Primary care diagnostic and treatment pathways in Dutch women with urinary incontinence

Figures & data

Figure 1. Patient selection. Of the total 724,843 records, the first search yielded 12,005 records. Screening a random selection of 2,800 records resulted in 374 women being included who received care from 183 different GPs (range, 1–9 patients per GP).

Table 1. Descriptive characteristics of 374 women with urinary incontinence selected from medical records.

	SUI n = 116	UUI n = 57	MUI n = 56	O/N n = 145	All n = 374
Age in years (Mean ± SD)	46.1 ± 13.0	51.8 ± 16.4	55.0 ± 12.1	51.3 ± 16.5	50.3 ± 15.1
Age groups (n (%))
18–25	4 (3.4)	5 (8.8)	1 (1.8)	12 (8.3)	22 (5.9)
26–35	23 (19.8)	6 (10.5)	2 (3.6)	23 (15.9)	54 (14.4)
36–45	36 (31.0)	5 (8.8)	7 (12.5)	17 (11.7)	65 (17.4)
46–55	28 (24.1)	14 (24.6)	19 (33.9)	24 (16.6)	85 (22.7)
56–65	12 (10.3)	12 (21.1)	15 (26.8)	33 (22.8)	72 (19.3)
66–75	13 (11.2)	15 (26.3)	12 (21.4)	36 (24.8)	76 (20.3)
Degree of incontinence (n (%))
≤1 episode per week	2 (1.7)	2 (3.5)	1 (1.8)	2 (1.4)	7 (1.9)
Two or three times a week	14 (12.1)	3 (5.3)	2 (3.6)	2 (1.4)	21 (5.6)
About once a day	6 (5.2)	7 (12.3)	6 (10.7)	7 (4.8)	26 (7.0)
Several times a day	4 (3.4)	6 (10.5)	8 (14.3)	5 (3.4)	23 (6.1)
All the time	0 (0.0)	1 (1.8)	2 (3.6)	1 (0.7)	4 (1.1)
Not reported	90 (77.6)	38 (66.7)	37 (66.1)	28 (88.3)	293 (78.3)
Duration of incontinence (n (%))
<1 month	5 (4.3)	4 (7.0)	2 (3.6)	17 (11.7)	28 (7.5)
1 month to 1 year	7 (6.0)	9 (15.8)	3 (5.4)	10 (6.9)	29 (7.8)
>1 year	24 (20.7)	12 (21.1)	17 (30.4)	21 (14.5)	74 (19.8)
Not reported	80 (69.0)	32 (56.1)	34 (60.7)	97 (66.9)	243 (65.0)

Note 1: SUI: Stress urinary incontinence; UUI: urgency urinary incontinence; MUI: mixed urinary incontinence; O/N: Other/not reported.

Table 2. Diagnostics by type of urinary incontinence.

	SUI n = 116	UUI n = 57	MUI n = 56	O/N n = 145	All patients n = 374
Voiding diary	10.3 (4.8–15.8)	14.0 (5.0–23.0)	8.9 (1.5–16.3)	4.8 (1.3–8.3)	8.6 (5.9–11.3)
Urine tests	30.2 (21.8–38.6)	63.2 (50.6–75.8)	30.4 (18.2–42.6)	49.0 (40.8–57.2)	42.5 (37.5–47.5)
External vaginal inspection	29.3 (21.1–37.5)	22.8 (11.8–33.8)	28.6 (16.6–40.6)	17.2 (11.1–23.3)	23.5 (19.2–27.8)
Per vaginal examination	25.0 (17.2–32.8)	29.8 (17.8–41.8)	21.4 (10.6–32.2)	18.6 (12.3–24.9)	22.7 (18.4–27.0)
PFM testing	12.9 (6.8–19.0)	3.5 (0.0–8.4)	7.1 (0.2–14.0)	9.7 (4.8–14.6)	9.4 (6.5–12.3)
Other diagnostics	0.9 (0.0–2.7)	5.3 (0.0–11.2)	1.8 (0.0–5.3)	4.8 (1.3–8.3)	3.2 (1.4–5.0)
No diagnostics	50.0 (40.8–59.2)	28.1 (16.3–39.9)	42.9 (29.8–56.0)	36.6 (28.8–44.4)	40.4 (35.5–45.3)

Note 1: SUI: Stress urinary incontinence; UUI: urgency urinary incontinence; MUI: mixed urinary incontinence; O/N: Other/not reported; PFM: Pelvic floor muscle.

