Successful Treatment of Mixed Urinary Incontinence

Successful Treatment of Mixed Urinary Incontinence in a Patient with Allergy to Multiple Medications

On a beautiful sunny day in 2021, a 64-year-old woman came for a consultation. She was desperate: for a long time, she had been suffering from urinary incontinence and frequent cystitis. The patient had seen many doctors, as they refused to treat her due to her allergy to “almost everything.” . This attempt was her last hope.

The woman was troubled by urinary dysfunction, pain in the lower abdomen, and unbearable itching of the vulva. All these symptoms significantly affected her life: “There is no life at all. I know every public restroom in the area… I constantly wear pads. I’m ready to follow any recommendations! I want to visit museums, theaters, calmly stroll in the Summer Garden…”

Periodic courses of antibiotic therapy relieved pain and burning during urination, but they worsened the condition of the vulva and vagina, and urinary incontinence persisted.

The situation was complicated by the fact that the patient was allergic to many medications and products, including Furadonin, Pancef, Vilprafen, penicillins, tetracyclines, vitamin C, propolis, rice, eggs, and milk. Allergic reactions varied: the body could respond with hives, Quincke’s edema, or intolerable headaches.

Frequent urination urges and urinary incontinence had occurred long ago and worsened with each passing year. Over time, cystitis developed, and two weeks before the visit, a burning sensation in the lower abdomen appeared. The woman tried to self-treat with Monural, Furadonin, and Levomycetin, but it was unsuccessful.

For 14 years, the patient has been in menopause and has not been sexually active. She gave birth naturally twice and previously had Bartholinitis.

The woman has stage II (moderate) arterial hypertension. In 1994, she had acute pyelonephritis, and in 2018, she had a mini-stroke. For several years, she has been under the care of a pulmonologist for pneumonias.

  • The patient’s grandmother had breast cancer.

Examination revealed hyperpigmented spots around the anal opening, cracks, and white patches on the vulva. The mucous membrane of the vulva, vagina, and cervix was thinning. There was a first-degree prolapse of the vaginal walls. Colpo-test showed a pH of 6.5, indicating atrophic vaginitis.

To check for stress urinary incontinence, a cough test was performed. It gave a negative result but was conducted incorrectly due to the inability to adequately fill the bladder.

A urine culture revealed hemolytic streptococcus (105).

Mammography results, ultrasound of the pelvic organs, and urinary bladder were within normal limits.

Genitourinary syndrome. Scleroatrophic lichen. First-degree vaginal wall prolapse. Chronic cystitis. Mixed urinary incontinence. Polyvalent allergy.

First and foremost, the patient was prescribed antibiotics and uroseptics. They were properly selected thanks to the clinical pharmacologist – my number one assistant.

Additionally, the woman was advised to follow a diet and a healthy lifestyle. She started keeping a diary of urination and training her bladder. Hormonal medications were also prescribed (she consulted a neurologist before taking them).

To rule out other vulvar dermatological conditions, the woman was referred to a dermatologist who performed a biopsy. She refused to visit a urologist she trusted because the doctor was far from her home.

Urinary tract infection was successfully eliminated: antibiotics and uroseptics worked quickly. Complaints of painful urination also subsided.

It took several months to restore the urogenital tract flora, skin, and mucous membranes. Considering the history of impaired cerebral circulation, hormonal medications needed to be taken in low doses for a long time. Abrupt discontinuation of the medication was strictly contraindicated.

After 2 months, the pain in the lower abdomen disappeared. The woman found it easier to control urges and urination. At the follow-up appointment, she noted that she could now go a little further from home without worrying about pad overflow.

Considering the treatment results, she was prescribed supportive hormonal therapy with dynamic monitoring.

This clinical case demonstrates that urinary disorders are not always solely related to bacterial infection, so such patients require comprehensive examination and treatment. This becomes possible only with the coordinated teamwork of doctors of different specialties. However, therapy will not be effective if the patient is not willing to follow all recommendations from specialists.