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Assessing bladder dysfunction – taking a history

Watch this video for a demonstration of an example clinical assessment of a women with bladder symptoms.
Hello, Mrs Brown isn’t it? Yes. It’s lovely to meet you. My name’s Janice and I am one of the clinical nurse specialists in the Continence Service. And you’ve been referred to me today about your bladder problems, is that right? Yes. Right, I’ve been asked to do an assessment of your bladder problem and so I’m going to take you through the history and some of the symptoms and we’ll take it from there and try and get a way forward as to how best to help you manage this. Is that okay? Yes. I’m going to start with you just telling me about the symptoms you experience and what impact that has on your life. I’ve got a very busy job.
I have to get up really early in the morning because I work in a bakery. So, what happens is that I have to get up, really, quite a few times during the night because I have this urgent need to wee. Okay. So, I get up and I go and then I think back asleep, and then I need to get up and go so my sleep is really disrupted the whole night through. I start my work very early in the morning but you can imagine because we’re an old-fashioned type of bakery so we need to knead our dough thoroughly before we put it aside to prove and then get it in the oven.
And I get these enormous urges to wee right in the middle of it but it’s not something that I can stop. So, what happens then is that I wet myself and it’s awful. It’s just really embarrassing. So, what I’ve been doing is, I’ve been wearing these pads, you know, the ones that are advertised on telly. So that sort of works but it’s been getting ever worse and more urgent. I mean this problem originally started years ago after I had my kids so I had three kids in quite quick succession and I noticed that after childbirth and after each one, that little things would set this off, you know I would sneeze, and I’d get a bit caught short.
But recently this has just got much worse where, yes. Okay, so it’s a problem you’ve had for a long time. Yes. But in recent times, certainly with your job and things that you feel the symptoms are getting much worse. Yes. And the measures you’re taking aren’t really helping. You just get this urge to go and then before you know it you haven’t got time to get to the toilet. Okay. Well, what we’re going to do is we’re going to go through the assessment with you and we’ll see what comes out of that and then we’ll look at ways of how we can help you manage your condition.
One of the things I thought I could have is may be a prescription for pads and pants because it’s really expensive. It’s costing me a lot of money. Yes, that is certainly an option but what I would prefer to do is look at what the treatment options are first because there are so many good treatments out there that we might actually be able to help your condition so that you actually don’t leak as much, or don’t have the urges and that would be the first thing we’d look at. And I’m sure for you that would be preferable. That would be amazing.
So, it’s being going on for many years it’s not something that’s just happened suddenly in the last year or anything like that? No. No. What’s your medical history? Do you have any other medical conditions that I should know about? No. Any medication that you’re on at the moment? No. Any allergies to anything? No. You said you had three children can you remember about the births? Were any of the births particularly traumatic? No, the first one was quite longwinded so I ended up having, when I was pushing that nothing was happening. I remember pushing very hard and in the end, they had to use forceps and I also had a episiotomy as well and that was quite painful.
Any caesarean sections for any of your births? No. Okay, that’s fine. Do you still have periods? No, they finished just over a year ago. In the menopause now? Yes, I get some. Do you get symptoms of that? Not too bad. I’m a bit, not so good at temperature control which is not surprising. Okay, and you’re not taking HRT or anything like that at all? No. Okay. If I was to ask you how your bladder impacts on your daily life so from 1 to 5, so 1 being not at all to 5 being absolutely awful. On that scale where do you think that you would rate your symptoms? I think it’s between 3 and 4. Okay. It’s quite bothersome.
It’s always on my mind. Okay. Any pain when you pass urine? No. Any blood in your urine that you’re ever aware of? No. And would you go to the toilet would you have to pass urine more than seven times during waking hours? Yes, definitely. So, do you feel then that you’ve gone to the toilet and you come back and do you feel you’ve emptied your bladder fully when you’ve been to the toilet? I think so but obviously I don’t really know. I wear the pads because they save the embarrassment but I just really hate it. Well let’s hope we can do something about that.
And would you ever leak urine before you actually get to the toilet, would you ever not get there in time? Yes, I mean definitely when I’m working. And night time then the urge would waken you. Yes. To pass urine and are you able to get up and go to the toilet and would you get there in time during the night? Not always. Not always. Okay. So, thinking slightly differently if you, in your job, you said it’s quite labour intensive so it’s quite heavy, would the action of lifting any of the trays of bread cause you to leak urine? Yes. You’d feel a leak just on the exertion of..? Yes, that’s different, that’s not this urgent feeling, yes.
And which of those symptoms would you feel as the most bothersome to you? Is it the leakage when you would lift something or is it this constant urge that you’re describing? It’s the constant urge and being caught short because I suppose the leakage in a way is avoidable, but the being caught short isn’t, there’s nothing you can do about it. And whenever you are passing urine do you have any difficulty? Is the stream normal enough from your point of view is it difficult to get started to pass urine? No. There is no abnormality in that respect then you feel that you’re passing your urine okay. Do you have to push it out, do you have to strain to pass urine?
No. Okay. And do you think that when you think you’re finished, do you feel that any dribble after you think you’ve actually finished? No. You think you’re finished. Okay. So, you’re not wet all the time? No. And you know when urine is leaking out you’re aware that you are passing urine? Yes. Just asking about using the toilet would you always sit on a toilet? Do you hover over a toilet? I hover over toilets if they’re ones… When I’m out. If it’s not your own toilet. So, in public toilet then you would probably hover. Yes. Okay that’s fine. And you’ve no problem actually getting to the toilet mobility wise or removing your clothing? No. You’ve no difficulty in that respect? Okay.
I think what’s coming across is that the symptoms of urgency are more dominant than the symptoms of stress urinary incontinence that you’re describing. The stress urinary incontinence is leakage of urine whenever you’re lifting something and it’s just putting pressure on your pelvic floor. Or I sneeze. Yes. That would be a symptom of stress incontinence but what you’re saying is you’re having much more bother with the urgency and that would suggest that you have what we call an overactive bladder. Oh right. Because there’s no evidence that you have any infection. You can get those symptoms from having a urinary tract infection but there’s no evidence of that. So, it would appear to be that you have symptoms of an overactive bladder.
So, there is certainly ways that that can be treated and that is something that we can discuss. How do you feel about that? I feel very relieved to hear that there are things that you can do to make it… Yes, it’s common. It is certainly very common in women that are in the menopause. The main treatments that we use would be lifestyle. We would look at your lifestyle. We’d look at how you manage your bladder and get you back in control of your bladder and give you regular monitoring to try and help you to cope with that and get your life back.
So, it’s basically you controlling your bladder and not the other way round which sounds like has been the case. Yes.
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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

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