Dr Baptiste Advice on OSCE Prep - Urinary Incontinence

We recently had the pleasure of speaking with Dr. Patrice Baptiste - Portfolio GP, Medical Educator, Entrepreneur, Writer, and Speaker - about the important topic of urinary incontinence.

A highly respected and accomplished clinician, Dr. Baptiste has previously worked at the College of Medicine and Dentistry and currently serves as an Associate Lecturer at The Open University. She has also taught as a GP tutor at Queen Mary University of London (QMUL).

In our conversation, Dr. Baptiste shared valuable insights on how medical students can best prepare for OSCEs, with a particular focus on the Obstetrics and Gynaecology rotation, specifically urinary incontinence and prolapse.

Below, we delve into Dr. Baptiste’s expert advice on effective OSCE preparation in this key area as well as showcase products that can be used to support Obstetrics and Gynaecology OSCE prep and revision.

For effective OSCE prep in Obstetrics and Gynaecology, hands-on tools like a pelvis model (as seen in below video), abdominal palpation trainer, and childbirth set are invaluable. These models help students practice key exams and procedures - from pelvic assessments to identifying foetal position and simulating delivery - boosting both confidence and clinical accuracy.

OSCEs don’t have to be overwhelming. In fact, Dr. Patrice Baptiste believes they should be an enjoyable opportunity to showcase your clinical knowledge and skills - and to demonstrate to the OSCE examiner that you know exactly what you’re doing.

Drawing from her extensive experience as an OSCE examiner, Dr. Baptiste highlights common mistakes made during OSCEs - many of which can be easily avoided. In this video, she generously shares her top tips to help medical students succeed. 

This video is part of our OSCE preparation series, designed to support medical students across various clinical specialties. The first installment focuses on urinary incontinence and prolapse—an ideal resource if you're currently on your Obstetrics and Gynaecology rotation or preparing for exams in this area.

Let's explore key topics related to female pelvic health, focusing on two common conditions: urinary incontinence and pelvic organ prolapse. It will cover:

• The anatomy of the female pelvis, including key structures involved in continence and support
• The assessment of urinary incontinence and pelvic prolapse, detailing: – The types and severity of urinary incontinence (incl. The Anatomy of Stress Incontinence  urge incontinence and mixed incontinence)
   – Causes and risk factors, such as childbirth, ageing, and hormonal changes
   – Potential complications if left untreated
• Management strategies, including physical examinations, conservative treatments like pelvic floor exercises, and medical or surgical options

This guide is ideal for medical students, trainees, and healthcare professionals looking to deepen their understanding of urogynecology, continence care, and the holistic management of pelvic floor disorders.

There are three bones of the pelvis and some key bony landmarks such as:

Pelvic inlet – the female pelvis is circular, whereas it is heart-shaped in men.

• The posterior aspect is S1, plus each side of S1 is the alae or wings
• The lateral side is the prominent rim of the pelvic bone
• The anterior aspect is the pubic symphysis (two pelvic bones join in the midline)

Pelvic walls – There are two important ligaments connecting each pelvic bone to the sacrum and coccyx: sacrospinous and sacrotuberous ligaments.

Pelvic outlet

• Anterior: pubic symphysis plus towards Ischial tuberosity
• Posterior: Sacrotuberous ligament (towards coccyx and sacrum)

Pelvic floor

• Separates the pelvic cavity from the perineum
• Levator ani (iliococcygeus/pubococcygeus/puborectalis x2) join together, plus the coccyges muscle are the pelvic diaphragm (they overlie the sacrospinous ligaments and pass between the sacrum /coccyx and ischial spine)

Take a look at our Pelvic Floor Anatomy Poster for more information! 

When these muscles become weak (due to pregnancy/childbirth, especially multiple pregnancies or being overweight), you can get symptoms of incontinence and prolapse (Keep reading – we talk about this later in the article). 

Understanding the female pelvis is essential for students like yourself studying urogynecology, obstetrics, gynaecology, and pelvic floor health. To enhance hands-on learning and bring textbook anatomy to life, we offer a comprehensive range of female pelvic anatomical models and urinary system anatomy models that illustrate the key structures involved in continence, prolapse, and childbirth.

