First Presentation of Bladder Symptoms Karen Nelson / Sara-Jane Barlow HNHSFT Continence Advisory Service

First Presentation of Bladder Symptoms 20 minutes Types of symptoms (Scenarios) Initial appointment Follow up? Referral on? Urology / gynaecology / continence service / district nursing team

First Presentation of Bladder Symptoms Types of symptoms: - Scenarios (group work) What have you come across? Dysuria? Supra pubic pain / discomfort? Dragging / signs of prolapse? Urinary frequency, urgency, incontinence? Actively question your patient

First Presentation of Bladder Symptoms What is worth knowing at this appointment? Obstetric history? Menopausal status? Medication? Prescribed and over the counter. What is the effect of lifestyle on bladder? And what is the effect of bladder symptoms on lifestyle?

First Presentation of Bladder Symptoms What should you do at this appointment? Fluids – types and amount Urinalysis Examination? – even if you just have a look! Skin condition – atrophic vaginitis? Exclude constipation Discharge?

First Presentation of Bladder Symptoms What should you do at this appointment? (GP) All of above – plus: - Abdominal examination Vaginal examination Examination of the prostate Neurological examination Blood tests

First Presentation of Bladder Symptoms Red Flags – two week wait. Follow up? – can you review symptoms? Gynaecology referral – grade 3 prolapse or above (cervix or lower portion of the uterus reach the region of the introitus) . Continence Service – ‘gateway’ to secondary care. Urology – voiding dysfunction in men (prostate / bladder scan first?); failed conservative treatments in women and men.

First Presentation of Bladder Symptoms Comments / Questions