A 74-year-old woman presented to the geriatric clinic with complaints of urinary incontinence that had progressively worsened over the past year. She reported episodes of leaking urine, especially when she laughed, coughed, or sneezed. The incontinence was becoming increasingly bothersome, leading to embarrassment and social withdrawal. She mentioned having to wear protective pads during the day and frequently waking up at night to urinate, which disrupted her sleep.
The patient had a medical history of hypertension and osteoarthritis but denied any recent urinary tract infections or changes in bowel habits. A review of her medications revealed that she was taking an antihypertensive and a nonsteroidal anti-inflammatory drug (NSAID) for her arthritis. She expressed concerns about her mobility, as she was hesitant to engage in social activities for fear of experiencing incontinence.
During the physical examination, the patient appeared well-nourished but somewhat anxious. A bladder diary revealed that she had significant daytime urgency and an increased frequency of urination. A physical exam indicated pelvic floor weakness, and a cough stress test demonstrated involuntary leakage of urine. After discussing the diagnosis of stress urinary incontinence, the geriatrician recommended a comprehensive management plan, including pelvic floor exercises (Kegel exercises), bladder training, and lifestyle modifications such as weight management. The option of referral to a pelvic floor specialist for biofeedback therapy was also discussed. Additionally, the patient was advised to reduce caffeine intake, which might exacerbate her symptoms. A follow-up appointment was scheduled in three months to monitor her progress and consider further treatment
options if necessary.