Whether you're teaching pelvic anatomy in a classroom or training in clinical settings, these models are ideal for practical demonstration and patient education. 

The International Continence Society defines incontinence as “the complaint of any involuntary urinary leakage.”

NICE Guidance 2019 details the main types of urinary incontinence: 

Stress – involuntary leakage on effort or exertion or when sneezing or coughing – we will focus on this type of incontinence in the video.

Urgency – involuntary leakage associated with or occurring before the sudden compelling desire to urinate, which is described as urgency (this is part of overactive bladder syndrome, which is urgency associated with frequency and nocturia. This can be divided into wet and dry, where the patient may or may not suffer from incontinence respectively).

Mixed – stress and urgency symptoms.

Overflow incontinence – this may be caused by

a) detrusor under activity (detrusor is a muscle which contracts and relaxes to release and help store urine respectively) or

b) bladder outlet obstruction means the bladder is unable to empty fully, therefore leading to the retention and then leakage of urine) – chronic urinary retention.

Continuous urinary incontinence – this might be caused by:

• A fistula (this is a connection between two body parts where there shouldn’t be one, for example, between the anal canal and vagina)
• The severity of their condition.
• Urethral diverticulum (a pocket or outpouching forms next to the urethra). This is a rare condition that you should be aware of.
• 
  

Situational – depending on the situation, for example, laughing or intercourse. 

In order to distinguish between the above types of urinary incontinence, you should ask the following questions during your history-taking:

Do you notice any urine leakage when coughing, sneezing, or exerting yourself?

Think stress incontinence

Do you feel the urge to rush to the toilet?

Urge + Overactive bladder (OAB) syndrome

Do you need to use the toilet/pass urine frequently throughout the day?

Urge + OAB

Do you have to get up at night to pass urine?

Urge + OAB

If the patient’s symptoms seem to be a mixture of the above – so roughly an equal amount of urgency and stress, then this is likely to be mixed incontinence.

If symptoms occur without physical activity or a sense to rush to the toilet/urgency, then it is unlikely to be stress or urgency incontinence. If this is the case, then you should ask:

Do you feel you have to strain to empty your bladder, or do you feel as though you have not finished passing urine when you go to the toilet?

Overflow incontinence

Do you feel that you are constantly leaking urine?

Fistula e.g., vesicovaginal

Do you notice dribbling/pain when passing urine? / Do you have recurrent urine infections? / Do you have abnormal vaginal discharge / Do you have pain before/during/after sex/ sexual intercourse?

Urethral diverticulum 

To determine how severe the urinary incontinence is, you should ask the following:

• How often does the patient suffer from incontinence – when does it occur (if they have identified a pattern), and is it associated with any particular activities or movements?
• Do often do they need to use incontinence pads – there are different sizes, so don’t forget to ask about this. How often do they change the pads or have to change their clothing?
• How often do they pass urine, during the day and at night?
  

Keep a bladder diary (Download our free bladder diary template) – NICE suggest three days at a minimum; this should include a variation in what they do each day to include different types of activities, for example, exercises and working pattern – it should include what type of fluid they drink, how much and when.

To determine the cause and contributing factors of urinary stress incontinence assess the following:

• Do they drink caffeine/coffee/tea /alcohol? And if so, how much?
• Obstetrics and gynaecology history.
• Sexual history.

Red flags include haematuria or blood in the urine, ongoing bladder or urethral pain, recurrent UTIs, and constant leakage, which might suggest a fistula.

Past medical history – medical conditions such as heart failure, diabetes mellitus, and neurological conditions that could cause incontinence, such as spinal cord injury, multiple sclerosis, and Parkinson’s disease. Cognitive impairment. Previous investigations or treatments for urinary tract issues and previous surgeries, such as spinal surgery.

Medication history – are you taking any regular, OTC, or recreational drugs? There is a long list of medications that can cause or exacerbate symptoms, but a few examples to consider would be alpha-1 adrenoceptor antagonists, such as doxazosin, antidepressants, diuretics, hormone replacement therapy, and benzodiazepines. 

Examination – you should always start with a general examination and then a closer inspection of the patient. You might want to look at the patient’s weight and if there are any signs of neurological disease. 

