The Role of the General Practitioner in the Care of Incontinent Patients

Urinary Incontinence in Numbers

Urinary incontinence is defined as a condition of involuntary urine leakage. In the Czech Republic, over 1 million patients of all ages struggle with this problem, although its prevalence increases with age. It affects up to 50% of women during their lifetime and over 20% of older men. However, the exact number of incontinent patients is unknown because few come to see a doctor. Others are unnecessarily embarrassed by their problem or consider it a natural part of aging.

Anamnesis Helps Determine the Type of Incontinence

The general practitioner should first focus on a detailed anamnesis. In the personal history, it is important to search for symptoms of the disease and try to distinguish the type of incontinence with targeted questions. Basic questions focus on the duration of the symptoms, the frequency of leaks during the day and night, including the quantity of leaked urine, the presence of urgency, triggering causes (such as coughing, sneezing, etc.), previous childbirths, or surgeries in the pelvic area. In men, it is also appropriate to ask about irritative symptoms. Many neurological diseases, spine problems, certain medications, or diabetes mellitus—all these conditions affect the functioning of the bladder, and a direct question about the presence of incontinence should not be omitted.

Important tools in distinguishing types of incontinence and evaluating the effect of treatment are standardized questionnaires, which, unfortunately, are often not available in general practitioners' offices. Urination diaries or the pad-weight test also play an irreplaceable role in objectifying difficulties.

Other Examinations within the Competence of the General Practitioner

At the general practitioner's level, basic physical examinations should be conducted, including the inspection of external genitalia and a per rectum examination in men, along with chemical and cultural urine tests. In indicated cases, these should be supplemented by biochemical renal parameter tests and sonography of the upper and lower urinary tract. Based on these examinations, the general practitioner should decide on the next steps: whether to consider organic causes of the symptoms and refer the patient for further specialized examination in urology or start conservative treatment.

Knowledge of Incontinence Aids is Important

The treatment of incontinence depends on its type and, in most cases, is in the hands of specialists. However, the general practitioner can recommend starting regimen measures early, such as adequate daily fluid intake, regular emptying routines, strengthening pelvic floor muscles, preventing colds, treating acute urinary tract infections if present, reducing body weight, or checking chronic medication. Lastly, the general practitioner should also be knowledgeable about incontinence aids and be able to advise on their selection according to the patient's individual needs.

Conclusion

Urinary incontinence often leads to limitations in physical activities, social isolation, and relationship problems, ultimately affecting the patient's psyche. The general practitioner should be a guide for the incontinent patient, helping to destigmatize this problem and actively offering assistance to patients.

(mraf)

Sources:
1. Ryšánková M. Incontinence—News and Solutions in the General Practitioner’s Office. Solen 2018; 15(5): 276−280.
2. Imam K. A. The role of the primary care physician in the management of bladder dysfunction. Rev Urol 2004; 6(suppl. 1): S38−S44.
3. Care for Incontinent Patients in the General Physician's Office or What Every Practitioner Should Know. proLékaře.cz, 2019. Available at: www.prolekare.cz/media/ebook_inkontinence_pro_praktiky.pdf