1. Stress incontinence: Half of the patients who have urinary incontinence have stress incontinence. This condition is caused by weakened pelvic muscles that have been stretched which allows urine to escape from the bladder. Stress incontinence can be described as mild, moderate or severe. Patients that have stress incontinence, notice leaking urine when coughing, sneezing, straining, exercising or with any other type of exertion. The patient can try to do Kegel exercises to help strengthen the pelvic muscles in mild cases. The primary treatment is surgery and the procedure is called a urethral bladder sling.
2. Urinary tract infection: UTI is one of the most common infections of primary care. UTIs can occur at all ages. Risk factors are
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A speculum was inserted into vagina with no abnormal findings noted. A bimanual exam did not note cystocele. A Q-tip was inserted into the vaginal secretions to lubricate cotton tip, then a small amount to KY jelly was placed on the tip. The Q-tip was then inserted approximately 2 -3 centimeters into the meatus of the urethra. The patient was told to bare down like she was trying to have a bowel movement and hold the muscles tight in buttocks. When the patient bared down, the end of the Q-tip was moving up and down constantly. Since the Q-tip moved more than 30 degrees from horizontal position, it is considered positive for inadequate bladder neck support. The provide informed the patient that she has stress incontinence and that she would need a procedure called a bladder sling to correct the condition. The plan is to add this procedure when she has her tubal in March. The patient will meet with the surgery scheduler when leaving the office today. I found the Q-tip test to be very cost efficient and quick to diagnose the patient. I agree with the plan. Based on the symptoms and the Q-tip test, stress incontinence is the most likely diagnosis. I personally would have had the patient leave a urine sample for UA and C&S to rule out the differential diagnosis of