URINARY INCONTINENCE
A
49-year-old woman presents
with leaking of urine. This started after the birth of her third
child 10 years ago
and has gradually worsened. She has
not felt comfortable talking to her general
practitioner about it until now. The
leakage occurs on coughing and
laugh- ing. However she has recently
started to play badminton to lose weight
and the symptoms are much worse, but she has discovered though
that the symptoms
are much better
if she wears a tampon while
playing. There is no dysuria,
nocturia, frequency or urgency. She is
mildly constipated.
All
her children were born by induction of labour post-term. They weighed 3.6 kg. 3.8 kg
and 4.1 kg respectively and she needed
a forceps delivery
for the third
child after failure to progress in the third stage.
She has a regular menstrual cycle and has had a laparo-
scopic sterilization. There
is no other relevant medical
history and she takes no medica-
tions. She smokes 15 cigarettes per day and does not drink alcohol.
Body mass index is 29 kg/m2. There are no significant findings on abdominal or vaginal
examination.
·
What is the diagnosis?
·
How
would you advise and manage this woman?
This woman is suffering from stress incontinence. Stress incontinence can be diagnosed from the history – involuntary loss of urine
when the intraabdominal pressure increases
(such as with exercise or coughing). Urodynamic stress incontinence (formerly referred to as genuine
stress incontinence) is the involuntary loss of urine
when the intravesical pres- sure exceeds the
maximum urethral pressure in the absence
of a detrusor contraction and can
only be diagnosed after urodynamic testing.
·
Lifestyle
·
The
woman should be advised to control factors
that exacerbate symptoms:
·
reduce weight
·
stop smoking to relieve
chronic cough symptoms
·
alter diet and consider
laxatives to avoid constipation
·
Pelvic floor exercises: properly
taught pelvic floor
muscle training is a very effective
treatment and can cause improvement in symptoms or cure in up to 85 per cent of women.
The two main surgical techniques
used currently are:
·
transvaginal or transobturator
vaginal tape
·
colposuspension.
Both are effective but the former technique is minimally invasive
and recovery is there-
fore more rapid. Alternative techniques such as periurethral bulking injections can be
used in refractory cases or where the woman is unsuitable for surgery.
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