Return to Scenario ListShow Learning Points most relevant to Phase 1:

Urinary incontinence in women

Clinical Discipline(s)/Organ System(s)
Genitourinary System, Obstetrics & Gynaecology, Urology
Progress Test Topic(s)
Women's health
A 53 year old NZ European woman presents to her GP with a 2 year history of losing control of her bladder. She had three vaginal births. She has to wear urinary incontinence pads daily. This has had a negative impact on her work and mood.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy and function of the lower urinary tract and pelvic floor
   - Normal micturition cycle, including autonomic and conscious controls of continence
   - Risk factors for urinary incontinence
   - Pharmacology of anticholinergic medications and local oestrogens
Clinical and Communication Skills 
   - History from a woman with urinary incontinence; differentiate stress, urge, mixed and neurological
   - Gynaecological examination including abdominal, vaginal and speculum examinations when indicated (including stress test and pelvic floor tone)
   - List the local and systemic causes of urinary incontinence
   - Interpret midstream urine and urinary diary
   - Knowledge of specific urogynaecological investigations such as cystometry, urodynamics, post void residual
   - Management of urinary incontinence: conservative, bladder retraining, medical, use of adjuncts (pessary, hormone therapy, continence aids), surgery
   - Recognise the common presenting features of a neurodegenerative condition
   - Preventative strategies for avoiding future urinary incontinence
Personal and Professional Skills 
   - Appreciate the role of the continence specialist nurse and physiotherapist for pelvic floor strengthening
   - Discussions around personal topics
   - The possible social isolation, loss of employment and wider psychological consequences of incontinence
   - Intimate examinations and use of a chaperone
Population Health 
   - Epidemiology of urinary incontinence
   - Service provision for incontinence
Conditions to be considered relating to this scenario
stress incontinence, urge incontinence, urinary tract infection, urogenital atrophy, urethritis/vaginitis, drugs (e.g. diuretics), diabetes mellitus, decreased mobility, lifestyle factors (e.g. caffeine intake)
Less common but 'important not to miss'
multiple sclerosis, tetra/paraplegia
psychological, metabolic (e.g. hypercalaemia), diabetes insipidus, cauda-equina syndrome