Female urinary incontinence — the role of the general practitioner

Abstract

Subject. Urinary incontinence is a frequent disorder among adult females, but very few of the incontinent women have consulted a doctor. Discussion. This paper reviews and discusses the possible roles of the general practitioner in the diagnostic and therapeutic work with women with urinary incontinence. Some characteristics of general practice and the selection process from primary care to the specialist level are described. The selection process (gatekeeper function) of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice. Recommendations and guidelines for diagnosis or therapy developed at secondary or tertiary care levels may be inappropriate at the primary care level, with a significantly different clinical picture of this condition. Results. Several studies show that most women seeking help in general practice can be satisfactorily treated at this level of care with fairly simple treatments, and that treatment is effective also in the long term. Some women with urinary incontinence need to be referred primarily to a specialist, or later if the response to treatment is disappointing. Recommendations. Based on literature studies and the authors' own experiences from clinical work and research, recommendations are presented for a basic evaluation and treatment of women with urinary incontinence who seek help in general practice.