Quality standard

Quality statement 1: Initial assessment

Quality statement 1: Initial assessment

Quality statement

Women first presenting with urinary incontinence have a physical examination, recording of the type and duration of symptoms, and categorisation of the urinary incontinence.

Rationale

Physical assessment and recording of the type and duration of symptoms help to categorise the urinary incontinence and enable referral for the correct treatment. Categorising urinary incontinence is important because different types of incontinence need different treatments.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that women first presenting with urinary incontinence have a physical examination, recording of the type and duration of symptoms, and categorisation of urinary incontinence.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

Proportion of women first presenting with urinary incontinence who receive a physical examination, recording of the type and duration of symptoms, and categorisation of urinary incontinence.

Numerator – the number in the denominator who receive a physical examination, recording of type and duration of symptoms, and categorisation of urinary incontinence.

Denominator – the number of women first presenting with urinary incontinence.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as GP practices, community continence services and hospitals) ensure that women first presenting with urinary incontinence receive a physical examination, recording of the type and duration of symptoms, and categorisation of urinary incontinence.

Healthcare professionals ensure that when women first present with urinary incontinence they carry out a physical examination, record the type and duration of symptoms, and categorise the incontinence.

Commissioners (such as integrated care systems, clinical commissioning groups and NHS England local area teams) ensure that they commission services that offer women first presenting with urinary incontinence a physical examination, recording of the type and duration of symptoms, and categorisation of urinary incontinence.

Women first going to their doctor with leakage of urine have an examination, with recording of the types of symptom and how long they have had them. This helps the healthcare professional to identify the type of problem and decide whether referral to a specialist is needed.

Definitions of terms used in this quality statement

Categorisation of urinary incontinence

Urinary incontinence can be categorised into stress urinary incontinence, urgency urinary incontinence/overactive bladder, or mixed urinary incontinence. [NICE's guideline on urinary incontinence and pelvic organ prolapse in women, recommendation 1.3.1]

Physical examination

Physical examination is carried out as part of the initial assessment to guide the diagnosis and management of incontinence and the identification of any underlying, modifying or serious conditions that require treatment.

As a minimum, physical examination should include palpation of the abdomen to look for gross abnormalities.

Depending on the symptoms and the woman's preferences and circumstances, consider other physical examinations, such as:

  • inspecting the woman's vulva and vagina for atrophy

  • asking them to bear down, to check for visible vaginal or rectal prolapse.

[NICE's full guideline on urinary incontinence and pelvic organ prolapse in women (September 2013) and NICE's guideline on pelvic floor dysfunction, recommendations 1.5.2 and 1.5.5 and expert opinion]

Equality and diversity considerations

Women with physical disabilities may have difficulty accessing the service so provision needs to be made for a home visit if necessary.

Women with learning disabilities may need to be accompanied by a support worker or family member and may need to receive information about the condition in a way that is easy for them to understand.

Some women, including those from certain ethnic groups, religious or cultural backgrounds, may prefer to be examined by a female healthcare professional. Provision for this should be made, if possible.