Gynea Stuff
9/18/2009
CASE PRESENTATION #1
URINARY INCONTINENCE
Clinical Clerkship Lecture Series
Mrs. V.M.
44 year old female GTPAL 44004 referred by her family doctor with urinary by her family doctor with urinary incontinence. What questions would assist you in making a diagnosis?
Urinary Incontinence - History
• Duration, severity, onset
• Aggravating and relieving factors
• Associations (eg. Cough, laugh, sneeze,
(eg Cough laugh sneeze related to physical activity?)
• Urinary urgency, frequency
• ?pads
• Interfering with life—normal activities?
Urinary Incontinence - History
•
•
•
•
Obstetrical history
Menstrual history
Menopause
Other medical illnesses—diabetes, neurological disorders, prior pelvic surgery
• Family medical history
• Vocational history--?heavy lifting
• Medication list
Urinary Incontinence - History
•
•
•
•
•
•
•
•
UTI, dysuria, hematuria
Nocturia
Enuresis
Small or large urinary losses
?continuous loss (WATT)
Weight changes
?prolapse symptoms
Fecal incontinence, constipation, diarrhea
Case #1 – Actual History
• Mrs. V.M.
44 year old female GTPAL 44004 with 6 year history of progressive urinary loss with cough, laugh, sneezing and exercise. Now needs pads. Interfering with life. Normal lif urinary frequency. Loss of small volumes only. No recent urinary tract infections. Large babies delivered vaginally, first required forceps and had associated tears. UI worsened after last delivery. Has a sensation of pelvic pressure. Still menstruating regularly. No associated bowel symptoms or weight changes. Interested in your advice—has heard about “pelvic exercises”.
1
9/18/2009
Urtinary Incontinence – Physical
Examination
What aspects of the physical examination are important to establishing diagnosis in are important to establishing a diagnosis in this patient?
Urinary Incontinence – Physical
Examination
• Vitals
• General physical exam and neurological exam lower
CASE PRESENTATION #1
URINARY INCONTINENCE
Clinical Clerkship Lecture Series
Mrs. V.M.
44 year old female GTPAL 44004 referred by her family doctor with urinary by her family doctor with urinary incontinence. What questions would assist you in making a diagnosis?
Urinary Incontinence - History
• Duration, severity, onset
• Aggravating and relieving factors
• Associations (eg. Cough, laugh, sneeze,
(eg Cough laugh sneeze related to physical activity?)
• Urinary urgency, frequency
• ?pads
• Interfering with life—normal activities?
Urinary Incontinence - History
•
•
•
•
Obstetrical history
Menstrual history
Menopause
Other medical illnesses—diabetes, neurological disorders, prior pelvic surgery
• Family medical history
• Vocational history--?heavy lifting
• Medication list
Urinary Incontinence - History
•
•
•
•
•
•
•
•
UTI, dysuria, hematuria
Nocturia
Enuresis
Small or large urinary losses
?continuous loss (WATT)
Weight changes
?prolapse symptoms
Fecal incontinence, constipation, diarrhea
Case #1 – Actual History
• Mrs. V.M.
44 year old female GTPAL 44004 with 6 year history of progressive urinary loss with cough, laugh, sneezing and exercise. Now needs pads. Interfering with life. Normal lif urinary frequency. Loss of small volumes only. No recent urinary tract infections. Large babies delivered vaginally, first required forceps and had associated tears. UI worsened after last delivery. Has a sensation of pelvic pressure. Still menstruating regularly. No associated bowel symptoms or weight changes. Interested in your advice—has heard about “pelvic exercises”.
1
9/18/2009
Urtinary Incontinence – Physical
Examination
What aspects of the physical examination are important to establishing diagnosis in are important to establishing a diagnosis in this patient?
Urinary Incontinence – Physical
Examination
• Vitals
• General physical exam and neurological exam lower