Key Points for Practice
•The WPSI recommends screening women for urinary incontinence annually based on low-quality evidence.
•Women with a positive screening result should be referred for further evaluation and treatment.
From the AFP Editors
Editor's Note: This recommendation to screen women for urinary incontinence belies the lack of evidence supporting its benefit. Only a thin logical thread exists, based on indirect evidence, linking early identification to any possible benefit in women not expressing concern. There is little consideration of the harms of early identification, such as labeling and exposure to the risks of further tests and possible treatments. The accuracy of current screening tools is low, and there is no research pointing to benefit of screening on health, function, or quality of life.—Allen F. Shaughnessy, PharmD, AFP Assistant Medical Editor
Urinary incontinence adversely affects health, quality of life, and function for most women at some point in their lives. However, it is underreported because of embarrassment, stigma, or acceptance as normal. Early intervention may reduce progression, improve quality of life, and limit the need for complex and costly treatment.
The Women's Preventive Services Initiative (WPSI) is a national coalition of 21 health professional organizations and patient representatives. It is supported by the Health Resources and Ser vices Administration (HRSA) with the intention to guide coverage of services for HRSA and other stakeholders. The WPSI develops, reviews, updates, and disseminates clinical recommendations for women's preventive health care services, focusing on gaps in current recommendations. Cost is not part of the evaluation. The WPSI performed a systematic review addressing the effectiveness of screening for urinary incontinence for improving symptoms, quality of life, and function, and the accuracy and adverse effects of screening methods. No studies were identified that directly evaluated the effectiveness or adverse effects of screening or the accuracy of diagnostic testing in women with incontinence detected by screening. Consequently, the systematic review focused on indirect evidence of the diagnostic accuracy of screening tests and on the effectiveness and adverse effects of treatment.
The WPSI recommends screening women for urinary incontinence annually. Screening ideally should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. Women with a positive screening result should be referred for further evaluation and treatment. Although increasing parity, advancing age, and obesity are associated with an increased risk of urinary incontinence, these factors should not be used to limit screening.
The systematic review found low-quality evidence to support the screening methods. The WPSI recommends an assessment instrument that includes questions about whether a woman has symptoms of urinary incontinence; the type and degree of incontinence; and how symptoms affect her health, function, and quality of life. Several brief clinician- or self-administered questionnaires for use in primary care settings can identify women with stress, urge, or mixed incontinence and may be used to guide diagnostic evaluations and management.
Guideline source: Women's Preventive Services Initiative
Evidence rating system used? No
Systematic literature search described? Yes
Guideline developed by participants without relevant financial ties to industry? Yes
Recommendations based on patient-oriented outcomes? Yes
Published source: Ann Intern Med. September 4, 2018;169(5):320–328