Female Stress Urinary Incontinence: Evidence-Based Approach

Case Study

A hypothetical case was developed based on the authors' experience and clinical expertise.

Initial Presentation

A 47-year-old para 3 Caucasian, mildly obese female presents to her health care provider with a complaint of urinary leakage. She describes progressively worsening UI for the past seven years. She indicates she has experienced UI occurring with forceful coughing and sneezing for several years; however, in the past year, she has had a number of respiratory infections that have exacerbated the condition. She is now wearing minipads on a daily basis. The patient has also noticed a worsening in her incontinence symptoms and vaginal dryness as she has progressed into perimenopause. She indicates that urinary leakage will occur daily with coughing, sneezing, straining, and occasional changes in position. The patient denies urinary urgency unless she has a very full bladder. She voids every three to four hours and experiences nocturia one time nightly. She ingests four to five sources of caffeine per day and smokes 10 cigarettes per day. Her medical history includes depression, hypertension, and asthma. The patient's current medications are fluoxetine (Prozac®) 40 mg, hydrochlorothiazide (Microzide®) 25 mg, albuterol (ProAir®) two puffs, and low-dose aspirin (Ecotrin®) 81 mg. Her past surgical history includes a Cesarean section x1, appendectomy, and total vaginal hysterectomy.