Case study: Susan who has stress incontinence

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?