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Case study: Susan who has stress incontinence
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Case study: Susan who has stress incontinence

In this video interview, 'Susan' talks about how stress incontinence affects her life.
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Every time I coughed, I really could not hold on the urine at all and it really used to come gushing out. I can remember sitting on the settee and coughing away, I could feel that I was losing urine and then I was frightened to stand up because I just didn’t know how far it had come through my clothes and I’d even had different absorbent pads. I’d gone from a low one to a medium and in the end, I got quite a high absorbency pad because I was so concerned about it coming through and showing through on my clothes. And there’s also the concern that it’s smelling as well. Not particularly comfortably, particularly when you’ve had a large loss of urine.
52.7
What I tried to do was, I’ve always felt I’ve got a large capacity bladder and I can go quite a few hours without going to the toilet but through these last few months with the stress incontinence, I’ve made a conscious effort to go to the toilet more to keep my bladder empty, so that I’m losing less urine when I actually cough. It’s not a nice thing to feel that you’re wet, that you’ve got to wear a pad and you want to feel in control of your bladder.
91.8
Sometimes after I’ve coughed and leaked urine, I was frightened to stand up just in case it had come through onto my clothes and people could see a damp patch, so yes it does impact on your daily life. It didn’t stop me from going out but I always made sure I went to the toilet last thing before I went out and also I made sure I put a clean pad on so I’d got a bad with a good amount of absorbency in it before I went out.

In this step, we meet ‘Susan’ again who is the second of our four case studies of people with different types of bladder dysfunction. Susan has stress incontinence.

In this video interview Susan talks about how having stress incontinence affects her life.

Susan is a 65 year old woman, grandma to Jake 7 years old and Emilia 18 months old. She looks after her grandchildren three days a week.

Susan is a retired teacher and she had two children herself. Her eldest, Tom, was born when she was 25. He weighed 8lb 12oz (3.97kg). It was a difficult labour, Tom was eventually delivered by forceps, and Susan had a tear which needed suturing.

Helen was born eight years later. She was a smaller baby weighing 7lb 5oz (3.32kg). She was delivered very quickly and Susan only needed a few sutures.

Susan has always been an active busy person but she has experienced odd episodes of stress incontinence over the years since the birth of her first child. She has been doing pelvic floor exercises which, until recently, have helped her to manage her bladder control.

She has been aware that the incidence of leakage was gradually becoming more frequent and at times was more than a dribble and this has made her vulva sore and itchy. She had a chest infection a few weeks ago and has been devasted a few times when urine has gushed, especially when coughing, but also when lifting Emilia and playing at the park with her grandchildren.

Susan has stopped going to the gym as she is frightened she might leak and someone would see.

She is still doing pelvic floor exercises and she can still feel something is happening, but she is not as confident about her technique as she once was and is worried the problem is getting worse.

She is aware that her bladder problem is affecting her family and social life and she does not want to wear pads. She is considering making an appointment to see her GP.

Your task

Read the case study and answer the following questions:

  • Why is the diagnosis for Susan stress incontinence?
  • From the obstetric history, what factors could contribute to the continence problems Susan is experiencing?
  • How do you think Susan’s bladder problems are affecting her life?
  • What factors could be contributing to her symptoms of stress incontinence?
  • Why do you think people in Susan’s situation often do not seek help straight away?
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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

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