URINARY INCONTINENCE
A
61-year-old woman complains of involuntary loss
of urine. She
has noticed it gradually
over the last 10 years and
has finally decided
to see her
general practitioner about
it after hearing a programme on the radio
about treatment for incontinence. The leaking is gen-
erally small amounts and she
wears a pad
all the time.
It tends to occur when
she cannot get to the toilet
in time. She
never leaks on coughing or sneezing. She
suffers urgency,
particularly when she comes home after being
out and is about to come into the house. She also has frequency, passing urine every
hour during the day and getting up two or three times each night.
Due
to the incontinence she tries not
to drink much
and usually has
two cups of tea first thing in the morning,
coffee mid-morning and a further
cup of tea mid-afternoon. Other than that she drinks
one glass of squash per day and has one glass of wine at night.
She is a non-smoker. She has had two
uncomplicated vaginal deliveries. Her periods stopped at the age
of 54 years. There is no other
gynaecological or medical
history of note.
Abdominal examination is normal.
On vaginal examination there is minimal
uterovaginal descent and no anterior or posterior vaginal
wall prolapse.
·
What is the diagnosis?
·
How
would you advise and manage this patient?
The
diagnosis is of overactive bladder
syndrome (OAB). This was formerly
referred to as detrusor instability. In this condition the bladder contracts involuntarily without the nor-
mal trigger to void caused
by bladder filling.
This results in involuntary loss of urine
that is embarrassing and often impacts
enormously on women’s
lives, as they are constantly aware of needing to void and where the nearest toilet might be.
Urodynamic investigation with filling
and voiding cystometry is helpful (as in this case)
in confirming the diagnosis by showing spontaneous detrusor contractions during
blad- der filling.
It
is important to exclude other
causes of such symptoms (such
as urinary tract
infection or a bladder
tumour) with urine microscopy.
·
the
woman should be advised that both caffeine
and alcohol are bladder stimulants and are likely to worsen symptoms so should be minimized. She
should take a nor-
mal fluid intake per day but avoid
drinks after about
7 pm to limit nocturia
·
bladder retraining for 6 weeks, involving
a ‘drill’ restricting voiding to increasing intervals should be taught.
Medical treatment: if lifestyle advice and bladder
retraining fail then
anticholinergic medication such as oxybutynin or tolterodine should
be commenced. The associated
side-effects include dry mouth, dry eyes and constipation.
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