Name: Mrs. Maggie Meriwether
Age: 56 years old
Mrs. Meriwether is a 56-year-old woman, who was apparently in good health until six months ago, at which point she started noticing an uncontrollable urge to urinate when she was exercising, lifting weights, sneezing, or coughing. The embarrassing part for her is that, although she has tried to suppress the urge, she has voided in her underwear very often. The problem has become more frequent, and she has to wear a sanitary pad constantly. The patient also shares that she has something protruding through her vagina. She is anxious because she thinks she has a tumor. After conducting a thorough medical interview and physical examination, the doctor diagnoses stress urinary incontinence and cystocele.
Our patient is a mother of four children with vaginal deliveries complicated by shoulder dystocia. During her last pregnancy, she had a whitish and cottage cheese-like vaginal discharge. A year ago, Mrs. Meriwether had an episode of gastroenteritis accompanied by profuse vomiting and diarrhea, which produced moderate dehydration and electrolyte and acid-base imbalances. Our patient also indicates she has had two episodes of right renal colic produced a renal lithiasis. Patient has no history of smoking or alcohol intake.
On physical examination we found:
Remarkable Signs on Physical Exam by Systems
Urinary system: Leakage of urine through the urethra during Valsalva maneuver
Reproductive system: Soft mass protruding through the vagina, mostly when the patient is pushing
Complete blood count (CBC)
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