Urinary retention is 13 times less common in woman than it is in men, and the differential diagnosis is wide. In this EM Cases Best Case Ever we have the return of Dr. David Carr describing a woman with an unusual diagnosis who presents with urinary retention. We discuss issues around the appropriate use of chaperones and what to do in the situation when you are in over your head…
Podcast: Play in new window | Download (Duration: 18:57 — 17.4MB)
Subscribe: Apple Podcasts | Google Podcasts
Podcast production by Anton Helman, May 2018
Differential diagnosis of female urinary retention
- Uterine fibroids
- Organ prolapse (cystocele, rectocele, uterine prolapse)
- Gynecologic malignancy
- Imperforate hymen
- Ischiorectal abscess
- Peripheral: Spinal mass/infection/bleed/trauma, cauda equina syndrome
- Central: e.g. Multiple sclerosis
Medications – anticholinergic and alpha-adrenergic agonists
Summary of recommendations from The Royal College of EM Best Practice Guidelines on chaperones in Emergency Departments
1. The presence of a chaperone should be offered to all Emergency Department patients undergoing a “Sensitive Area Examination”, regardless of patient practitioner genders.
2. Chaperones need to be Emergency Department health care professionals or volunteers that have received appropriate training.
3. The presence or absence of a chaperone should be appropriately documented.
4. Vulnerable Emergency Department patients should be offered a chaperone for any examination or procedure.
5. If an Emergency Department patient declines a chaperone, the fact that one was offered and declined should be documented in the ED record.
6. A local hospital chaperone policy should be tailored to the specific requirements of patients within Emergency Department, and constraints within the Emergency Department.
Selius, B. et al. Urinary Retention in Adults: Diagnosis and Initial Management. Am Fam Physician. 2008 Mar 1;77(5):643-650.
Mevcha A, Drake MJ. Etiology and management of urinary retention in women. Indian J Urol. 2010;26(2):230-5.
The Royal College of EM Best Practice Guideline on chaperones in Emergency Departments. Full PDF
I’m a female internal medicine resident in Slovenia, where patients are referred by a family or emegency medicine physician to me for workup and treatment if their presenting complaint in ED is within the scope of internal medicine. On occassion I’d do a rectal exam and never had I had a chaperone present, regardless of age or gender. I think the same holds true for my male colleagues as well. Having a chaperone present is simply not something that would be considered standard of care at our institution and I regret to think of all the patients that didn’t have a chance of greater comfort via the presence of a chaperone.
This is late to comment but Im a female medical student in Ontario. What we are being taught now, and I think this gets rid of a lot of the issue surrounding chaperones, is to ask all patients (male or female) who are undergoing a sensitive exam if they would like a chaperone and what gender they would prefer. Of course you can only work with the staff you have available but simply asking the patient what they prefer is a good way to prevent having to come up with practice rules on which genders/ages etc you should be having a chaperone for. It also doesn’t make any assumptions about the patient’s genitalia or sexual orientation ahead of time.