A helpful way to assess whether someone is overweight based on what is considered average for their height, is by calculating their Body Mass Index (BMI). Our Body Mass Index Chart is a useful visual guide for this, offering a quick reference for determining BMI ranges and identifying whether a patient falls into underweight, healthy, overweight, or obese categories. 

Abdominal examination 

Complete as you usually would for a palpable bladder (chronic urinary retention) or a mass (cancer, fibroids).

Pelvic examination 

• You should inspect for any skin changes, for example, signs of atrophic vaginitis, masses – prolapses (a pelvic organ prolapse is when one or more pelvic organs bulge into the vagina – it can be the uterus/bowel/bladder or top of the vagina), diverticulum which is a sac-like protrusion between the periurethral tissues and anterior vaginal wall.
• Ask the patient to cough and look at the urethral opening or meatus to see if there is any leakage or urine (stress).
• During the bimanual examination (where you insert two fingers into the ‘patient’s vagina to palpate the cervix and ovaries), you can ask the patient to squeeze your fingers (like they are trying to hold their urine) to check for muscle tone and contraction. This can be assessed using the modified Oxford grading system – allowing you to assess the strength of the contraction:

0 – no contraction

1 – flicker

2 – weak

3 –moderate

4 – good

5 – strong

A bedside test you could perform would be a urine dipstick looking for evidence of a UTI – leucocytes and nitrites. You might want to mention to the examiner that you would send midstream urine or MSU sample for culture whilst treating with antibiotics if you thought the patient had a urine infection. 

Depending on the scenario, you could also consider the following:

• Renal function: Look for AKI or acute kidney injury if you suspect a urinary obstruction.
• Assess the patient for depression. This could significantly affect the patient’s quality of life and mood.
• Asking about insomnia – if there are frequent trips to the toilet at night.
• An assessment of mobility or their risk of falling and potential fractures.
• Asking about their family/carers – how is this affecting them? 

• Address any causes or contributing factors as above.
• Lifestyle advice on reducing caffeine/fluid/weight. Our Healthy Lifestyle Poster Collection can be a good reference to refer to.
• Smoking cessation, if applicable. Our Dangers of Smoking Chart is a good resource to use to quickly share with patients the negative impact smoking will have on them. 
• Provide sources of support and further information, such as the NHS website.
• The patient can be referred for a trial of 3 months minimum supervised pelvic floor training – this can be with a continence adviser or nurse specialist in urogynaecology, physiotherapist specialising in women’s health [guidance is a minimum of 8 pelvic floor muscle contractions at least three times a day].
• NICE CKS does not recommend things like absorbent containment products, i.e. pads and toileting aids, unless there are certain circumstances, such as waiting for assessment/ongoing treatment and for long-term management but only after other options have been considered/tried.

If the above does not work, then a referral to urogynae/gynae or urology for surgical procedures, or the patient can be offered duloxetine (a type of antidepressant) if they do not want to consider it or they are not suitable for surgery. 

Thank you for reading our article on OSCE Preparation for Obstetrics and Gynaecology rotation. We hope you now have a strong understanding of Urinary Incontinence and Prolapse: Assessment, Causes, and Management.

Complement practical training with educational posters covering stress incontinence, pelvic floor anatomy, and the urinary system. These visual aids reinforce core concepts, clarify anatomical relationships, and support better recall during exams. Ideal for study spaces, they help link theory to practice at a glance.

We’re proud to offer a range of free downloadable guides to support elderly care education and enhance geriatric training. These valuable resources include Classroom Ideas to Help Students Develop Empathy Towards Older Adults, perfect for fostering meaningful discussions and reflective learning. The Geriatric Training Implementation Guide provides practical advice on how to integrate ageing simulation into your curriculum, while the Geriatric Experience Curriculum Overview outlines key learning objectives and session structures. For a closer look at the content, you can also download a Sample Lesson from the Geriatric Curriculum, ideal for educators seeking to embed empathy and understanding into their healthcare training programmes.

• Download the Classroom Ideas to Help Students Develop Empathy Towards Older Adults

• Download the Geriatric Experience Curriculum Overview)

• Download a Sample Lesson from the Geriatric Curriculum    

If you’re looking to inspire future healthcare professionals and create deeper understanding around the realities of aging, the RealCare™ Geriatric Simulator is the perfect solution. It's more than training, it’s a transformative experience.