Feature Article| Volume 13, ISSUE 10, P675-680, November 2017

Improving Care for Women With Urinary Incontinence in Primary Care

Published:September 18, 2017DOI:


      • Urinary incontinence (UI) is prevalent and burdensome, primarily impacting women.
      • UI is undertreated due to lack of regular leakage screening by clinicians.
      • Targeted history and physical exam skills can lead to accurate UI diagnoses.
      • Nonpharm first-line interventions are effective at improving UI and quality of life.
      • Clinicians should screen for and offer first-line treatment for women with leakage.


      Urinary incontinence (UI) is highly prevalent in primary care, disproportionately impacts women, and is associated with poor quality of life related to significant psychological, physical, social, and financial burdens. UI places significant economic burden on the United States health care system. Cost-effective, first-line UI treatments improve continence and can be successfully offered in primary care. Unfortunately, UI is largely untreated, in part because health care providers fail to inquire about involuntary urine leakage and are uncomfortable with UI diagnosis and treatment. The aim of this article is to familiarize clinicians with UI risk factors and effective nonpharmacologic management strategies for primary care.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Minassian V.A.
        • Yan X.
        • Litchenfeld M.J.
        • Sun H.
        • Stewart W.F.
        The iceberg of health care utilization in women with urinary incontinence.
        Int Urogynecol J. 2012; 23: 1087-1093
        • Dennis J.
        Changing our view of older people’s continence care.
        Nurs Times. 2016; 112: 12-14
        • Coyne K.S.
        • Wein A.
        • Nicholson S.
        • Kvasz M.
        • Chen C.-I.
        • Milsom I.
        Economic burden of urgency urinary incontinence in the United States: a systematic review.
        J Manag Care Specialty Pharm. 2014; 20: 130-140
        • Hung K.J.
        • Awtrey C.S.
        • Tsai A.C.
        Urinary incontinence, depression and economic outcomes in a cohort of women between ages of 54 and 65 years.
        Obstet Gynecol. 2014; 123: 822-827
        • Ramage-Morin P.L.
        • Gilmour H.
        Urinary incontinence and loneliness in Canadian seniors.
        Health Rep. 2013; 24: 3-10
        • Yip S.O.
        • Dick M.A.
        • McPencow A.M.
        • Martin D.K.
        • Ciarleglio M.M.
        • Erekson E.A.
        The association between urinary and fecal incontinence and social isolation in older women.
        Am J Obstet Gynecol. 2013; 208: 146e1-146e7
        • Hawkins K.
        • Pernarelli J.
        • Ozminkowski R.J.
        • et al.
        The prevalence of urinary incontinence and its burden on the quality of life among older adults with Medicare supplement insurance.
        Quality Life Res. 2011; 20: 723-732
        • Minassian V.A.
        • Devore E.
        • Hagan K.
        • Grodstein F.
        Severity of urinary incontinence and effect on quality of life in women by incontinence type.
        Obstet Gynecol. 2013; 121: 1083-1090
      1. National Institute of Diabetes and Digestive and Kidney Diseases. Urinary incontinence in women. July 2016. Accessed June 4, 2017.

      2. Bai X, Leung DY, Lai CK, Chong AM, Chi I. Mediating effect of decline in social activities on urinary incontinence and negative mood: do sex and marital differences exist? Geriatr Gerontol Int. 2017.

        • Pierce H.
        • Perry L.
        • Gallagher R.
        • Chiarelli P.
        Urinary incontinence, work, and intention to leave current job: a cross sectional survey of the Australian nursing and midwifery workforce.
        Neurourol Urodyn. 2017; 36 ( 1876-1883
        • Damián J.
        • Pastor-Barriuso R.
        • García López F.J.
        • de Pedro-Cuesta J.
        Urinary incontinence and mortality among older adults residing in nursing care homes.
        J Adv Nurs. 2017; 73: 688-699
        • John G.
        • Gerstel E.
        • Jung M.
        • et al.
        Urinary incontinence as a marker of higher mortality in patients receiving home care services.
        BJU Int. 2014; 113: 113-119
        • Duralde E.R.
        • Walter L.C.
        • van den Eeden S.K.
        • et al.
        Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women.
        Am J Obstet Gynecol. 2016; 214: 266e1-266e9
      3. Shamilyan T, Wyman J, Kane RL. Nonsurgical treatments for urinary incontinence in adult women: Diagnosis and comparative effectiveness. Comparative Effectiveness Review No. 36. AHRQ Publication No. 11(12)-EHC074-EF. 2012. Accessed June 4, 2017.

        • Reuben D.B.
        • Ganz D.A.
        • Roth C.P.
        • McCreath H.E.
        • Ramirez K.D.
        • Wenger N.S.
        Effect of nurse practitioner comanagement on the care of geriatric conditions.
        J Am Geriatr Soc. 2013; 61: 857-867
        • Avery K.
        • Donovan J.
        • Peters T.J.
        • Shaw C.
        • Gotoh M.
        • Abrams P.
        ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence.
        Neurourol Urodyn. 2004; 23: 322-330
        • Brown J.S.
        • Bradley C.S.
        • Subak L.L.
        • et al.
        The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence.
        Ann Intern Med. 2006; 144: 715-723
        • Hewison A.
        • McCaughan D.
        • Watt I.
        An evaluative review of questionnaires recommended for the assessment of quality of life and symptom severity in women with urinary incontinence.
        J Clin Nurs. 2014; 23: 2998-3011
        • Wood L.N.
        • Anger J.T.
        Urinary incontinence in women.
        BMJ. 2014; 349: 4531
        • Khandelwal C.
        • Kistler C.
        Diagnosis of urinary incontinence.
        Am Fam Phys. 2013; 87: 543-550
        • Parker W.P.
        • Griebling T.L.
        Nonsurgical treatment of urinary incontinence in elderly women.
        Clin Geriatr Med. 2015; 31: 471-485
      4. Shernot PJ. Urinary incontinence in adults. Merck Manual Professional Version. Accessed September 4, 2017.

        • Bright E.
        • Cotterill N.
        • Drake M.
        • Abrams P.
        Developing and validating the International Consultation on Incontinence Questionnaire bladder diary.
        Eur Urol. 2014; 66: 294-300
      5. Lucas MG, Bedretdinova D, Bosch JLHR, et al. Guidelines on urinary incontinence. European Association of Urology 2014 Update. 2014. Accessed June 4, 2017.

        • Institute of Medicine
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        National Academies Press, Washington, DC2001
        • Qaseem A.
        • Dalls P.
        • Forciea M.A.
        • Starkey M.
        • Denberg T.D.
        • Shekelle P.
        Nonsurgical management of urinary incontinence in women: A clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2014; 161: 429-440
        • Hersh L.
        • Salzman B.
        Clinical management of urinary incontinence in women.
        Am Fam Phys. 2013; 87: 634-640
        • Lee M.
        • Rozette N.A.
        Newman D.K. Wyman J.F. Welch V.W. Guide to Urologic Medications: A Supplement to the SUNA Core Curriculum for Urologic Nursing. Society of Urological Nurses and Associates, Pitman, NJ2016
        • Borello-France D.
        • Burgio K.L.
        • et al.
        Adherence to behavioral interventions for stress incontinence: rates, barriers, and predictors.
        Phys Ther. 2013; 93: 757-773


      Susan G. Wiers, DNP, FNP-BC, is a clinical assistant professor at Wayne State University in Detroit, MI. She can be reached at .


      Linda J. Keilman, DNP, GNP-BC, is an assistant professor in health programs in the College of Nursing at Michigan State University in East Lansing, MI.