Mixed urinary incontinence — DRCOG MCQ
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Correct answer: A — Assess the predominant symptom and start conservative treatment for mixed incontinence
The best answer is “Assess the predominant symptom and start conservative treatment for mixed incontinence”. This is mixed urinary incontinence, so management begins by determining which component is predominant and agreeing conservative treatment that may include weight advice, bladder training and supervised pelvic-floor muscle training. Urgency does not automatically predominate simply because nocturia is present, and stress-focused surgery may leave urgency unchanged or worsen it. Medication is considered after appropriate conservative urgency treatment, while procedural referral follows adequate assessment and shared decision-making. Antenatal decisions combine gestation, maternal stability, fetal risk and whether care can safely remain in the community. Screening, diagnostic testing and urgent assessment are not interchangeable. The UK pathway should be followed with clear safety-netting whenever symptoms may evolve before the next routine appointment.
Reference: NICE NG123: Urinary incontinence and pelvic organ prolapse in women: https://www.nice.org.uk/guidance/ng123/chapter/recommendations