity, it is
recommended that effective means are used to ensure
- Patients with ‘‘complicated’’ incontinence referred directly to bladder emptying, for example, intermittent catheterization
specialized management, are likely to require additional (Grade B/C).
testing, cytology, cystourethoscopy and urinary tract imaging. - If incontinence is associated with bladder outlet obstruction,
then consideration should be given to surgical treatment to
If these tests prove normal then those individuals can be relieve obstruction (Grade B). a-blockers and/or 5alpha
treated for incontinence by the initial or specialized manage- reductase inhibitors would be an optional treatment . There
ment options as appropriate. is increased evidence for the safety of antimuscarinics for
If symptoms suggestive of detrusor overactivity, or of overactive bladder symptoms in men, chiefly in combination
sphincter incompetence persist, then urodynamic studies are with an a-blocker (Grade B).
recommended in order to arrive at a precise diagnosis, prior to
invasive treatment.
Women
Treatment
Initial management
When initial management has failed and if the patient’s
incontinence markedly disrupts his quality of life then Initial assessment should identify
invasive therapies should be considered. . ‘‘Complicated’’ incontinence group.
- For sphincter incompetence the recommended option is the Those with pain or hematuria, recurrent infections, sus-
artificial urinary sphincter (Grade B). Other options, such as a pected or proven voiding problems, significant pelvic organ
male sling, may be considered (Grade C). prolapse or who have persistent incontinence or recurrent
- For idiopathic detrusor overactivity (with intractible over- incontinence after pelvic irradiation, radical pelvic surgery,
active bladder symptoms) the recommended therapies are
bladder augmentation (Grade C) and neuromodulation e
At the time of writing, botulinum toxin is being used ‘‘off-label.’’
previous incontinence surgery, or who have a suspected . Supervised pelvic floor muscle training (Grade A),
fistula (Fig. 5). vaginal cones for women with stress incontinence
(Grade B).
. Three other main groups of patients should be identified by . Supervised bladder training (Grade A) for OAB.
initial assessment. . If oestrogen deficiency and/or UTI is found, the patient
- Women with stress incontinence on physical activity. should be treated at initial assessment and then reassessed
- Women with urgency, frequency with or without urgency after a suitable interval (Grade B).
incontinence. . Antimuscarinics for OAB symptoms with or without
- Those women with mixed urgency and stress incontinence. urgency incontinence (Grade A); duloxetinef may be consid-
ered for stress urinary incontinence (Grade B).
Abdominal, pelvic and perineal examinations should be a
routine part of physical examination. Women should be asked Initial treatment should be maintained for 8–12 weeks
to perform a ‘‘stress test’’ (cough and strain to detect leakage before reassessment and possible specialist referral for further
likely to be due to sphincter incompetence). Any pelvic organ management if the patient has had insufficient improvement.
prolapse or uro-genital atrophy should be assessed. Vaginal or Clinicians are likely to wish to treat the most bothersome
rectal examination allows the assessment of voluntary pelvic symptom first in women with symptoms of mixed incon-
floor muscle function, an important step prior to the teaching tinence (Grade C).
of pelvic floor muscle training. Some women with significant pelvic organ prolapse can be
treated by vaginal devices that treat both incontinence and
Treatment. For women with stress, urgency or mixed prolapse (incontinence rings and dishes).
urinary incontinence, initial treatment should include appro-
priate lifestyle advice, physical therapies, scheduled voiding
regimes, behavioral therapies and medication. In particular:
f
Duloxetine is not approved for use in United States. It is approved for use in
Europe for severe stress incontinence (see committee report on pharmacological
. Advice on caffeine reduction (Grade B) and weight reduction management for information regarding efficacy, adverse events, and ‘‘black box’’
(Grade A). warning by the Food and Drug Administration of the United States).
Treatment
- If urodynamic stress incontinence is confirmed then the g
At the time of writing, botulinum toxin is being used ‘‘off-label’’ and with
treatment options that are recommended for patients with caution.
Management
Fig. 8. Management of pelvic organ prolapse (including urogenital prolapse, and recta prolapse).
. Pelvic floor muscle training may: . Patients with known neurologic disease often need evalua-
tion to exclude neurologic bladder, not only if symptoms
- reduce the symptoms of urogenital prolapse (Grade B), occur, but as a standard diagnostic approach if neurogenic
although topographic change is not expected; bladder has a high prevalence in this disease (for prevalence
- prevent or slow deterioration of anterior urogenital prolapse figures see chapter).
