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Guideline, with no evidence, suggests annual screening for urinary incontinence in women
Clinical Question
Should women be screened for symptoms of urinary incontinence?
Bottom line
The goal of screening is to identify a disorder before it becomes symptomatic if early treatment has the potential for greater benefit than waiting until symptoms are reported. Despite the failure to meet this definition, this guideline from the fox guarding the chickens (see below) suggests annual screening of women for urinary incontinence and the effect, if any, on their lives. This guideline development group has too much investment in the recommendations to be credible, especially given the lack of evidence. 5
Reference
Study design: Practice guideline
Funding: Government
Setting: Outpatient (any)
Synopsis
This guideline comes from the Women's Preventive Services Initiative, a collaboration between the US government and the American College of Obstetrics and Gynecology, with input from several other professional societies whose members care for women. Seeming to step on the sensible shoes of the US Preventive Services Task Force, the stated goal of this group is to assure that women receive a "comprehensive set of preventive services" that are paid for by the government (https://www.womenspreventivehealth.org/about/). Hmm. . . already an inherent conflict of interest, so let's dig a little deeper. The authors performed a systematic review, finding no studies that evaluated the effectiveness of screening on improving symptoms, quality of life, or function. The strength of the evidence that supports the accuracy of screening methods is low. There is no research into the adverse effects of screening. The strength of the evidence that supports treatments for incontinence is low to moderate, and there is no evidence that suggests early detection results in better outcomes. Yet the group has decided that clinicians should use a validated assessment instrument annually for all women to determine if they have incontinence and whether it affects their health, function, or quality of life.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Consider the difference between "enquiry", as in functional enquiry, and screening. Enquiry shows a concern about the patient quality of life and her function. Screening suggests possible harm if it lead to more investigations and treatment.
Many people don’t volunteer their symptoms unless asked and yet it can have a serious impact on wellbeing so I would support the idea of routinely asking about it (as for pelvic pain/dyspareunia)
Thanks to the author of the POEM for his/her time and analysis. A unbiased assessment of guidelines is always appreciated.
Another screening tool whose only purpose is convince more people that they are in need of medical care.
Urinary tract infection is common among women.So I think even with out evidence of infection annual screening for urinary incontinence in women is very important.
see above
good poem
I agree with the comments re this guideline.
In addition, I am of the opinion that every guideline that is added on to what is becoming an impossible expectation for care, both from a time and cost perspective, should be required to have an assessment on implentation of the recommendation into an already overburdened and under resourced primary care system.
Great information
I can think of a patient with severe atrophic genital changes (in spite of adequate estrogen replacement). I will probably not screen her for developing unstable bladder, UI, etc on the basis of this article
I agree with the reviewers critique. It is a timely reminder that studies which are self-serving and questionable honesty like this one attempt to ally themselves with reputable guides to practice.
Testing for incontinence in women early on is a step ahead to improve women's lives. In my opinion incontinence affects women's mental health as well as their general well being.
I am not in clinical practice now but I do agree with the author that such screening is not necessary and possibly harmful making otherwise healthy person ill.