Urinary incontinence in neurological disease: assessment and management

National Institute for Health and Care Excellence

Key priorities for implementation

Assessment of lower urinary tract dysfunction in patients with neurological conditions

  • When assessing lower urinary tract dysfunction in a person with neurological disease, take a clinical history, including information about:
    • urinary tract symptoms
    • neurological symptoms and diagnosis (if known)
    • clinical course of the neurological disease
    • bowel symptoms
    • sexual function
    • comorbidities
    • use of prescription and other medication and therapies
  • If the dipstick test result and person’s symptoms suggest an infection, arrange a urine bacterial culture and antibiotic sensitivity test before starting antibiotic treatment. Treatment need not be delayed but may be adapted when results are available
  • Be aware that bacterial colonisation will be present in people using a catheter and so urine dipstick testing and bacterial culture may be unreliable for diagnosing active infection
  • Refer people for urgent investigation if they have any of the following ‘red flag’ signs and symptoms:
    • haematuria
    • recurrent urinary tract infections (for example, three or more infections in the last 6 months)
    • loin pain
    • recurrent catheter blockages (for example, catheters blocking within 6 weeks of being changed)
    • hydronephrosis or kidney stones on imaging
    • biochemical evidence of renal deterioration

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