1. Refer to the management of urinary incontinence in women Appendix 1.

2. Accurate assessment and diagnosis of the cause of incontinence is vital for treatment success. Non-drug treatments have an important role in management. First-line treatment for urge or mixed urinary incontinence should be bladder training lasting for at least 6 weeks. If symptoms remain troublesome, consider adding an antimuscarinic drug.

3. Oxybutynin is the first choice drug therapy. Patients may experience anticholinergic side effects. Therefore the minimum effective dose should be used. However, many patients referred to secondary care on low doses respond well to higher doses so GPs should consider increasing the dose of oxybutynin to 5 mg TDS and trying a second antimuscarinic if not effective before referral.

4. Trospium XL is an appropriate second line antimuscarinic treatment after oxybutynin immediate release or tolterodine immediate release for urge incontinence and/or increased urinary frequency and urgency. A face to face or telephone review four weeks after the start of each new antimuscarinic drug treatment is advised to ascertain degree of improvement and whether any intolerable side effects have occurred. Women who remain on long-term drug treatment for urge incontinence or overactive bladder should be reviewed annually in primary care (or every 6 months for women over 75).

5. Desmopressin (refer to section 6.5.2) is licensed for nocturnal enuresis.