Female LUTS

Storage LUTS (in the absence of UTI):

• Frequency
• Urgency
• Nocturia

With or without urinary incontinence episodes

Fluid advice:

• Aim for 1.5–2.0 L fluid/day³
• Reduce caffeine^1,3 and carbonated drink consumption

Weight loss advice if BMI >30¹

Pelvic floor PT^2,3/SPHERE referral (especially if there is concordant stress incontinence/prolapse symptoms)
Bladder re-training¹/SPHERE referral

• Abdominal/pelvic examination¹
• Urinalysis +/- MSSU
• Consider US urinary tract (not renal US) to include post-void residual volume²

If residual >150 mL, refer to Urology as Routine

Consider topical/pessary oestrogen² in peri- or post-menopausal women

• Anticholinergic trial for 6 weeks e.g. Solifenacin¹ GGC Medicines: Drugs for genito-urinary disorders
• Beta 3 agonist, e.g. Mirabegron (consider if anticholinergic is contraindicated, ineffective or cognitive concern.)  GGC Medicines: Drugs for genito-urinary disorders
• No improvement at 3 months then consider referral to secondary care as below.

• Red flag features as above (Urgent Urology)
• Continued symptoms despite above measures (Routine Urology/Urogynaecology)

Treatment options for overactive bladder (OAB) | The British Association of Urological Surgeons Limited

• BMI, body mass index
• LUTS, lower urinary tract symptoms
• MSSU, midstream specimen of urine
• POP, pelvic organ prolapse
• PT, physical therapy
• RTx, radiation therapy
• US, ultrasound
• UTI, urinary tract infection.

1. NICE. Scenario: Management of a woman with predominantly urgency incontinence. 2024. Available at: cks.nice.org.uk/topics/incontinence-urinary-in-women/management/managing-urgency-incontinence (Accessed: January 2025)
2. NICE. Urinary incontinence and pelvic organ prolapse in women: management. 2019. Available at: www.nice.org.uk/guidance/ng123/chapter/recommendations (Accessed: January 2025)
3. British Association of Urological Surgeons (BAUS). Comparison of treatment options for overactive bladder (OAB). 2025. Available at: www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/OAB%20options.pdf (Accessed: January 2025)
4. CfSD Modernising Patient Pathways Programme: Urinary incontinence and prolapse pathway (Draft). November 2024.