Physical Therapy & Urinary Incontinence

Many people lose urine when they don’t want to. When this happens enough to be a problem, it is called urinary incontinence.

Urinary incontinence is not a natural part of aging. It can happen at any age and can be caused by many physical conditions.

Weakness of the pelvic floor muscles which form a sling or support around the urethra, vagina, and rectum may cause leakage of urine or prolapse of the bladder, uterus, or rectum. Pregnancy, childbirth, obesity, chronic coughing, chronic constipation, estrogen deficiency and improper lifting (while holding one’s breath) can weaken the pelvic floor muscles.

Other risk factors include:

• Immobility commonly associated with chronic degenerative disease
• Diminished cognitive status and delirium
• Medications; including diuretics
• Smoking
• Diabetes
• Stroke
• Low fluid intake
• Pelvic and abdominal surgery

A physical therapy program may include: 

• Education on pelvic floor anatomy and function.
• Teaching you how to keep a bladder diary and form good bladder habits.
• Instruction in strengthening exercises or”Kegels” for the pelvic floor muscles.
• Instruction on using your pelvic floor muscles during common activities that stress the bladder such as lifting, walking, going up or down stairs and coughing or sneezing.
• Suggesting foods and beverages which may contribute to bladder leakage and irritability
• Designing an exercise program to address other areas of weakness or muscle imbalance such as the low back, thighs, and abdomen.

The most common types of incontinence are: 

• Stress incontinence: Leakage of urine when you cough, sneeze, laugh, walk, lift or do other physical activities.
• Urge incontinence: leakage of urine that occurs with a strong desire to urinate with a few seconds to minutes warning – the bladder contracts when you don’t want it to.
• Mixed incontinence: a combination of stress and urge incontinence symptoms.

Why Physical Therapy?

Although incontinence is common, it is not normal and can be treated by a medical team approach including a physical therapist. A therapist can evaluate your problem and help you manage urinary incontinence through low-risk interventions which can be used alone or in conjunction with pharmacological and surgical options.

If you think you may benefit from physical therapy ask your physician to refer you to a physical therapist who has received special training in this area. A pelvic exam and urinalysis are strongly recommended prior to referral in order to identify or rule out problems that may interfere with or be contraindicative of physical therapy treatment.

Improve Bladder Control with Physical Therapy

More than 12 million Americans experience urinary incontinence each year. If you have incontinence, you may experience urine leakage, trouble urinating and/or intense pressure to urinate. It can disrupt your daily life and lead to embarrassing accidents.

Fortunately, physical therapy can help 85 to 90% of people gain better bladder control in just 1 to 2 appointments. At Bon Secours In Motion, our certified physical therapists offer customized treatment, including:

Urinary incontinence is most often caused by weakening in the pelvic floor. Your pelvic floor is a group of muscles at the bottom of your pelvis that help you control your bladder and bowel. Aging, pregnancy and other factors can cause your pelvic floor to weaken, so you no longer have proper control.

During your first appointment, your physical therapist will evaluate your pelvic floor muscles. They will identify any weakness or dysfunction that may cause your incontinence. Your physical therapist will use this information to create a personalized exercise program for you.

You can’t see your pelvic floor muscles, so you may not know when you are using them correctly. But you need to be able to tell when you are flexing or relaxing your pelvic floor to strengthen it and gain better control.

Biofeedback therapy uses sensors to help you ensure you are using your pelvic floor during exercises. These sensors or placed on your abdomen and butt. As you do exercises, the sensors will show on a screen if you are using the correct muscles. 

As you learn more about how it feels you use your pelvic floor, you can do exercises at physical therapy and at home to strengthen your muscles. Your physical therapist will give you customized exercises you can do every day to stop incontinence. 

Gentle, electrical stimulation can also increase your awareness of using your pelvic floor muscles. Your physical therapist can attach small pads to your lower abdomen. Small electrical currents flow into the pelvic floor to cause the muscles to contract. 

Electrical stimulation can strengthen your muscles and help you understand what it feels like when your pelvic floor muscles move, so you can better perform exercises. 

At Bon Secours In Motion, we use the latest techniques and personalized exercises to help you overcome urinary incontinence. Our certified physical therapists have the training and experience you need for better bladder control.  

Experience freedom from urinary incontinence; contact Bon Secours In Motion today to schedule your first appointment.

