Assessment (high-yield, primary care)
- Type: stress (cough/sneeze/exertion), urgency/OAB, mixed, overflow/retention.
- Tools: 3-day bladder diary (frequency, volumes, urgency, triggers, fluids) + validated symptom questions if available.
- Exclude/consider: UTI, pregnancy, constipation, diuretics, new neuro symptoms; examine abdomen and (where appropriate) pelvic exam for atrophy/prolapse.
- Red flags: visible haematuria, pelvic mass, acute retention, suspected neurological cause, or cancer concern → urgent pathway.
First-line treatment (what to do before tablets)
- PFMT: supervised pelvic floor programme for at least 3 months (stress/mixed).
- Bladder training: for urgency/OAB (typically ≥6 weeks).
- Adjuncts: weight loss where relevant, treat constipation, caffeine moderation, rationalise fluids; consider vaginal oestrogen for GSM/atrophy-related symptoms.
Medicines for OAB (pragmatic)
- Antimuscarinic trial: start low and review at 4–6 weeks (e.g., solifenacin 5 mg OD per local formulary); avoid high anticholinergic burden in older adults.
- Mirabegron: option if antimuscarinics not suitable; monitor BP.
- Stop if ineffective: do not continue long-term without clear benefit.
- Refer: bothersome symptoms despite conservative + first-line pharmacotherapy, significant prolapse affecting QoL, or complex/uncertain diagnosis.
Frequently asked questions
Do I need urodynamics before referral?
Not usually in primary care. Start with clinical assessment, diary, conservative measures, and a time-limited medicine trial for OAB; specialist teams decide on urodynamics based on the intervention being considered.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.