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Urinary incontinence (female)

Urinary incontinence (female) – Adult

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Unexplained acute onset urinary incontinence suspected as part of acute, or acute-on-chronic urinary retention (patient in discomfort/pain and unable to void)

Immediately contact the on-call registrar or service to arrange an immediate urology assessment (seen within 7 days) for:

  • Nil

To contact the relevant service, please see HealthPathways: Acute Urology Assessment

Presenting issues
  • Urge, stress or mixed or continued urinary incontinence and/or other Lower Urinary Tract Symptoms (LUTS)
Mandatory referral information (referral will be returned if this information is not included)

History

  • Details of previous treatment and outcome (e.g. anticholinergics such as oxybutynin or solefenicin / beta-3 agonists such as mirabegron)
  • History or risk for bladder tumours and presence/absence of haematuria
  • Evidence of Pelvic Floor Training Exercises (PFTE) referral and results

Note: Unless suffering continuous incontinence and/or incomplete bladder emptying, women should have completed a 3-month period of PTFE and received continence service advice before referral to Urology.

Investigations

  • MSU M/C/S
  • Urinary tract USS including post-void residual

If unable to attach reports, please include relevant information/findings in the body of the referral   

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)  
Highly desirable referral information
  • Bladder diary (time and volume)
  • STI screening
  • FBC including BGL/HbA1c
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Suspected malignant mass
  • Urinary retention
  • Visible haematuria and/or sterile pyuria
  • Elevated post-void residuals and hydronephrosis on USS (obstructive uropathy)
  • Known or suspected neurogenic bladder
  • Suspected urogenital fistulae
Category 2
Appointment within 90 days
  • Incontinence requiring multiple (>3) pad changes per day (despite 3 months of pelvic floor training exercises (PFTE)) and any of the following:
    • Nocturnal incontinence
    • Recurrent symptomatic (> 3 per year) or persistent microbiologically confirmed UTI (organisms cultured in urine despite 3 courses of oral antibiotics administered based on sensitivities)
    • Persisting bladder or urethral or perineal pain
    • Socially limiting
    • Inadequate response (persisting symptoms) to physiotherapy/continence nurse management
    • Inadequate response (persisting symptoms) to anti-cholinergic and beta3 adrenergic agonist therapy
Category 3
Appointment within 365 days
  • Incontinence requiring 1-2 pad changes per day (despite 3 months of PFTE) and any of the following:
    • Nocturnal incontinence
    • Persisting (not responding to simple analgesia) bladder or urethral or perineal pain
    • Recurrent (> 3 per year) or persistent UTI (as defined above)
    • Socially limiting (severe)
    • Inadequate response to physiotherapy/continence nurse management
    • Inadequate response to anti-cholinergic and beta3 adrenergic agonist therapy
Excluded urology services

Referral to public adult urology outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Moderate to severe organ prolapse
  • Refer to gynaecology
 Urinary incontinence

Excluded condition for the following:

  • Patients who have not yet tried and failed conservative treatments. These may include: Tamsulosin / Duodart / anticholinergics, physiotherapy for Pelvic Floor Training Exercises (PFTE)
  • See HealthPathways: Adult Urinary Incontinence
Last reviewed: 05-01-2024
wa.gov.au