(Grade B). . A possible neurologic cause of ‘‘idiopathic’’ incontinence
should always be considered. Diagnostic steps to evaluate
. Pessaries, when successfully fitted, may improve protrusion this include basic assessments, such as history and physical
symptoms (Grade B). Regular follow up is mandatory. examination, urodynamics and specialized tests.
Support pessaries that concurrently treat stress inconti- . Incontinence in neurologic patients does not necessarily
nence should be considered when appropriate. relate to the neurologic pathology. Other diseases such as
. Local oestrogens may benefit hypoestrogenic women for the prostate pathology, pelvic organ prolapse, etc. might have an
prevention and/or treatment of vaginal epithelial ulceration influence. These have to be ruled out.
(Grade C). . Extensive diagnostic workout seems useful and necessary
. Reconstructive surgery should aim to optimize anatomy and only to tailor an individual treatment based on complete
function (see full text for grades of recommendation for neurofunctional data. This may not be needed in every
specific surgical techniques). Pre- and postoperative pelvic patient, for example, patients with suprapontine lesions or
floor muscle training may promote quality of life and fewer in patients where treatment will consist merely of bladder
symptoms after surgery for urogenital prolapse (Grade C). drainage due to bad medical condition or limited life
. Obliterative surgery is reserved for selected women who expectancy.
agree to permanent vaginal closure (Grade B). . There is often a need to manage bladder and bowel
together
Neurogenic Urinary Incontinence
II. Initial assessment:
Initial management.
. The management of neurologic urinary incontinence
I. Strong general recommendations (Fig. 9): depends on an understanding of the likely mechanisms
producing incontinence. This can in turn depend on the site Specialized management
and extent of the nervous system abnormality.
Assessment
. Therefore neurogenic incontinence patients can be divided
into those having peripheral lesions (as after major pelvic . Most patients with neurogenic urinary incontinence require
surgery) including those with lesions of the lowest part of specialized assessment urodynamic studies are mandatory
the spinal cord (e.g., lumbar disc prolapse); central lesions with videourodynamics if available (Fig. 10).
below the pons (suprasacral infrapontine spinal cord . Upper tract imaging is needed in most patients and more
lesions); central lesions above the pons (cerebrovascular detailed renal function studies will be desirable if the upper
accidents, stroke, Parkinson’s disease). tract is considered in danger: high LUT pressure, UUT
. History and physical examination are important in helping dilatation, recurrent or chronic upper tract infection, (major)
distinguish these groups. stones, (major) reflux.
. In patients with peripheral lesions clinical neurophysiologi-
III. Initial treatment cal testing may be helpful for better definition of the lesion.
. Patients with peripheral nerve lesions (e.g., denervation
after pelvic surgery) and patients with suprasacral infra- Treatment. Also for specialized management conservative
pontine spinal cord lesions (e.g., traumatic spinal cord treatment is the mainstay (A) Management of neurogenic
lesions) should get specialized management (A). urinary incontinence has several therapeutic options. The
. Initial treatment for patients with incontinence due to algorithm details the recommended options for different
suprapontine pathology, like stroke, need to be assessed for types of neurologic dysfunction of the lower urinary tract.
degree of mobility and ability to cooperate. Initial recom- The dysfunction does not necessarily correspond to one type/
mended treatments are behavioral therapy (C) and bladder level of neurologic lesion but must depend mostly on
relaxant drugs for presumed detrusor overactivity (A). urodynamic findings. One should always ascertain that the
Appliances (B) or catheters (C) may be necessary for non- patient’s management is urodynamically safe (low pressure,
cooperative or less mobile patients. complete emptying).
History and symptom assessment resistance and severe adverse effects, for example, Clostri-
dium difficile colitis (Grade C).
