Page 1 of 1: OSCE-Buster: Waterworks - History taking from female

pritlost · Credits: 1648 My Scrapbook

A woman who is 35 years old has come to see you. She has been complaining of problems with her waterworks. Take a history and explain management to her.’
First you have to take a through history to work out the potential cause of her problem:

Mrs Jones, I understand that you have been having problems with your waterworks. I need to ask some specific questions so that we can work out what may be causing it. From this we will be able to offer you treatment.

Stress Incontinence:

· Do you leak urine when you cough or sneeze?

· Do you ever leak when you are just walking?

· Do you have to wear pads to keep yourself dry? How many pads do you have to use in one day? – This gives an indication of severity.

· Have you any children?

· Were your children born by normal delivery? If yes, was it a prolonged labour?

· After you had your children did you practice pelvic floor exercises?

· Have you noticed any lumps/prolapse down below.

Urge Incontinence:

· When you feel like going to pass water, do you have to rush?

· Have you had any accidents?

· Do you feel as if you need to go straight after you have just been?

· Do you feel as if you have not completely emptied after passing water?

Urinary Tract Infection/Bladder Pathology :

· Do you have any burning on passing water?

· Any blood in your urine?

· What job did you do? – Perhaps she worked with dyes.

Diabetes:

· How many times do you pass water during the day/night?

· Do you feel thirsty?

· Have you lost any weight?

· Any family history of diabetes?

General:

· Are you on any medication?

· Have you had any back problems?

· Are you bowels normal?

· Have you lost any weight?

· Do you drink coffee/tea? – How much?

Then you need to explain the management to the patient. This would depend on the diagnosis.

Stress Incontinence: Mrs Jones, I think you have something called stress incontinence. Have you heard of this? Shall I explain to you about this?

Well, because you have had children this causes a weakness in your bladder. We all have a something called a sphincter at the base of the bladder. This holds urine in the bladder until you are ready to go. Unfortunately, childbirth can weaken this sphincter leading to leakage of urine when you cough or sneeze. This happens because when you cough/sneeze the pressure rises in your bladder.

We will send you to a specialist at the hospital who will do some tests to measure the strength of your bladder (urodynamic studies).

We can get this better. There are a number of ways. The simplest way is by doing some exercises called ‘pelvis floor exercises’. This strengthens this sphincter and prevents this problem. I can refer you to the physiotherapist for this.

The second thing we could try is some vaginal cones. The physiotherapist can teach you how to use these. Generally, you have to use a vaginal cone and the aim is that you tense your pelvic muscles to stop it from dropping. This way your pelvic floor muscles strengthen.

If this doesn’t work we can refer you to the specialist who can offer you some operations (transvaginal tape etc.) or some tablets.

Urge Incontinence: Mrs Jones you have something called urge incontinence. This happens because your bladder is only filling to a small amount and then it starts telling your brain to pass water. One way of treating this is by doing something called ‘bladder training’. Here a specialist physiotherapist will teach you to hold onto your urine for slightly longer each day.

Again there are tablets but we generally try the bladder training first. If you did take the tablets they have some side-effects like dry mouth. Also, if you have glaucoma you cannot take them.

We will send you to a specialist at the hospital who will do some tests to measure the strength of your bladder (urodynamic studies).

UTI: in all incontinence cases mention that you will do a fasting sugar and urine for culture and sensitivity to rule out for infections.

bookworm · Credits: 6218 My Scrapbook

thanks prit

friendy · Credits: 736 My Scrapbook

Pritlost! U do really gr8.

aliceinchains · Credits: 317 My Scrapbook

Thanks a lot! Great Job!

Fzab · Credits: 184 My Scrapbook

Hey Pritlost

Thanx alot..tht was really helpful:)

Best wishes

ultimatechamp · Credits: 2578 My Scrapbook

Prit...u r just 2 good!!that was of much help!

AUN · Credits: 2566 My Scrapbook

ok but certain qs were not asked with regard to obstructive complaints
mrs jones would u please tell me do u hav to wait for making m water
once u started do u hav to exert pressure to continue it
is the flow continuous
do u experience dribbling after that
do u find any discharge from ur below
thanks

dr999 · Credits: 2055 My Scrapbook

Great job done, thanks a lot.

For UTI, Mrs johns! We will give you some medication which are known as antibiotics.

As we will investigate other problems as well, so by finding the diagnosis we will give you apropriate treatment.

Kai1111 · Credits: 2036 My Scrapbook

If there is no evidence of infection......while waiting for Uro consult.....can we try some ditropin (oxybutynin).

side effects:
>10%
constipation
drymouth
somnloence

6-10%
asthenia(weakness or debility), blurred visn, diarrhea, dizziness, ha, nausea, pain, rhinitis

Not specified SEs
cycloplegia(loss of power in ciliary muscle of the eye), hot flashes, mydriasis, tachy

anticholinergic SEs are less with use of transdermal patch

babo7511 · Credits: 200 My Scrapbook

thanx good info

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