Incontinence – Physiopedia

Original Editor – Kirsten Ryan

Top Contributors – Kirsten Ryan, Nicole Sandhu, Admin, Nicole Hills, Wendy Walker, Agoro Bukola Zainab, Vidya Acharya, Kim Jackson, Laura Ritchie, Lucinda hampton, Evan Thomas, WikiSysop and Lauren Lopez

Page Owner – Sadaf Tanveer as part of the One Page Project

Urinary Incontinence is a common condition that often goes under treated. Estimates of prevalence vary depending on the population studied, the measurement period (eg, daily or weekly) and the instruments used to assess severity. It is estimated to affect about 50% of adult women and 3% to 11% in adult men, however, only 25% to 61% of those women seek care. ^[1][2] This may be due to embarrassment, lack of knowledge about treatment options, or a belief that urinary incontinence is a normal inevitable part of aging.^[3]
Watch this video for a good brief overview

^[4]

Identifying the classification of urinary incontinence can help to guide treatment, however, an individual could exhibit symptoms from more than one of the classifications.^[5]

• Urinary incontinence (symptom): Complaint of involuntary loss of urine.
• Stress urinary incontinence: Complaint of involuntary loss of urine on effort or physical exertion (e.g. sporting activities), or on sneezing or coughing.
• Urgency urinary incontinence: Complaint of involuntary loss of urine associated with urgency.
• Mixed urinary incontinence: Complaint of involuntary loss of urine associated with urgency and also effort or physical exertion or on sneezing or coughing.
• Urgency: Complaint of a sudden, compelling desire to pass urine which is difficult to defer.
• Overactive bladder (OAB, Urgency) syndrome: Urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.^[6]

Urinary incontinence remains a worldwide problem, affecting both males and females, across different cultures and races. As mentioned above, the world wide prevalence is difficult to determine due to differences in definitions used, population surveyed, survey type, response rate, age, gender, availability and efficacy of health‐care, and other factors.^[7]

Clinically Relevant Anatomy: Pelvic Floor[edit | edit source]

The pelvic floor is made up of the muscles, ligaments, and fascial structures that act together to support the pelvic organs and to provide compressive forces to the urethra during increased intra-abdominal pressure.

The pelvic floor muscles refer to the muscular layer of the pelvic floor. It includes the levator ani, striated urogenital sphincter, external anal sphincter, ischiocavernosus, and bulbospongiosus.^[8]

The urethra, vagina, and rectum pass through the pelvic floor and are surrounded by the pelvic floor muscles. During increased intra-abdominal pressure, the pelvic floor muscles must contract to provide support. When the pelvic floor muscles contract the urethra, anus, and vagina close. The contraction is important in preventing involuntary loss of urine or rectal contents. The pelvic floor muscles must also relax in order to void.^[8]

^[9]

Stress urinary incontinence:

• Urethral hypermobility: increases in intra-abdominal pressure (eg, from coughing or sneezing) with insufficient support of the pelvic floor musculature and vaginal connective tissue to the urethra and bladder neck can lead to incontinence.^[10]
• Pregnancy and vaginal birth, post-partum, obesity, chronic cough, chronic heavy lifting and constipation: if there is an increase in abdominal pressure that is greater than the opposing force of the pelvic floor muscles, it can result in stress incontinence^[11][12]
• Intrinsic sphincteric deficiency (ISD): this results from a loss of intrinsic urethral mucosal and muscular tone that normally keeps the urethra closed, it can occur in presence or absence of urethral hypermobility and with minimal abdominal pressure. ^[13][14]

Urgency urinary incontinence:

• This may be secondary to neurologic disorders (eg, spinal cord injury), bladder abnormalities, increased or altered bladder microbiome, or may be idiopathic.^[15][16]

Overactive bladder:

• This could be due to neuropathic, an infection (i.e. urinary tract infection), weak pelvic floor muscles, diet (i.e. consumption of diuretics), medications, excess weight^[17]

Mixed Incontinence:

• Individuals can present with more than one type of incontinence
• For example stress incontinence and/or urge incontinence might be “masked” by an overactive bladder (frequenting the washroom often to avoid leakage).

Risk Factors[edit | edit source]

Risk factors for urinary incontinence (UI)
Age	The prevalence and severity of UI increases with age. [18][19] Age may not be an independent risk factor, when studies have controlled for co-morbidities.[20]
Obesity	This is a strong risk factor for UI. Additionally, weight reduction is associated with improvement or resolution of symptoms, particularly with stress urinary incontinence.[19][21][22]
Parity	Increasing parity is a risk factor for UI, however, nulliparous women also report bothersome UI.[23][22]
Mode of delivery	Women who have had a vaginal delivery have an increased risk of UI, however, cesarean delivery does not protect women from UI.[24]
Family history	This may be a risk factor for UI, particularily with urge incontinence and overactive bladder.[25][26]
Other	Conditions such as diabetes, stroke, and depression are associated with an increased risk of UI. [21][27][28]

• Urine Leaking
• Urinary Frequency
• Urinary Urgency
• Nocturia
• Prolapse

A large portion of women with urinary stress incontinence can be diagnosed from clinical history alone. In a systematic review performed in 2006^[29], little evidence was found to support the use of urinary diaries, and pad-tests although these measures are common diagnostic assessments used in physical therapy.^[29]

Clinical history[edit | edit source]

Clinical history taking compared with multi-channel urodynamics was found to have 0.92 sensitivity and 0.56 specificity for the diagnosis of urinary stress incontinence based on the presence of stress incontinence symptoms.^[29]

Pelvic Floor Muscle Function and Strength[edit | edit source]

Modified Oxford grading system:

• 0 – no contraction
• 1 – flicker
• 2 – weak squeeze, no lift
• 3 – fair squeeze, definite lift
• 4 – good squeeze with lift
• 5 – strong squeeze with a lift

