I was delighted to read the article on the SIGN guideline on the management of urinary incontinence in primary care (Guidelines in Practice, March 2005, p. 15).This is an embarrassing condition resulting in a reluctance to report the problem. Incontinence is one of the most common forms of disability and one which we in primary care can do more to address.
The guidance, as with all SIGN guidelines, is supported by an evidence base. The use of a quality of life questionnaire sounds rather cumbersome for general practice; however, the ICIQ questionnaire in Annex 1 is a validated instrument that is quick and easy to use.
The guideline clarifies the classification of incontinence and facilitates a rational, systematic multidisciplinary approach to management. Many areas have a local incontinence adviser, who can carry out most of the history taking and examination. In our area this role is delegated to appropriately trained district nurses when a home visit is required. Physiotherapists may also have a role, for example with pelvic floor exercises.
The SIGN guideline is a valuable and informative read for everyone in the primary healthcare team. Increased awareness of this condition will enable us to help more of our patients who are at present suffering in silence.
Dr Charles Sears, GP, Salisbury;
Chair, RCGP Disability Task Group