. Active case finding and screening for UI should be done in all . Utility of clinical stress test in this population is uncertain
frail older persons (Grade A). History should include (Grade D).
comorbid conditions and medications that could cause or . Wet checks can assess UI frequency in long-term care
worsen UI. The physical should include rectal exam for fecal residents (Grade C).
loading or impaction (Grade C), functional assessment
(mobility, transfers, manual dexterity, ability to toilet)
(Grade A), screening test for depression (Grade B), and PostVoiding Residual volume (PVR) testing is impractical in
cognitive assessment (to assist in planning management, many care settings, and there is no consensus for the
Grade C). The mnemonic DIAPPERS (see algorithm) covers definition of ‘‘high’’ PVR in any population. Yet, there is
some of these comorbid factors, with two alterations: (1) compelling clinical experience for PVR testing in selected frail
atrophic vaginitis does not itself cause UI and should not be older persons with: diabetes mellitus (especially longstand-
treated for this purpose (Grade B); and (2) current consensus ing), prior urinary retention or high PVR; recurrent UTIs;
diagnostic criteria for urinary tract infection (UTI) are poorly medications that impair bladder emptying (e.g., opiates);
sensitive and specific in nursing home residents. severe constipation; persistent or worsening urgency UI
. The patient and/or carer should be asked about the degree of despite antimuscarinic treatment; or prior urodynamics
bother of UI (Grade B), goals for UI care (dryness, decrease in showing detrusor underactivity and/or bladder outlet obstruc-
specific symptom[s], quality of life, reduction of comorbid- tion (Grade C). Treatment of contributing comorbity may
ity, lesser care burden) (Grade B), likely cooperation with reduce PVR. Trial with catheter may be considered for
management (Grade C), and the patient’s overall prognosis PVR > 200–500 ml if the PVR is felt to contribute to UI or
and remaining life expectancy (Grade C). frequency (Grade C).
. Urinalysis is recommended for all patients, primarily to Nocturia Assessment of frail elders with bothersome
screen for hematuria (Grade C); treatment of otherwise nocturia should identify potential underlying cause(s) includ-
asymptomatic bacteriuria/pyuria is not beneficial (Grade D), ing nocturnal polyuria (by bladder diary [frequency-volume
and it may cause harm by increasing the risk of antibiotic chart] or wet checks; oedema on exam) (Grade C) and primary
Fecal Incontinence
Initial assessment
. History taking: this includes
. Physical examination:
- Cognitive functions; motor, sensory and sacral reflexes—
voluntary anal sphincter contraction, deep perianal sensa-
tion, anal tone, anal and bulbo-cavernosus reflexes.
- Spasticity of the lower limbs.
- Abdominal palpation for fecal loading and rectal examination.
unsuccessful to look for comorbidity and certainly before - Artificial sphincter (C).
performing invasive treatment (Fig. 16). - Sacral Anterior Root Stimulation SARS (C).
. Do not assume that all symptoms are due to neuropathy, for - Botulinum Toxine (C).
example, women with neurologic pathology might have had - Neuromodulation (C).
childbirth injury to the sphincter.
. Special investigations: manometry, endoanal ultrasound, . It is recommended to look at urinary and bowel function
(dynamic) MRI, (needle) EMG. together if both systems are affected, as symptoms and
. These specific bowel functional tests and electrodiagnostic treatment of one system can influence the other and vice
tests must be considered optional as their value in neuro- versa (A).
logic pathology is not sufficiently demonstrated so far.
As therapeutical approach can differ in different neuro-
Treatment
logical diseases, the most prevalent diseases are discussed
. Also for specialized management conservative treatment for separately in chapter.
neurogenic fecal incontinence is the mainstay.
Management of neurogenic incontinence does not include RECOMMENDATIONS FOR CONTINENCE PROMOTION,
very extensive treatment modalities and many conservative EDUCATION, AND PRIMARY PREVENTION
are still empirical. Continence promotion, education and primary prevention
- Transanal irrigation (C). involves informing and educating the public and health care
- Electrical stimulation sphincter (C). professionals that urinary incontinence and fecal inconti-
- Percutaneous neuromodulation: further research needed. nence are not inevitable, but are treatable or at least
manageable. In addition, other bladder disorders such as
. Surgical management of neurogenic fecal incontinence has bladder pain syndrome and pelvic organ prolapse can be
different options which need a very strict patient selection. treated successfully. Progress has been made in the promotion
of continence awareness through advocacy programs, organ-
- Antegrade Continence Enema ACE (C). ization of the delivery of care, and public access to information
- Graciloplasty (C). on a worldwide basis. These have also been advocated in the
education of professionals and primary prevention of mainly . There is a need for research on the most effective means to
urinary incontinence However, not much has changed in help- educate the public and professional groups on continence
seeking behavior for these disorders. This chapter updates issues (Grade D).
