Management practices for urinary incontinence in women in the primary care setting: healthcare professionals’ perspectives
Urinary incontinence (UI) is a debilitating condition that affects up to 40% of women in the UK. The National Institute for Health and Care Excellence guidelines and the National Health Service Long Term Plan recommend involving multidisciplinary teams in the management of pelvic floor disorders, and also the adoption of a clear management strategy. The aim of this study was to provide a snapshot of healthcare professionals’ (HCPs’) current knowledge of UI, and the provisions made for the management of the condition in primary care, where women with UI may routinely present. The authors conducted semi-structured interviews with general practitioners, practice nurses and physiotherapists. An interview guide was prepared in advance. The transcripts were analysed using the framework method of analysis in order to identify key themes associated with the management of UI. The findings suggest that it is unusual for women to present with UI as their primary condition, but rather, that this is often mentioned as a side issue. The HCPs interviewed were not aware of any clearly defined local strategies for onward management. It was further suggested that only younger women would benefit from pelvic floor rehabilitation, and there was an overarching belief that physiotherapy was only relevant for this group. Older women were referred for continence advice in the expectation that this would result in pharmaceutical treatment, and/or pads for protection rather than rehabilitation. The recent Independent Medicines and Medical Devices Safety Review highlights the need for all women presenting with UI to be initially offered conservative treatment. The results of this study suggest that important factors in providing this will be ensuring that robust local
management strategies exist, and that HCPs working in primary care receive better education about appropriate treatment protocols.
Keywords: management practices, pelvic floor muscle training, physiotherapy, primary care, urinary incontinence.