Abrams, P., Andersson, K. E., Apostolidis, A., Birder, L., Bliss, D.,
Brubaker, L., Cardozo, L., Castro-Diaz, D., O'Connell, P. R.,
Cottenden, A., Cotterill, N., de Ridder, D., Dmochowski, R., Dumoulin,
C., Fader, M., Fry, C., Goldman, H., Hanno, P., Homma, Y., ...
Pennsylvania State University (2018). 6th International Consultation
on Incontinence. Recommendations of the International Scientific
Committee: Evaluation and treatment of urinary incontinence, pelvic
organ prolapse and faecal incontinence.
Neurourology and
Urodynamics
,
37
(7), 2271-2272. https://doi.org/10.1002/nau.23551
Peer reviewed version
License (if available):
Unspecified
Link to published version (if available):
10.1002/nau.23551
Link to publication record in Explore Bristol Research
PDF-document
This is the author accepted manuscript (AAM). The final published version (version of record) is available online
via Wiley at https://onlinelibrary.wiley.com/doi/abs/10.1002/nau.23551 . Please refer to any applicable terms of
use of the publisher.
University of Bristol - Explore Bristol Research
General rights
This document is made available in accordance with publisher policies. Please cite only the
published version using the reference above. Full terms of use are available:
http://www.bristol.ac.uk/red/research-policy/pure/user-guides/ebr-terms/
2017
Co-sponsored by
InternatIonal ConsultatIon on
Urological DIseases (ICUD)
International Continence
Society (ICS)
In collaboration with
major international
associations of urology,
gynaecology and
urodynamics
and other medical
associations
6th International Consultation on
Incontinence
Recommendations of the
International scientific
Committee:
EVALUATION AND TREATMENT
OF URINARY INCONTINENCE,
PELVIC ORGAN PROLAPSE
AND FAECAL INCONTINENCE
P. Abrams, K-E. Andersson, A. Apostolidis,
L. Birder, D. Bliss, L. Brubaker, L. Cardozo,
D. Castro, P.R. O’Connell, A. Cottenden,
N. Cotterill, D. de Ridder, R. Dmochowski,
C. Dumoulin, M. Fader, C. Fry, H. Goldman,
P. Hanno, Y. Homma, V. Khullar, C. Maher,
I. Milsom, D. Newman, J.M. Nijman,
K. Rademakers, D. Robinson, P. Rosier,
E. Rovner, S. Salvatore, M. Takeda, A. Wagg,
T. Wagner, A. Wein
and the members of the committees
INTRODUCTION
The 6th International Consultation on Incontinence met between September 13-15th 2016 in Tokyo and was
organised by the International Consultation on Urological Diseases and the International Continence Society
(ICS), in order to develop consensus statements and recommendations for the diagnosis, evaluation and treat-
ment of urinary incontinence, faecal incontinence, pelvic organ prolapse and bladder pain syndrome.
The consensus statements are evidence based following a thorough review of the available literature and the
global subjective opinion of recognised experts serving on focused committees. The individual committee re-
ports were developed and peer reviewed by open presentation and comment. The Scientific Committee, con-
sisting of the Chairs of all the committees then refined the final consensus statements.These consensus state-
ments published in 2017 will be periodically reevaluated in the light of clinical experience, technological pro-
gress and research.
CONTENTS
1. DEFINITIONS
2. EVALUATION
3. MANAGEMENT CONSENSUS STATEMENTS
I. URINARY INCONTINENCE IN CHILDREN
II. URINARY INCONTINENCE IN MEN
III. URINARY INCONTINENCE IN WOMEN
IV. FISTULAE
V. PELVIC ORGAN PROLAPSE
VI. URINARY INCONTINENCE IN NEUROLOGICAL PATIENTS
VII. BLADDER PAIN SYNDROME
VIII. FAECAL INCONTINENCE IN ADULT PATIENTS
IX. FAECAL INCONTINENCE IN NEUROLOGICAL PATIENTS
X. URINARY AND FAECAL INCONTINENCE IN FRAIL OLDER MEN AND WOMEN
4. RECOMMENDATIONS FOR FURTHER RESEARCH IN EPIDEMIOLOGY
5. RECOMMENDATIONS FOR FURTHER BASIC SCIENCE RESEARCH
6. RECOMMENDATIONS FOR PRIMARY PREVENTION, CONTINENCE PROMOTION, MODELS OF
CARE AND EDUCATION
7. RECOMMENDATIONS FOR TRANSLATIONAL AND CLINICAL RESEARCH
8. INTERNATIONAL CONSULTATION ON INCONTINENCE MODULAR QUESTIONNAIRE (ICIQ):
QUESTIONNAIRES AND BLADDER DIARY
DEFINITIONS
1. DEFINITIONS
The consultation agreed to use the current Interna-
tional Continence Society definitions (ICS) for lower
urinary tract dysfunction (LUTD) including inconti-
nence, except where stated. These definitions were
published in the journal Neurourology and Urodynam-
ics (2002; 21:167-178 and 2006; 25: and can be
viewed on the ICS website: www.ics.org
The following ICS definitions are relevant:
1. LOWER URINARY TRACT
SYMPTOMS (LUTS)
LUTS are divided into storage and voiding symptoms.
Urinary incontinence is a storage symptom and de-
fined as the complaint of any involuntary loss of urine.
This definition is suitable for epidemiological studies,
but when the prevalence of bothersome incontinence
is sought, the previous ICS definition of an “Involun-
tary loss of urine that is a social or hygienic problem“,
can be useful.
Urinary incontinence may be further defined accord-
ing to the patient’s symptoms
• Urgency Urinary Incontinence is the complaint
of involuntary leakage accompanied by or imme-
diately preceded by urgency.
