For Student

An elderly woman with hypertension is attending the surgery for regular assessment of her blood
pressure. On this occasion her daughter attends as well and mentions that the family is very
concerned about the patient’s apparent incontinence of urine. The daughter goes on to say that her
mother’s house and clothing have now developed a constant smell of urine. On direct questioning,
the patient makes light of this problem. She seems sensible.

Tasks:

How would you proceed?

Student’s name
For examiner
An elderly woman with hypertension is attending the surgery for regular assessment of her blood
pressure. On this occasion her daughter attends as well and mentions that the family is very
concerned about the patient’s apparent incontinence of urine. The daughter goes on to say that her
mother’s house and clothing have now developed a constant smell of urine. On direct questioning,
the patient makes light of this problem. She seems sensible.
Task 1 (3.5) Urinary incontinence is a common problem in old age and is often unreported. The
reasons for this reluctance to seek medical advice are multifactorial and include embarrassment
and a belief that nothing can be done or that it is an inevitable consequence of ageing. Health-care
professionals may fail to enquire about the symptom or, if it is mentioned, may feel unable to
intervene in an effective manner.
Task 2 (3.0) The first step is to secure the patient’s confidence and trust. An approach by the
practice nurse may be a more successful first step to gain an initial history and preliminary
assessment. It will be important for the nurse or doctor to emphasize that assessment is relatively
simple and that an effective treatment is very likely. Even if cure is not feasible, improvement or
containment of symptoms is certainly possible.
Task 3 (3.5) The initial assessment should include a thorough history and examination (note rectal
and vaginal examinations), paying particular attention to medications and any gynaecological or
neurological symptoms and signs. Urinalysis, urine culture and bladder scan (to assess bladder
emptying and residual volume) are also essential steps in the assessment. Most assessments can be
completed in a general practice setting, and measures can be instituted to improve the common
conditions of urge and stress incontinence. The advice of a continence nurse specialist is useful for
the treatment of complex cases and where a more detailed knowledge of containment devices and
pads is required.

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