At age 40, Ms. Blair could easily be mistaken for a woman in her late 20s....

At age 40, Ms. Blair could easily be mistaken for a woman in her late 20s. She was fit and thin, a committed long-distance runner, and a mother of two boys. She was also embarrassed to describe her reason for coming to her physician. For several months, each time Ms. Blair finished her run, she felt an uncontrollable urge to urinate. This happened as soon as she stopped running. She would try to suppress the urge, but could not, and would void a small amount of urine while still dressed in her running clothes and before she could enter her home. This did not happen at any other times during the day, or at night—it only occurred the moment that she ended a run. In addition to feeling uneasy about discussing the problem, she was anxious, because she thought she might have a tumor. She had no known health problems, took no medications, did not smoke, ate a healthy diet, and assumed that this problem came “out of the blue” because she must have a serious condition such as a tumor in her urinary tract. A cystourethrogram, or X-ray of the bladder, was obtained, along with urinalysis and urine cultures. Physical examination was normal. The main diagnostic aid was the history, particularly the details about exactly when incontinence occurred. Ms. Blair did not have the incontinence risk factors of being overweight, smoking, or other diseases, but she did have two risk factors: female gender and advancing age. In addition, changes resulting from pregnancy can weaken the sphincter muscle. 1. What type of incontinence did Ms. Blair have? Why? 2. The physician decides on a conservative management strategy for Ms. Blair. Which technique would the physician be most likely to use? A. A pessary B. Pelvic floor muscle exercises C. Botulinum toxin type A (Botox) injections into the bladder muscle D. An implanted sacral nerve stimulator.

Solutions

Expert Solution

1.Incontinence is the involuntary leaking of urine ,when one loses control over the bladder.It is more common in older people especially women.There are two types of incontinence stress urinary incontinence and urge incontinence.

Stress incontinence occurs when a person coughs,sneezes or laugh or exert pressure on the pelvic floor.

Urge incontinence occurs when a perso have asudden and intense urge to urinate.Mrs Blair is experiencing stress incontinence ie urine leaks out when you sneeze or run.

2.Pelvic floor excercise will be the preferred treatment as she is not having any additional risk factors.Strengthening of the pelvic floor muscles have a great impact in controlling stress incontinenceThis excercises need to be continued for atleast five times a day.An electrical stimulation or heavier vaginal cones are used to work for very weak muscles.is only a second option if the first one didnt work out.Running itself does not cause stress incontinence but it ncreases the pressure on the bladder which may cause leaking.Taking injections of Botux is complicated as it requires cystoscopy ,which is an inconvenient procedure which requires antibiotic prophylaxis and can cause cuts and tears.it is also difficult to administer.So option B will be better for Mrs Blair

Nightingale answered 1 year ago

Next > < Previous

Related Solutions

Julie Brown is in her late 20s. She is renting an apartment in the fashionable part...

Julie Brown is in her late 20s. She is renting an apartment in the fashionable part of town for $1,200 a month. After much thought, she’s seriously considering buying a condominium for $175,000. She intends to put 20 percent down and expects that closing costs will amount to another $5,000; a commercial bank has agreed to lend her money at the fixed rate of 6 percent on a 15-year mortgage. Julie would have to pay an annual condominium owner’s insurance...

5.3 Julie’s Rent-or-Buy Decision Julie Brown is in her late 20s. She is renting an apartment...

5.3 Julie’s Rent-or-Buy Decision Julie Brown is in her late 20s. She is renting an apartment in the fashionable part of town for $1,200 a month. After much thought, she’s seriously considering buying a condominium for $175,000. She intends to put 20 percent down and expects that closing costs will amount to another $5,000; a commercial bank has agreed to lend her money at the fixed rate of 6 percent on a 15-year mortgage. Julie would have to pay an...

A medical assistant calls in her patient, an African American transgendered woman (in her late 40s)...

A medical assistant calls in her patient, an African American transgendered woman (in her late 40s) to take a patient history, blood pressure, weight, and other vitals before she sees the physician. The assumption is that she is of middle class economic status. The medical assistant notes in her history that she is in the process of transitioning from male to female and questions the patient’s religious beliefs in relation to her decisions. The patient becomes agitated and expresses to...

A pregnant woman has come to you for counseling. She is in her late forties and this...

A pregnant woman has come to you for counseling. She is in her late forties and this is her first pregnancy. She has had a difficult pregnancy and is very worried about having a miscarriage. She has come to you to determine whether her child will be born with Down Syndrome. a. Explain what test or tests you would suggest that could answer her question, b. Explain to her why you would recommend this test. c. What results would you expect...

Ms. Ray is age 46 and single. Her employer made a $2,900 contribution to her qualified...

Ms. Ray is age 46 and single. Her employer made a $2,900 contribution to her qualified profit-sharing plan account, and she made the maximum contribution to her traditional IRA. Compute her IRA deduction if Ms. Ray’s $51,400 salary is her only income item. Compute her IRA deduction if Ms. Ray’s $68,450 salary is her only income item. Compute her IRA deduction if Ms. Ray’s $68,450 salary and $7,420 dividend income are her only income items.

Ms. Ray is age 46 and single. Her employer made a $2,900 contribution to her qualified...

Ms. Rand is a 65-year-old woman who spends most of her day sitting on her porch...

Ms. Rand is a 65-year-old woman who spends most of her day sitting on her porch and recovering from a recent surgery involving the removal of suspected cancerous lymph glands in the inguinal area. She is now complaining that her shoes are fitting too tightly, and she has developed poorly healing sores on her legs and ankles. A closer examination also shows distention in her varicose veins. Blood tests reveal a low level of proteins in the plasma. Based on...

Let x = age in years of a rural Quebec woman at the time of her...

Let x = age in years of a rural Quebec woman at the time of her first marriage. In the year 1941, the population variance of x was approximately σ2 = 5.1. Suppose a recent study of age at first marriage for a random sample of 51 women in rural Quebec gave a sample variance s2 = 2.8. Use a 5% level of significance to test the claim that the current variance is less than 5.1. Find a 90% confidence...

Let x = age in years of a rural Quebec woman at the time of her...

Let x = age in years of a rural Quebec woman at the time of her first marriage. In the year 1941, the population variance of x was approximately σ2 = 5.1. Suppose a recent study of age at first marriage for a random sample of 41 women in rural Quebec gave a sample variance s2 = 2.4. Use a 5% level of significance to test the claim that the current variance is less than 5.1. Find a 90% confidence...

Let x = age in years of a rural Quebec woman at the time of her...

Let x = age in years of a rural Quebec woman at the time of her first marriage. In the year 1941, the population variance of x was approximately σ2 = 5.1. Suppose a recent study of age at first marriage for a random sample of 41 women in rural Quebec gave a sample variance s2 = 2.8. Use a 5% level of significance to test the claim that the current variance is less than 5.1. Find a 90% confidence...

Subjects