Presentations
- Abdominal and pelvic pain
- Altered bowel habit
- Constipation
- Diarrhoea
- Dysuria
- Faecal incontinence
- Frequency
- Haematuria
- Indwelling urinary catheter (IDC) / suprapubic catheter complications
- Lower urinary tract symptoms
- Nocturia
- Overflow incontinence
- Pressure injuries
- Stress incontinence
- Urinary incontinence
- Urinary retention
- Urinary urgency
Conditions
- Atrophic vaginitis
- Benign prostatic hyperplasia
- Bladder pathologies
- Bowel cancer
- Delirium
- Dementia
- Detrusor instability
- Diabetes mellitus
- Drug induced effects on continence
- Faecal impaction and overflow
- Functional incontinence
- Medication side effects, e.g. diuretics, acetyl-cholinesteraseinhibitor (AchEI)
- Multimorbidity effect on continence - sleep apnoea, cognition, congestive cardiac failure
- Parkinson disease
- Pelvic floor dysfunction
- Pelvic organ prolapse
- Prostate cancer
- Retention
- Situational incontinence
- Sphincter dysfunction
- Spinal disease
- Stoma
- Stroke
- Urethral pathologies
- Urinary tract infection
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Pelvic mass
- Postoperative radical prostatectomy
- Spinal cord injuries / compression
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Differences in anatomy between genders
- Pathophysiology of ageing urinary tract
- Pelvic floor failure due to structural issues with the sphincters or supporting musculature
- The complex and varied aetiology of incontinence
- Types of urinary incontinence and common aetiologies
Examinations
- Abdominal examination
- Bladder diary
- Bladder scan estimating post-void residual urine
- Cough stress test
- Digital rectal exam, pelvic examination
- Functional impairment assessment, including impairments in manual dexterity leading to difficulty undressing, presenting as incontinence
- Relevant neurological examination
- Screens for functional, cognitive, and mobility impairment
Investigations
- Gait assessment
- Imaging of pelvic and urinary tract with plain films, ultrasounds, CT scans or MRIs
- Kidney function, serum glucose
- Medication review
- Urinalysis
- Urodynamic testing
- Behavioural strategies that may help reduce incontinence, including practising urge suppression and bladder retraining techniques, using appropriate containment products, managing constipation, and strengthening pelvic floor muscles
- Botox and nerve stimulation for urge incontinence
- Carer stress with managing continence
- Devices and surgical options for stress incontinence
- Dignity in continence care
- Efficacy and adverse effects of pharmacological and surgical therapy options
- Impact of comorbidity / frailty / function on continence
- Lifestyle strategies such as weight loss, adequate fluid intake and appropriate timing of fluids, dietary change to ensure adequate fibre intake, the role of caffeine, alcohol, artificial sweeteners, and concentrated sugars
- Likelihood of future improvement with therapy
- Management of continence aids and urinary catheters, e.g. IDC and SPC, and the difference between community dwelling and residential care
- Perioperative assessment for invasive procedures
- Promote seeking help early
- Psychosocial impact and consequences of symptoms, e.g. depression
- Shared decision making and patient-centred management decisions
- Strategies to assist patients with significant cognitive impairment, including timed or prompted voiding
- The impact of ageing on stoma management
- The impact of incontinence and patients’ need for residential care
- The impact on older adults in hospital, including their ability to participate in rehabilitation activities such as hydrotherapy
- The impacts of incontinence on socialising, self-esteem, leaving the home environment, and physical activity
- Urinary incontinence is common, it is not normal and requires management
