Quality standard

Quality statement 2: Bladder diaries and lifestyle changes

Quality statement 2: Bladder diaries and lifestyle changes

Quality statement

Women first presenting with urinary incontinence are asked to complete a bladder diary for a minimum of 3 days and given advice about the impact that lifestyle changes can have.

Rationale

Bladder diaries can provide a variety of information about urinary incontinence and may also be used for monitoring the effects of treatment. A bladder diary can help healthcare professionals and the woman to understand when urgency or leakage occurs, which is important when considering the management options.

Lifestyle changes can improve symptoms in women with urinary incontinence or overactive bladder. Giving lifestyle advice to women when they first present means they can benefit from these improvements as soon as possible.

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

a) Evidence of local arrangements to ensure that women first presenting with symptoms of urinary incontinence are asked to complete a bladder diary for a minimum of 3 days.

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

b) Evidence of local arrangements to ensure that women first presenting with urinary incontinence are given lifestyle advice.

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

Process

a) Proportion of women first presenting with urinary incontinence who are asked to complete a bladder diary for a minimum of 3 days.

Numerator – the number in the denominator who are asked to complete a bladder diary for a minimum of 3 days.

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.

b) Proportion of women first presenting with urinary incontinence who are given advice about lifestyle changes.

Numerator – the number in the denominator who are given advice about lifestyle changes.

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 and community continence services) ensure that staff are trained to ask women first presenting with urinary incontinence to complete a bladder diary for a minimum of 3 days and give advice about the impact that lifestyle changes can have.

Healthcare professionals ensure that they ask women first presenting with urinary incontinence to complete a bladder diary for a minimum of 3 days and give them advice about the impact that lifestyle changes can have.

Commissioners (such as integrated care systems, clinical commissioning groups and NHS England local area teams) ensure that they commission services in which staff are trained to ask women first presenting with urinary incontinence to complete a bladder diary for a minimum of 3 days and give them advice about the impact that lifestyle changes can have.

Women first going to their doctor with leakage of urine are asked to fill in a bladder diary for at least 3 days and given advice about how lifestyle changes can help. A bladder diary is used to record how much liquid they drink, how often they need to urinate and how much urine they pass. This diary is important to help understand patterns when considering options for management. Making lifestyle changes can improve symptoms.

Source guidance

Definitions of terms used in this quality statement

Bladder diary

A diary that records times and amounts of urine passed, leakage episodes, pad usage and other information such as fluid intake, degree of urgency and degree of incontinence. A bladder diary should cover variations in the usual activities, such as both working and leisure days. [Adapted from NICE's full guideline on urinary incontinence and pelvic organ prolapse in women (September 2013)]

Advice about the impact that lifestyle changes can have

Lifestyle changes are part of conservative management and include weight loss (for women with a body mass index [BMI] over 30 kg/m2), fluid management (increasing fluid intake if it is too low or decreasing it if it is too high) and caffeine reduction.

When discussing lifestyle changes, motivate women to make changes by focusing discussions on how this will improve their symptoms. Give women regular encouragement to keep up the changes, because it may take weeks or months before they notice a benefit. [NICE's guideline on urinary incontinence and pelvic organ prolapse in women, recommendations 1.4.1 to 1.4.3 and NICE's guideline on pelvic floor dysfunction, recommendations 1.6.4, 1.6.5 and 1.6.10]

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. They may also need support to complete the bladder diary.

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

Different versions of bladder diaries should be available for women who do not speak or read English. These women may also need support to complete the diary.