Management practices for urinary incontinence in women in the primary care setting: health care professionals’ perspective

Urinary incontinence (UI) is a debilitating condition affecting up to 40 % of women. NICE guidelines and the NHS long term plan recommend access to multidisciplinary teams for management of pelvic floor disorders, and a clear management strategy. Our aim was to provide a snapshot of current knowledge and provision in primary care where women with UI may routinely present.We conducted semi-structured interviews using a pre-prepared interview guide, with GPs, practice nurses and physiotherapists in primary care. The transcripts were analysed using the framework method of analysis in order to identify key themes regarding management of UI. Findings suggested that it is unusual for women to present with UI as the primary condition but rather that this often mentioned as a side issue. The health care professionals interviewed were not aware of any clearly defined local strategies for onward management. It was further suggested that only younger women would benefit from pelvic floor rehabilitation and there was an overarching belief that physiotherapy was only relevant for this younger group. Older women were referred for continence advice with the expectation that this would result in pharmaceutical treatment and/or pads for protection rather than rehabilitation. The recent Independent Medicines and Medical Devices Safety review highlights the need for all women presenting with UI to be offered conservative treatment initially. Our findings suggest that an important factor in providing this will be ensuring robust local management strategies exist and improved education of those in primary care regarding appropriate protocols