Case 059: Urinary Incontinence

PATIENT PRESENTATION

Chief Complaint

“I can’t go anywhere without wearing a pad, and the smell can be embarrassing.”

History of Present Illness

BW is a 76-year-old female with complaints of urinary incontinence. Her friend told her that Vesicare has helped her symptoms a lot, and BW is interested in trying it.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What type of urinary incontinence is BW experiencing? What led you to that conclusion?

   Hint: See Pathophysiology in PPP

2. What are some of BW’s risk factors for urinary incontinence?

   Hint: See Pathophysiology in PPP

3. What medication(s) may be exacerbating BW’s symptoms of incontinence? How do you suggest addressing this/these issue(s)?

   Hint: See Table 53-1 in PPP

4. Do you initiate solifenacin (Vesicare) today? Why or why not?

   Hint: See Table 53-3 and 53-5 in PPP

5. What non-pharmacologic recommendations do you have today to improve her symptoms?

   Hint: See Treatment in PPP

FOLLOW-UP

3 months later, BW returns to your clinic and notes that the non-pharmacologic interventions you recommended at her last visit have not helped. She insists on starting pharmacologic therapy. What would you like to try today?

Hint: See table 53-5 in PPP

CASE SUMMARY

Global Perspective

Urinary incontinence (UI) is a global issue that disproportionately impacts women, from young girls in developing countries experiencing post-partum UI to postmenopausal women experiencing urge or stress incontinence. Unfortunately, UI is often accompanied by shame, embarrassment, and reluctance to seek treatment across many cultures and countries. While patients are oftentimes requesting pharmacologic therapy by the time they seek treatment for UI, it is important to first determine the type of incontinence causing the symptoms. In many cases, medications with adverse side effect profiles (e.g., antimuscarinic drugs) are initiated when they are not indicated or where non-pharmacologic therapy should be attempted first.

Key References