24 September 2013

Greater Options for Women with Urinary Incontinence

Women could be offered botox as a treatment option for urinary incontinence if medication has not been effective, according to updated NICE guidance.

Urinary incontinence 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.

New methods of managing urinary incontinence have become available on the NHS since the publication of NICE's 2006 guideline, with botulinum toxin A now more commonly used for treating overactive bladder (OAB) symptoms.

This updated guidance recommends offering bladder wall injection with botulinum toxin A to women with OAB caused by proven detrusor overactivity that has not responded to conservative management, which includes OAB drug therapy.

Other new recommendations include advising healthcare professionals to discuss with women the possible side effects associated with OAB drug treatment and that they may not see the full benefits until they have been taking the treatment for 4 weeks.

NICE recommends that women with OAB or mixed urinary incontinence are offered oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation).

If the first treatment for OAB or mixed urinary incontinence is not effective or well-tolerated, healthcare professionals should consider offering another drug with the lowest acquisition cost. The lowest recommended dose should be offered when starting a new OAB drug treatment.

If a woman's OAB drug treatment is effective and well-tolerated, do not change the dose or drug, says NICE.

The updated guideline contains new recommendations on reviewing OAB drug treatment which states that patients should be offered a review before 4 weeks if the adverse events of OAB drug treatment are intolerable.

Patients should be referred to secondary care if they do not want to try another drug, but would like to consider further treatment.

A further face-to-face or telephone review should be offered if a woman's condition stops responding optimally to treatment after an initial successful 4-week review.

Women who remain on long-term drug treatment for UI or OAB should be reviewed annually in primary care or every 6 months for women over 75.

Dr Julian Spinks, a GP in Medway who was involved in the development of the guideline, said: “Urinary incontinence is more common than people imagine and many women will suffer in silence before going to see their GP.

“The original guideline is now up to date in an accessible and practical format that GPs can use. I welcome the increasingly flexibility around first line mediation which will help GPs to tailor treatment to their patients.”

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, added: “Urinary incontinence is a distressing condition affecting the lives of millions of women of all ages. This updated clinical guideline suggests a range of treatments that women should be able to access to limit the distress that urinary incontinence can cause.”