Introduction

Urinary incontinence affects between three and six million people in the UK with the number of people affected increasing due to the ageing population. It may be under-reported and is less common in men. The effects of urinary incontinence are often underestimated and can impinge on daily living, as this quote shows: 

“My bladder and bowel own my life 24/7. They are a dictator and a tyrant lying in wait to cause trouble and embarrassment and social isolation. I can go nowhere and do nothing without continence preparation and planning a day ahead of an event and the locations of toilets en route.” (Patient, Age UK report 2018). 

There are three types of urinary incontinence: urge, including overactive bladder (15 per cent), stress (50 per cent) and mixed (35 per cent).

A patient with a prescription should already have had a lifestyle review, at least six weeks of bladder training (for urge incontinence/overactive bladder), 12 weeks of pelvic floor exercises (stress incontinence) or both (mixed incontinence). 

The prescriber should also have reviewed the concurrent use of medicines that affect the total anticholinergic load (e.g. antidepressants), along with the risk of adverse effects, including cognitive impairment.