| · A 73-year-old Caucasian female P2+0 presented with a two-year history of increased daytime urinary frequency and urgency.
· She has also been experiencing nocturia where she voids at least thrice every night, which disrupts her sleep.
· The symptoms have further worsened as she currently experiences a sudden urge to void and has occasional urinaryincontinence with structured physical activity.
· She has also been changing three pads a day and complains ofsuperficial dyspareunia.
· In the last year, she has also had mild constipation and three episodes of urinary tract infections (UTI).
· The patient denies being on overactive bladder medications and hormonal replacement.
· Her medical history includes, hypertension, UTIs, and an appendectomy done in 1998.
· She is currently on Cardura 2mg daily and furosemide 20mg daily.
· She is allergic to penicillin.
· Her obstetric history includes:
i) Forceps-assisted vaginal delivery in two pregnancies.
ii) Menarche was attained at 14 years and her last menstrua period was 25-years ago.
iii) There is no history ofsexually transmitted infections (STDs) and her last pap smear was done when she was 67- years-old.
iv) There is no history of contraceptive use.
· Barbara currently lives alone and is a retired schoolteacher.
· She takes 1-2 glasses of red wine every night but denies recreationaldrug use.
· She plays bingo thrice weekly and participates in structured physical activities, such as playingPickle ball and Pilates 3-4 times weekly.
· Her mother died at 79 years following a cerebrovascular accident at 79-years of age while her father died at 72 years following a myocardial infarction. |
· Vital signs: BP- 133/68, P- 68, RR- 16, T-97.3, Weight-134lbs, Height-64 inches, BMI-23 kg/m2
· A pelvic exam revealed marked urogenital atrophy with no ulcerations, urine leakage when Barbara was asked to cough, uterine descent into vagina up to the introitus, bladder descent up to theopening of the vagina, and rectum was halfway to hymen. |
· A urinalysis to screen for an UTI as the patient is predisposed to the condition(Pietropaolo, 2023).
· Basic Metabolic Panel to assess the patient’s renal function.
· Fasting blood sugar-to evaluate for the current blood sugars.
· Pelvic ultrasound as an imaging test to evaluate pelvic organ position within the pelvis (Barbier et al., 2023).
· Abdominopelvic MRI as an additional imaging test. |
Pelvic Organ Prolapse (POP)
· This is a condition that occurs where there is descent of the pelvic organs, including the bladder, urethra, uterus, cervix, vagina, and rectus, towards theintroitus.
· It occurs when there is weakness in the supportive structures including the muscles or ligament(Raju et al., 2021).
· Previous pelvic surgery, multiparity, and postmenopausal state predispose women to POP.
· As a result, patients with POP may experiencea bulged or fullness sensation in the vagina, pelvic pressure, groin pain, low back pain, dyspareunia, constipation, urinary or fecal incontinence, and sexual dysfunction, as seen in Barbara’s case(Barbier et al., 2023).
Urinary tract
infection.
· The patient has had three UTI diagnosis in the last year and is currently experiencing increased urinary frequency, urgency, and incontinence commonly seen in patients with UTIs (Pietropaolo, 2023).
Diabetes mellitus (DM)
· DM can affect the structure and function of the lower urinary tract resulting in bladder storage symptoms, such as increased daytime urinary frequency, nocturia, urgency, and incontinence (Blair et al., 2022).
· The condition alsopredisposes the patients to frequent UTI infections, as seen in Barbara’s case. |
POP
a) Supportive therapies include:
i) Vaginal pessary rings
ii) Kegel pelvic exercises
iii) Topical estrogen creams
iv) Dietary changes to high fiber diets to relieve constipation(Raju et al., 2021).
b) Reconstructive surgeries, such as hysterectomy or a surgical mesh.
c) Psychotherapy to manage the psychological stress associated with the condition.
UTI
· Nitrofurantoin 100 mg PO QID for a week.
DM
· Metformin 500 mg PO OD(Blair et al., 2022). |
· Barbara’s is a 73-year-old female who despite living alone, has an active social life as she plays Bingo, Pilates, and pickle ball with friends. Engaging in such social activities in promoting her social and mental wellbeing.
· It may also be crucial to evaluate whether there are any available healthcare units in Barbara’s neighborhood that can provide health education and services to her in a more convenient manner (Chelak et al., 2022).
· Barbara is a retired teacher and additional healthcare costs may place a financial strain on her. |
· Gynecologist to evaluate Barbara’s best treatment option and to assess her gynecological health (Raju et al., 2021).
· Physiotherapists to train Barbara on different pelvic floor exercises she can use (Carroll et al., 2022).
· Nephrologist: to assessing renal function following the three previous UTIs and is currently experiencing some urinary symptoms(Pietropaolo, 2023).
· Psychologist to evaluate the psychological impact of the symptoms. He may also be crucial in strengthening Barbara coping strategies during treatment.
· Nutritionists to provide appropriate meal plans that can help relieve the patient’s constipation and some bowel symptoms.
Patient education
· It is crucial to educate Barbara what POP is, its symptoms, causes, and the different treatment methods available to enable her understand the condition she has.
· One also needs to inform the importance of the Kegel exercises, vaginal pessaries, and diet modification in managing the POP symptomatology(Carroll et al., 2023).
· One also needs to inform her that one of the treatment modalities available is hysterectomy and reassure her that the procedure will not interfere with her sexual function.
· I would also encourage her to avoid taking alcoholic drinks and to continue engaging in her social and physical activities. |