Note 2: Values are presented as percentage (95% CI).

Note 3: Other diagnostics consisted of ultrasound (n = 7), general blood test (n = 3) and pap smear (n = 2).

Table 3. Treatment by type of urinary incontinence.

	SUI n = 116	UUI n = 57	MUI n = 56	O/N n = 145	All patients n = 374
Basic treatment
Education during consult	19.8 (12.5–27.1)	21.1 (10.4–31.8)	28.6 (16.7–40.5)	11.0 (5.9–16.1)	17.9 (14.0–21.8)
Normal fluid intake	3.4 (0.1–6.7)	12.3 (3.7–20.9)	1.8 (0.0–5.3)	7.6 (3.3–11.9)	6.1 (3.7–8.5)
Weight reduction	0.0	1.8 (0.0–5.3)	0.0	0.7 (0.0–2.1)	0.5 (0.0–1.3)
Treating comorbidities	0.9 (0.0–2.7)	1.8 (0.0–5.3)	0.0	2.1 (0.0–4.5)	1.3 (0.1–2.5)
PFM training by GP	21.6 (14.2–29.0)	5.3 (0.0–11.2)	16.1 (6.3–25.9)	6.9 (2.8–11.0)	12.6 (9.3–15.9)
Bladder training by GP	0.0	7.0 (0.3–13.7)	7.1 (0.2–14.0)	2.1 (0.0–4.5)	2.9 (1.1–4.7)
Incontinence pads	7.8 (2.9–12.7)	8.8 (1.4–16.2)	26.8 (15.0–38.6)	14.5 (8.8–20.2)	13.4 (9.9–16.9)
Pessary	2.6 (0.0–5.5)	0.0	3.6 (0.0–8.5)	1.4 (0.0–3.4)	1.9 (0.5–3.3)
Medication
Adjust medication	0.0	0.0	0.0	0.7 (0.0–2.1)	0.3 (0.0–0.9)
Start anticholinergics	0.9 (0.0–2.7)	15.8 (6.2–25.4)	5.4 (0.0–11.3)	7.6 (3.3–11.9)	6.4 (3.9–8.9)
Start mirabegron	0.0 (0.0–0.0)	1.8 (0.0–5.3)	1.8 (0.0–5.3)	2.1 (0.0–4.5)	1.3 (0.1–2.5)
Start antibiotics	4.3 (0.6–8.0)	8.8 (1.4–16.2)	7.1 (0.2–14.0)	15.2 (9.3–21.1)	9.6 (6.7–12.5)
Other treatment	4.3 (0.6–8.0)	8.8 (1.4–16.2)	1.8 (0.0–6.7)	3.4 (0.0–4.8)	4.3 (2.3–6.3)
Referral
Pelvic physiotherapy	33.3 (24.7–41.9)	27.3 (15.3–39.3)	41.1 (28.2–54.0)	20.8 (14.1–27.5)	28.7 (24.0–33.4)
Gynaecology/urology	25.0 (17.1–32.9)	28.1 (16.3–39.9)	21.4 (10.6–32.2)	16.6 (10.5–22.7)	21.7 (17.6–25.8)
No treatment or referral	12.9 (6.8–19.0)	15.8 (6.2–25.4)	7.1 (0.3–13.9)	21.4 (14.7–28.1)	15.8 (11.1–19.5)

Note 1: SUI: Stress urinary incontinence; UUI: urgency urinary incontinence; MUI: mixed urinary incontinence; O/N: Other/not reported.

Note 2: Values are presented as percentage (95% CI).

Note 3: Other treatment consists of other medication (n = 6), relaxation exercises (n = 2), stop drinking caffeine (n = 2), using an app for treatment of incontinence (n = 2), Botox injection (n = 1), cranberry advice (n = 1), tampon use during exercise (n = 1).