Woman who presents with complaint of inability to hold urine.
MP is a 55-year-old woman who presents with complaint of inability to hold urine. She describes incidents where laughing or coughing results in a small to moderate release of urine. She has started wearing Peri Pads to avoid embarrassment.
Past Medical History
• Six vaginal deliveries, all to full term
• Osteoarthritis
• Postmenopausal
Medications
• Boniva, 150 mg once a month
• Calcium, 500 mg daily
• Vitamin D3, one daily
Family History
• Mother, alive and well; hypertension, type 2 diabetes
• Father, deceased; cardiovascular disease, myocardial infarction at age 77
Social History
• No alcohol intake
• Previous smoker
• Walks 2 miles/day
Physical Examination
• Vital signs normal
• Palpation of uterus suggests enlargement
Labs
• Liver function: Normal
Discussion Questions
1. What factors in MP's history would help support a diagnosis of overactive bladder?
2. The clinician prescribes oxybutynin 10 mg (extended-release). What does MP need to know about this drug?
3. If oxybutynin is ineffective, the clinician could use mirabegron, a beta-3 agonist. What does MP need to know about this new drug?
Sample Solution
1. Factors Supporting Overactive Bladder Diagnosis:
Several factors in MP's history support a diagnosis of overactive bladder (OAB):
- Symptoms: MP describes involuntary urine leakage (stress incontinence) triggered by activities that increase abdominal pressure like laughing or coughing. This is a classic symptom of OAB.
- Age: OAB is more common in older adults, and MP is 55 years old.
- Childbirth: Multiple vaginal deliveries can weaken pelvic floor muscles, contributing to OAB. MP has a history of six vaginal deliveries.
- Postmenopausal: Decreased estrogen levels after menopause can weaken pelvic floor muscles and contribute to OAB symptoms.
Full Answer Section
2. Information about Oxybutynin 10mg (extended-release):
Here's what MP needs to know about oxybutynin:
- Mechanism of Action: It relaxes the bladder muscle, reducing involuntary contractions and improving urine storage.
- Effectiveness: Oxybutynin is a common and effective treatment for OAB.
- Side Effects: Dry mouth is a common side effect. MP may experience constipation, dizziness, or blurred vision.
- Dietary Considerations: Oxybutynin may work better on an empty stomach. However, it can cause stomach upset, so taking it with food might be necessary.
- Importance of Reporting Side Effects: MP should inform her doctor if any side effects are bothersome or worsen.
- Driving and Activities: Oxybutynin can cause dizziness, so MP should be cautious while driving or operating machinery until she knows how it affects her.
3. Information about Mirabegron (Beta-3 Agonist):
If oxybutynin is ineffective, mirabegron might be considered. Here's what MP should know:
- Mechanism of Action: Mirabegron works differently than oxybutynin. It relaxes the bladder muscle by a different pathway, increasing bladder capacity.
- Side Effects: High blood pressure is a potential side effect. MP should monitor her blood pressure regularly. Other possible side effects include headache, dizziness, and constipation.
- Drug Interactions: Mirabegron can interact with some medications. MP should provide her doctor with a complete list of medications she takes.
Additional Notes:
- Pelvic floor muscle exercises (Kegels) can be helpful for strengthening pelvic floor muscles and improving OAB symptoms.
- Lifestyle modifications like managing fluid intake, avoiding caffeine and alcohol, and emptying the bladder regularly can also be beneficial.
It's important for MP to discuss these points with her doctor to gain a full understanding of the medications and treatment plan for her OAB.