Incontinence in Women

Advice: Conservative measures can be tried in straightforward cases before referral. However, Nick can liaise with the expert Calvary continence nurses if necessary.

Look for ‘red-flag’ signs/symptoms and refer urgently if present.

Refer To: Urologist or Bladder Physiotherapists

Causes of incontinence to consider

Stress incontinence

Urgency incontinence

Mixed urge and stress incontinence

Overflow incontinence

Post-micturition dribbling




Causes of incontinence to consider

  • Urinary tract infection
  • Weak pelvic floor muscles
  • Pelvic organ prolapse
  • Atrophy of hormone-sensitive tissue
  • Detrusor muscle dysfunction
  • Obstruction
  • Incompetent sphincter
  • Urethral diverticulum
  • Fistula
  • Cognitive impairment
  • Neurological impairment

Stress incontinence

If incontinence is associated with haematuria, an urgent referral is needed.

Other ‘red flag’ signs that require urgent referral if associated with incontinence include:

  • Palpable bladder
  • Bladder or pelvic pain
  • Failed previous stress incontinence treatment
  • Continuous incontinence (fistula)
  • Neurological disease/abnormal neurological findings

Urgency incontinence

This common symptom can be managed in primary care with bladder physiotherapy and training, followed by, or complemented with, medical treatment. If recalcitrant or difficult to manage, please refer.

If urgency incontinence is associated with haematuria, an urgent referral is needed.

Other ‘red flag’ signs that require urgent referral if associated with incontinence include:

  • Palpable bladder
  • Bladder or pelvic pain
  • Failed previous stress incontinence treatment
  • Neurological disease/abnormal neurological findings

Mixed urge and stress incontinence

It is common to find both entities in combination. The principle is to treat the most concerning symptom or form of incontinence first, and reassess the second after. This may be an oversimplification in some patients, but is a reasonable initial approach.


Overflow incontinence

This may be a symptom of chronic retention of urine, so referral is needed. Examine for new neurological signs; if present, an emergency referral is required.


Post-micturition dribbling

This may (rarely) be a symptom of urethral diverticulum or urethral stricture, so warrants referral. However, often a cause is not found.


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  • Nick Brook Urology
    Calvary North Adelaide Hospital
    89 Strangways Tce,
    North Adelaide,
    Adelaide SA 5006
  • 08 8267 1424
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