5/16/2017 Clinical: Case Study: Urinary Incontinence - OurMed

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OriginalmaterialscreatedinAugust1998byTamaraG.Bavendam,M.D.
TreatmentsandProcedures
Contents[hide] Drugs
1History
2Exam FirstAid
3Discussion
4Plan1 HealthCareIssuesandPolicy
4.1ONEWEEKFOLLOWUP
5Plan2 ClinicalResearchandTrials
5.1SiwWeekFollowUp
6ListofPotentialBladderIrritants InternationalHealth
7References
EnvironmentalHealth

History VeterinaryMedicine

Organizations
Ms.EQisa56y/oCaucasianfemalewithasixmonthhistoryofacuteonseturgerelatedurinaryincontinence.She
denieddysuria,hematuria,senseoffecalurgencyorfecalincontinence.Previousurinalysisrevealednoevidenceof DiagnosticTest/results
bladderinfection.Shehasnoongoingmedicalillnessesanddoesnottakemedicationonaregularbasis.Shedenies
BasicScience
anyglobalorlocalizingneurologicalsymptoms.
MedicalSpecialties
ShehadthreeCsectionsandahysterectomyremotelyforlocalizeduterinecancer.Shehasnotbeenonhormone
Dentistry
replacementtherapyandisnotcurrentlysexuallyactive.
Journals

Others

http://www.ourmed.org/wiki/Clinical:_Case_Study:_Urinary_Incontinence 1/4
 5/16/2017 Clinical: Case Study: Urinary Incontinence - OurMed

Sheisemployedinsalesandherjobinvolvesextensivedriving.Shedrinkscoffeeandcaffeinatedsodastostayalert.
Sherarelydrinksmorethansipsofwater.Shehasneverusedtobaccoproducts. Directories

Physicians
Exam Hospitals

Herurinalysisisnegativeforbloodandevidenceofinfection.Ultrasoundestimationofpostvoidresidualurinewas
Toolbox
negligible.
BecomeaPublisher
Abdominalexaminationrevealsamoderatelyobeseabdomenwithactivebowelsoundsandnopalpablemasses.
AddanArticle
Vaginalexamrevealedatrophicexternalgenitaliaandvaginaltissues.Shehadgoodanatomicsupportofherbladder
andurethraandnoevidenceofenterocele,vaultprolapse,orrectocele.Shewasabletoperformaweakand Whatlinkshere
unsustainedvoluntarycontractionofpelvicfloormuscles.Herbulbocavernosusreflexwasintact.Analtonewasnormal.
Relatedchanges

Herscreeningneurologicalexamination(perinealsensation,analtone,lowerextremitysensationandreflexes)was Specialpages
unremarkable.
Printableversion

Discussion Permanentlink

Browseproperties
Acuteonsetofurgerelatedincontinencecanbesecondarytoabladderinfectionwhichareoften,butnotalways
associatedwithsymptomsoffrequencyanddysuria.Astheurinalysisshowsnoevidenceofinfection,herhistoryof AddHospitalListing
acuteonsetofurgeincontinenceshouldraisesuspicionforneurogenicetiology.Intheabsenceofanyhistoryor
AddPhysicianListing
physicalfindingssupportinganeurologicalevent,thereisnoneedtoimmediatelypursueanextensiveneurological
assessment.Theabsenceofbloodintheurineandthefactthatsheisanonsmokermakesitunlikelythatthereisan
underlyingbladdermalignancycausingthesymptoms.Shehasnopostvoidresidualmakingabladderemptying SearchArticles
dysfunctionunlikely.

Oncetheseriouspotentialcausesareeliminated,attentioncanbeturnedtootherpotentialcausesandcontributing
factors.Herbehaviorofdrinkingsignificantamountsofcaffeinatedcoffeeandcolascanbeanunderlyingsourceof
thesesymptoms,especiallywhencombinedwithatrophicurogenitaltissues.Itisalsoimportanttoknowwhathersafe
Contributor(s)
bladdercapacityisvolumesvoidedwhenshegetstothetoiletintime.
DJoiner
Plan1
ShewasaskedtokeepaBladderDiaryrecordingthetimeandvolumeofurinationsincreaseherwaterintakeand
decreaseherintakeofcoffeeandsodaandreturninoneweektogooverherdiary.

ONEWEEKFOLLOWUP

Herdaytimebladdervolumesare200500ccandnighttimevolumes200300cc.Shehadnoticedlessurgencywith
increasedwaterintake.

Plan2

http://www.ourmed.org/wiki/Clinical:_Case_Study:_Urinary_Incontinence 2/4
 5/16/2017 Clinical: Case Study: Urinary Incontinence - OurMed

Begintopicalestrogenandlowdoseanticholinergiceachmorningandfollowupinsixweeks.

SiwWeekFollowUp

Herfrequencyandurgeincontinencealmostresolved.Shehaddramaticallydecreasedhercoffeeandsodawhile
increasingherwater.Noproblemswithtopicalestrogen.Shehadnotfilledherprescriptionfortheanticholinergics.Her
symptomswerecompletelymanagedwithtopicalestrogenreplacementandbehavioralchangesinherfluidintake.Itis
importanttonotethatdecaffeinatedcoffeeandsodascanalsobeirritatingtothebladdertheacidityisan
independentfactortothecaffeine.

ListofPotentialBladderIrritants
(acidicandhighpotassiumfoods)ACIDICFOODSANDBEVERAGES

AvoidoruseinmoderationAtleasthalfoffluidintakeeverydayshouldbenoncarbonatedwater.

Allalcoholicbeverages
Applesandapplejuice
Coffeeevendecaffeinated
Cantaloupe
Carbonatedbeverages
Chocolate
Citrusfruitsandjuices
Cranberriesandjuice
Grapes
Lemon
Onions
Peaches
Pineapple
Plums
Spicy/hotfoods
Strawberries
Teaevendecaffeinated
Tomatoesandtomatobasedproducts
Vinegar

Whenbladdersymptomsarecausedbydietaryfactors,avoidingtheabovefoodproductscombinedwithmaintaininga
goodwaterintakeshouldbringimprovementinsymptomswithin710days.Theproofisreturningtoprevioushabits
andexperiencingreturnofthesymptoms.Oncesymptomsarebetter,foodscanbeaddedbackoneatatimetoidentify
whatproductsaremostlikelytocausesymptoms.ITISCRUCIALTOMAINTAINAGOODWATERINTAKE!!!

References

http://www.ourmed.org/wiki/Clinical:_Case_Study:_Urinary_Incontinence 3/4
 5/16/2017 Clinical: Case Study: Urinary Incontinence - OurMed

TamaraG.Bavendam,M.D.President,ACWHP
CenterforPelvicFloorDisorders
Philadelphia,PA

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