What kind of incontinence is this

[maixungphong]

A 45 y/o G3P3 came into your clinic because she was having urinary incontinence. Her internal medicine doctor put her on Detropan (oxybutynin) but it did not get better. She stated that when she coughs, sneezes, or laughs she leaks urine.

What type of urinary incontinence is this? Is Ditropan a good choice for this incontinence?

[jagian]

The patient is having stress incontinence.
ditropan or oxybutinin wont be useful in this case. instead it will be useful in case of hypertonic urge incontinence. For stress incontinence kegels exercise, or surgical therapy like urethropexy (MMK procedure ) can be done. or tension free vaginal tape procedure can be performed.

[student-2]

Not enough info!!!! Can she stop the leakage when it starts? If yes then it's GSI if not it can be detrusor dyssynergia which is ussually associated with leakage in the supine position and of large amounts of urine.
If it is dyssynergia the treatment is good but not enough. It requires also bladder retraining and also some other meds that I don't remember which right now

[veleznic]

Just for what you said about the clinical it sounds more like stress incontinence.

[manleyjb]

Stress it is. Could possibly be something more complicated than this however for board purposes it is Stress.

[AUCMD2006]

Originally Posted by manleyjb

Stress it is. Could possibly be something more complicated than this however for board purposes it is Stress.

i agree for step 2 it is stress ioncontinence. they will also likely ask what simple tests can you do or what is the next step in evaulation and you should know the cotton swab test and the degree of change needed to diagnose

also you can use estrogen cream, alpha blockers, tca's to increase outlet tone. when all else fail do surgery