All women should be screened annually for urinary incontinence, according to new guidelines from the Women's Preventive Services Initiative (WPSI). Screening should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. If treatment is indicated, women should be referred for further evaluation. The clinical guideline and evidence review are published in Annals of Internal Medicine.
Urinary incontinence, or the involuntary loss of urine, affects an estimated 51 percent of women overall and can adversely affect a woman's physical, functional, and social well-being. However, many women are reluctant to discuss urinary incontinence with their health care providers, so they may endure symptoms for a long time before the issue is addressed. Urinary incontinence is often never recognized by health care providers.
Researchers from Oregon Health and Science University conducted a systematic review of published studies to evaluate whether screening for urinary incontinence in women not previously diagnosed improved physical and functional outcomes. They also assessed studies on the accuracy of screening methods and potential harms. The researchers found that no studies evaluated the overall effectiveness or harms of screening. Limited evidence suggested that some screening methods (brief questionnaires) had fairly high accuracy for identifying symptoms of urinary incontinence in primary care settings.
Despite the lack of direct evidence, the WPSI asserts that screening has the potential to identify urinary incontinence in many women who silently experience its adverse effects. Because early intervention may reduce symptom progression, improve quality of life, and limit the need for more complex and costly treatment, the WPSI recommends annual screening for women of all ages.
The authors of an accompanying editorial from the Women's Health Research Program at Monash University in Melbourne, Victoria, Australia argue that applying a screening test to a large population is a very serious responsibility and should be implemented with caution. The authors suggest advocating for a randomized trial to directly assess the benefits and harms of urinary incontinence screening in women before recommending it for all.
Guideline (Free): http://annals.org/aim/article/doi/10.7326/M18-0595
Journal information: Annals of Internal Medicine
Provided by American College of Physicians