Synopsis
Use three simple first-line assessments to phenotype lower-urinary-tract symptoms, detect infection or systemic disease, and recognise impaired emptying without overtesting uncomplicated incontinence.
- Ask every woman presenting with urinary incontinence for a urine sample and dip for blood, glucose, protein, leucocytes and nitrites.
- Interpret leucocytes and nitrites with symptoms: a dipstick is not a stand-alone diagnosis of UTI and asymptomatic bacteriuria is not treated routinely.
- A bladder diary should cover at least three representative days and record timing and volume of drinks and voids, urgency, leakage, pads and relevant activities.
- The diary distinguishes frequency from polyuria, reveals nocturnal patterns and links leakage to exertion or urgency; it does not prove a person's account true or false.
- Measure post-void residual when symptoms suggest voiding dysfunction or recurrent UTI, not as a universal screening test in uncomplicated incontinence.
- Prefer portable bladder ultrasound to catheterisation because it is more acceptable and causes fewer adverse events.
- Record the voided volume, time since void and scan conditions; NICE does not define one universal residual-volume cutoff for women.
- Do not use pad testing, cystoscopy or CT, MRI or X-ray routinely for urinary incontinence alone; each should answer a separate clinical question.
Key red flags
Inability to void with a painful or palpable bladder, oliguria, rising creatinine or systemic illness needs urgent assessment for retention and obstruction.
Visible haematuria, clot retention or persistent non-visible haematuria must follow the relevant haematuria and suspected-cancer pathway rather than being attributed to incontinence.
Fever, rigors, flank pain, hypotension or vomiting with urinary symptoms suggests upper-tract infection or sepsis and requires prompt treatment.
A high or persistent residual with saddle sensory change, leg weakness or new bowel dysfunction is a neurological emergency.
Glycosuria with polyuria, weight loss, thirst or acute illness requires diabetes assessment; proteinuria or renal impairment needs renal evaluation.
Investigation priorities
Quantify intake, output, timing, urgency and leakage during representative daily routines.
Management branches
Urinary incontinence, urgency, frequency or nocturia is being assessed.
- Explain the purpose and provide a measured container or suitable method, asking for at least three days spanning ordinary variation.
- Record drinks, every voided volume, urgency, leakage, pad use, sleep and the activity surrounding episodes without deliberately changing habits.
- Review the diary with the person, separating storage symptoms, stress triggers, excessive intake, polyuria and night-time patterns before setting goals.