TEALE FENNING

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

You are in the Gynae Clinic.
PR, a 75-year-old woman presents with chief complaint of urinary frequency, urgency, nocturia, and urge incontinence. She's had these symptoms for about 7 years, but had not sought treatment because she thought it was "just a fact of getting older...the same with my memory."

Counsel her .

Abik · Posted: Sun Apr 29, 2007 10:30 am Post subject:

History

more detail of her symptoms, any stress incont?
affect on life
symptoms of prolapse?
bowel OK?
drinking habits - amounts,what and when

dysuria/haematuria?

gynae hx? - has uterus/ovaries?
menopause, HRT incl. topical
PMB
smear history (10 yrs ago)

obs - parity and outcomes
PMH - fitness for GA, chronic cough?, SH
DH - incl allergies
SH - sexually active, who at home, frailty, daily activities, smoker

o/e - BP, urinalysis, , abdominal masses, bimaunal pelvic masses, size of uterus, spec prolpase? stress incont? atrophy
ix - urinalysis, MSU and cytology

discussion
if only OAB symptoms and nothing suspicious
"the bladder often misbehaves in women when we get older - usually through years of abuse and running around afetr everyone else in our lives! The problems that you have are suggestive that the bladder muscle is contracting whenever it feels like it and not when you tell it to. (draw a picture!). There are many effective ways to help with your symptoms and the most effective is going to require some work on your part I'm afraid. We need to moderate your fluid intake so that you are only drinking to thirst and not more than 2 litres/day. It may also be helpful to reduce your fluid intake in the evening to stop you needing to empty so much at night. You should completely avoid caffeine - which means tea, coffee and coke. Try decaffeinated tea if you want.
The next thing we have to do is re-teach your bladder to feel relaxed when it is filling up with urine and not contract until we are ready. This is more tricky and requires you to prolong the time until you rush to the toilet little by little. It may be that at first you can only hold an extra minute or two but this is fine. You may also find more accidents initially but this will improve with time. I have some written information here on bladder re-training. If you are having difficulties we can involve a specialist bladder nurse who can help.
There should be a noticeable difference in the next few months. If needed, there are some tablets which can compliment the training and we can consider adding these as necessary. If these don't work very well we may also consider doing a little test where we fill your bladder up with fluid and measure the pressures in your bladder. We have sent some urine to the lab and if there is anything in the urine we may consider looking inside your bladder with a camera.
Bladder problems of this kind are very common and I want you to know that the vast majority of women have a radical improvement in their symptoms eventually. It may take a little time so don't give up.
Do you have any questions?