Year Woman With Explained for Students (Easy Guide)

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Original Question

A 65-year-old woman with a history of hypertension on amlodipine presents with worsening urinary incontinence episodes over the past year. She often has incontinence episodes and wears heavy pads to stop leaks. She says it initially happened when she coughed or sneezed, but lately, she has had episodes where she suddenly has the urge to urinate and cannot make it to the bathroom in time. She has had three normal spontaneous vaginal deliveries. She denies any particular neurological symptoms or uterine prolapse. Her vitals are BP 150/80, HR 75, RR 17, temp 98.6, O2 sat 98% on RA. Her exam is essentially unremarkable, in particular with a normal neurological exam. What treatment options should this patient be given initially? A. Refer to urogynecologist for sling procedure B. Recommend adult diapers C. Pelvic floor exercises, anticholinergics, and avoidance or reduction of alcohol and caffeine D. Place vaginal pessary

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