previous International Consultation on Incontinence (ICI)
chapters on three areas: continence promotion, education
Continence Advocacy
and primary prevention and the following are the recom-
mendations in these individual areas. . Government support and co-operation are needed to
develop services, and responsibility for this should be
identified at a high level in each Health Ministry. Incon-
Continence Awareness and Promotion tinence should be identified as a separate issue on the health
care agenda. There is a need for funding as a discrete item
. Continence awareness should be included in any and for funding, not to be linked to any one patient
national advocacy program that is working towards an group (e.g., elderly or disabled), and should be mandatory
effective health literacy system, as it is consistent with (Grade D).
and requires the involvement of many levels of . No single model for continence services can be recom-
educational, health-care, and community service providers mended. Because of the magnitude of UI prevalence,
(Grade D). detection and basic assessment will need to be performed
. Continence awareness should be part of the main stream by primary care providers. Specialist consultation should
and on-going health education and advocacy programs with generally be reserved for those patients where appropriate
emphasis on eliminating stigma, promoting disclosure and conservative treatments have failed, or for specified indica-
help-seeking behavior and improving quality of life tions (Grade D).
(Grade D). . There is a need for research on patient-focused outcomes,
. There is a need for research to provide higher level of should include evaluation of the outcomes for all sufferers
evidence on the effectiveness of continence promotion who present for care, use validated audit tools/outcome
programs to increase awareness, be it for primary preven- measures and longitudinal studies of the outcomes of
tion, treatment or management (Grade D). services provided (Grade D).
. We support the NIH statement (http://grants.nih. . Research is needed to define the epidemiology of nocturia
gov/grants/guide/notice-files/not98-024.html) calling for and how the symptom relates to normal aging.
increased clinical research in children. All investigators that . Clinical research in treatment of nocturia should begin with
work with children should be aware of the details of the classification of patients by voiding diary categories, 24 hr
document. polyuria, nocturnal polyuria, and apparent bladder storage
. Long-term follow-up is of critical importance in the pediatric disorders. If desired, patients with low bladder capacity can
population with a primary focus of establishing safety of be further divided into those with sleep disturbances and
chronic treatments. those with primary lower urinary tract dysfunction.
Fig. 17. ICIQ-UI urinary incontinence questionnaire (short form) . Fig. 18. Fully validated ICIQ modules and derivation.
Bladder Diaries
of the tests we do, so that we can try to improve your
. the information above, but also symptoms. On the chart you need to record:
. assessments of urgency,
. degree of leakage (slight, moderate or large) and descriptions (1) When you get out of bed in the morning, show this on the
of factors leading to symptoms such as stress leakage, for diary by writing ‘‘GOT OUT OF BED.’’
example, running to catch a bus It is important to assess the (2) The time, for example, 7.30 am, when you pass your urine.
individual’s fluid intake, remembering that fluid intake Do this every time you pass urine throughout the day and
includes fluids drunk plus the water content of foods eaten. also at night if you have to get up to pass urine.
It is often necessary to explain to a patient with LUTS that it (3) If you leak urine, show this by writing a ‘‘W’’ (wet) on the
may be important to change the timing of a meal and the diary at the time you leaked.
type of food eaten, particularly in the evenings, in order to (4) When you go to bed at the end of the day show it on the
avoid troublesome nocturia. diary—write ‘‘WENT TO BED.’’
The micturition time and frequency volumes charts can be
collected on a single sheet of paper (Fig. 1). In each chart/diary, Instructions for Using the Frequency Volume Chart
the time the individual got out of bed in the morning and
the time they went to bed at night should be clearly indicated. This chart helps you and us to understand why you get
Each chart/diary must be accompanied by clear instruc- trouble with your bladder. The diary is a very important part
tions for the individual who will complete the chart/diary: the of the tests we do, so that we can try to improve your
language used must be simple as in the suggestions given for symptoms. On the chart you need to record:
patient instructions. There are a variety of designs of charts
(1) When you get out of bed in the morning, show this on the
and diaries and examples of a detailed bladder diary are given.
chart by writing ‘‘Got out of bed.’’
The number of days will vary from a single day up to 1 week.
(2) The time, for example, 7.30 am when you pass your urine.
Do this every time you pass urine throughout the day and
Instructions for Completing the Micturition Time Chart
also at night if you have to get up to pass urine.
This chart helps you and us to understand why you get (3) Each time you pass urine, collect the urine in a measuring
trouble with your bladder. The diary is a very important part jug and record the amount (in ml or fluid oz) next to