I Can't Seem To Control My Urine, I Feel Like I Have To Urin
I Cant Seem To Control My Urine I Feel Like I Have To Urinate All T
I Cant Seem To Control My Urine I Feel Like I Have To Urinate All T
“I can’t seem to control my urine. I feel like I have to urinate all the time. However, when I do go to the bathroom, I often pass only a small amount of urine. Sometimes I wet myself. I was started on a medication for my leaking a few weeks ago, but it doesn’t seem to be working.
I also can’t seem to remember anything. It is a wonder that I remembered to come to the clinic today.”
Assessment and Detailed Explanation:
Assessing the severity of urinary incontinence requires evaluating both subjective experiences and objective findings. In this case, the primary complaints include urinary urgency, frequency, and incontinence episodes that occur multiple times daily, with some instances leading to soiling of underwear. The patient reports using multiple panty liners and changing underwear several times a day, indicating a significant impact on her quality of life. Social withdrawal from volunteer work and activities further reflects the severity of her condition.
Subjectively, the patient experiences persistent symptoms without improvement despite medication with Detrol LA (tolterodine), a common antimuscarinic used to treat overactive bladder (OAB). Her episodes of incontinence include at least two to three daily occurrences, with no reported episodes of dry intervals between episodes, indicating high frequency. The fact that leakage occurs without warning suggests a degree of urgency and severity.
Objectively, the clinical examination corroborates her complaints. On physical exam, she has atrophic vaginitis, a common finding in postmenopausal women, which can contribute to irritative urinary symptoms. Her pelvic exam shows cystocele, which may contribute to her symptoms but is mild and not directly associated with the severity of her incontinence. A notable point is that her bladder scan shows no residual urine, indicating no significant post-void residual volume and ruling out some forms of overflow incontinence.
Further, her history of symptoms suggests urge incontinence, where involuntary bladder contractions lead to sudden leakage, especially with a high frequency. Her medication history, including the previous trial of Detrol LA, provides context for management assessment. Her worsening symptoms despite treatment reflect refractory urgency and incontinence, often categorized as severe incontinence.
In quantifying severity, clinicians often use patient-reported outcome measures, such as the Incontinence Quality of Life scale or severity grading scales like the International Consultation on Incontinence Questionnaire (ICIQ). Although not explicitly detailed here, her reported frequency (multiple episodes daily), impact on social life, and the need for frequent changes of undergarments signify a high severity level.
Overall, her symptoms can be classified as severe urinary incontinence due to the high frequency, significant impact on her daily activities, and refractory nature despite standard therapy. These factors point toward a substantial reduction in her quality of life and necessitate further assessment and tailored interventions.