The NCA agreed that it is worthwhile trying non-pharmacological treatments first, to try to alleviate Mrs Scottís episodes of incontinence. If this proves difficult, a prescription of low dose oxybutynin may be indicated.
Mrs Scott has been restricting her fluids intake to reduce the risk of incontinence. Unfortunately this has had the opposite effect by causing her bladder to become irritated. The NCA thus advised her to increase her fluid consumption, especially water, to 6-8 cups per day. In addition, introduction of caffeine free tea or herbal tea will eliminate the diuretic and bladder irritating effects of caffeine. In avoid to avoid nocturia, I suggest that Mrs Scott does not drink large quantities of fluid after dinner.
Mrs Scott was shown how to correctly apply her oestrogen cream. She does not need to use the applicator as only a small pea sized amount is to be applied around the urethra.
She has been shown how to do the pelvic floor exercises to strengthen her pelvic floor and at present has had no difficulty in learning these techniques. She will have a follow-up appointment with the physiotherapist for further advice on pelvic floor rehabilitation and I will recommend that the physiotherapist check on Mrs Scottís technique for performing the exercises to ensure that she is performing them correctly.
Use of appropriate containment products was discussed with Mrs Scott and she has taken a few different samples to try. She is aware that she needs to change the pad after each episode of incontinence, to clean and dry the area and apply a barrier cream.
In regards to persistent UTIís, Mrs Scott is commencing twice daily cranberry 400mg capsules.
In terms of further management of her urge incontinence, Mrs Scott has agreed to try timed voiding.