• Stress Urinary Incontinence is the complaint of
involuntary leakage on effort or exertion, or on
sneezing or coughing.
• Mixed Urinary Incontinence is the complaint of
involuntary leakage associated with urgency,
and also with effort, exertion, sneezing and
coughing.
• Nocturnal Enuresis is any involuntary loss of
urine occurring during sleep.
• Post-micturition dribble and continuous uri-
nary leakage denotes other symptomatic forms
of incontinence.
Overactive bladder is characterised by the storage
symptoms of urgency with or without urgency in-con-
tinence, usually with frequency and nocturia.
2. URODYNAMIC DIAGNOSIS
• Detrusor Overactivity is a urodynamic observa-
tion characterised by involuntary detrusor con-
tractions during the filling phase, which may be
spontaneous or provoked.
Detrusor overactivity is divided into:
o Idiopathic Detrusor Overactivity, defined
as overactivity when there is no clear cause
o Neurogenic Detrusor Overactivity is de-
fined as overactivity due to a relevant neu-
rological condition.
• Urodynamic stress incontinence is noted dur-
ing filling cystometry, and is defined as the invol-
untary leakage of urine during increased ab-
dominal pressure, in the absence of a detrusor
contraction.
3. BLADDER PAIN SYNDROME
Bladder pain syndrome is defined by ESSIC as
chronic pelvic pain, pressure or discomfort of greater
than 6 months duration perceived to be related to the
urinary bladder accompanied by at least one other
urinary symptom like persistent desire to void or uri-
nary frequency. Confusable diseases as the cause
of the symptoms must be excluded.
4. PELVIC ORGAN PROLAPSE
• Urogenital prolapse is defined as the sympto-
matic descent of one or more of: the anterior vag-
inal wall, the posterior vaginal wall, and the apex
of the vagina (cervix/uterus) or vault (cuff) after
hysterectomy. Urogenital prolapse is measured
using the POP-Q system.
• Rectal prolapse is defined as circumferential full
thickness rectal protrusion beyond the anal mar-
gin.
5. ANAL INCONTINENCE
Anal incontinence defined as “any involuntary loss
of faecal material and/or flatus and/or mucus” and
may be divided into:
• Faecal incontinence, any involuntary loss of
faecal material
• Flatus incontinence, any involuntary loss of gas
(flatus)
• Mucus incontinence, any involuntary loss of
mucus only (not faeces)
* At the time of this consultation, these definitions are
not included in the current ICS terminology.
RECOMMENDATIONS OF THE INTERNATIONAL SCIENTIFIC COMMITTEE
2. EVALUATION
The following phrases are used to classify diagnos-
tic tests and studies:
• A highly recommended test is a test that should
be done on every patient.
• A recommended test is a test of proven value
in the evaluation of most patients and its use is
strongly encouraged during evaluation.
• An optional test is a test of proven value in the
evaluation of selected patients; its use is left to
the clinical judgement of the physician
• A not recommended test is a test of no proven
value.
This section primarily discusses the Evaluation of Uri-
nary Incontinence with or without Pelvic Organ Pro-
lapse (POP) and Faecal Incontinence.
The recommendations are intended to apply to chil-
dren and adults, including healthy persons over the
age of 65.
These conditions are highly prevalent but often not
reported by patients. Therefore, the Consultation
strongly recommends case finding, particularly in
high risk groups.
A. HIGHLY RECOMMENDED
TESTS DURING INITIAL
EVALUATION
The main recommendations for this consultation
have been abstracted from the extensive work of the
23 committees of the 6th International Consultation
on Incontinence (ICI, 2016).
Each committee has written a report that reviews and
evaluates the published scientific work in each field of
interest in order to give Evidence Based recommen-
dations. Each report ends with detailed recommenda-
tions and suggestions for a programme of research.
The main recommendations should be read in con-
junction with the management algorithms for children,
men, women, the frail older person, neurogenic pa-
tients, bladder pain, pelvic organ prolapse, and anal
incontinence
The initial evaluation should be undertaken, by a cli-
nician, in patients presenting with symptoms/ signs
suggestive of these conditions.
1. HISTORY AND GENERAL
ASSESSMENT
Management of a disease such as incontinence re-
quires caregivers to assess the sufferer in a holis- tic
manner. Many factors may influence a particular indi-
vidual’s symptoms, some may cause incontinence,
and may influence the choice and the success of
treatment. The following components of the medical
history are particularly emphasised:
1.1. Review of Systems:
• Presence, severity, duration and bother of any
urinary, bowel or prolapse symptoms. Identifying
symptoms in the related organ systems is critical
to effective treatment planning. The use of vali-
dated questionnaires to assess symptoms are
recommended.
• Effect of any symptoms on sexual function: vali-
dated questionnaires including impact on quality
of life are a useful part of a full assessment.
• Presence and severity of symptoms suggesting
neurological disease
1.2. Past Medical History:
• Previous conservative, medical and surgical
treatment, in particular, as they affect the genito-
urinary tract and lower bowel. The effectiveness
and side effects of treatments should be noted.
• Coexisting diseases may have a profound effect
on incontinence and prolapse sufferers, for ex-
ample asthma patients with stress incontinence
will suffer greatly during attacks. Diseases may
also precipitate incontinence, particularly in frail
older persons.
• Patient medication: it is always important to re-
view every patient’s medication and to make an
assessment as to whether current treatment may
be contributing to the patient’s condition.
• Obstetric and menstrual history.
• Physical impairment: individuals who have com-
promised mobility, dexterity, or visual acuity may
need to be managed differently
1.3. Social History:
• Environmental issues: these may include the so-
cial, cultural and physical environment.