Palpation[edit | edit source]

Palpation of the pelvic floor muscles per the vagina in females and per the rectum in male patients. ^[30]

PERFECT mnemonic assessment^[30]:

P – power, may use the Modified Oxford grading scale
E – endurance, the time (in seconds) that a maximum contraction can be sustained
R – repetition, the number of repetitions of a maximum voluntary contraction
F – fast contractions, the number of fast (one second) maximum contractions
ECT – every contraction timed, reminds the therapist to continually overload the muscle activity for strengthening^[30]

Pad Test[edit | edit source]

The 1 hour pad test was found to have 0.94 sensitivity and 0.44 specificity for diagnosing any leakage compared with multi-channel urodynamics. The 48 hour pad-test was found to have 0.92 sensitivity and 0.72 specificity for the diagnosis of urinary stress incontinence.^[29]

While the 48 hour pad test is better used in clinical research due to it’s high reproducibility, the 1-hour pad test is the standardized method in a clinical setting. ^[31]

The test involves the patient wearing a pre-weighed pad, next the patient drinks 500 ml of sodium-free liquid in < 15 minutes, resting, after which he/she exercises for 30 minutes. The exercise would include activities such as walking, climbing up and down a flight of stairs, standing up from sitting, coughing vigorously, running on the spot for 1 minute. The pad is then re-weighed and the resulting measurement given in grams of urine lost.^[32]

Urinary (Voiding) Diary[edit | edit source]

One study found a scale derived from a 7 day diary was 0.88 sensitive and 0.83 specific for the diagnosis of detrusor overactivity in women.^[29] The National Institute for Diabetes and Digestive and Kidney Diseases provides clinicians with a easy to use Bladder Diary pdf that may be used in clinical practice^[33].

Physical Therapy Management[edit | edit source]

Pelvic Floor Muscle Training (PFMT)[edit | edit source]

This brief video gives a good run down on how to teach pelvic floor exercises.

^[34]

The pelvic floor muscles are known as the levator ani, made up of the pubococcygeus – puborectalis complex. Those muscles form a sling around the anorectal junction. They are made up of both Type I (slow-twitch) and Type II (fast-twitch) fibers. The majority are Type I (about 70%) which provide sustained support and are fatigue resistant. The remaining Type II fibers provide the quick compressive forces necessary to oppose leakage during increased abdominal pressure. A contraction of the pelvic floor muscles also causes a reflex inhibition of the detrusor muscle.^[35]

Patient specific training is necessary to ensure a proper contraction of the pelvic floor muscle group. It is also essential to train both the fast and slow-twitch muscle fibers. Also, training must include instruction in volitional contractions before and during an activity that may cause incontinence, such as coughing, sneezing, and lifting. ^[30] Patients are typically recommended to perform exercises four to five times daily.^[36][30]

A non-controlled trial studying the effects of a home-based pelvic floor muscle training and bladder training in women with urinary incontinence showed that combined pelvic floor muscle training and bladder training decreased the symptoms and improved the quality of life^[37].

PFMT for the prevention of postpartum incontinence[edit | edit source]

Pelvic floor muscle training (PFMT) performed during pregnancy helps to decrease the short-term risk of urinary incontinence in women without prior incontinence. A meta-analysis that included randomised or quasi-randomised trials on pregnant or postnatal women, found that women assigned to antenatal PFMT had a significant decrease in the rate of urinary incontinence at up to three months postpartum.^[38]

A systematic review including randomised or quasi-randomised trials on primiparous or multiparous pregnant or postpartum women found that PFMT during pregnancy and after delivery can prevent and treat urinary incontinence. The authors recommended a supervised training protocol following strength-training principles, emphasizing close to maximum contractions and lasting at least 8 weeks.^[39]

PFMT for stress urinary incontinence[edit | edit source]

Similarly to the findings stated above, PFMT has been found to be effective for treating stress urinary incontinence as well.^[40][41] A systematic review looking at the effects of PFMT by comparing the effects of this training with no treatment, or with any inactive treatment (for example, advice on management with pads). The authors found women with stress urinary incontinence in the PFMT group were, on average, eight times more likely to report being cured. In addition the participants reported an improved QoL. A recent review suggested that integrating PFMT with self-management strategies-lifestyle changes to maintain a healthy weight and quit smoking had a good outcome in mild-to-moderate stress urinary incontinence^[42].

A Randomized Controlled Trial in women with stress urinary incontinence suggests that the Pelvic floor Muscle Training and Extracorporeal Magnetic Innervation are effective in improving the stress urinary incontinence and quality of life in women^[43]. Another randomized control study suggested better outcomes with a combined training of PFMT and Transversus Abdominis muscle than with PFMT alone in patients with stress urinary incontinence. However, the training was more effective in the group of women who had lesser than three vaginal births^[44].

A study examining the training parameter for strengthening the pelvic floor found the most effective protocol to consists of digital palpation combined with biofeedback monitoring and vaginal cones, including 12 week training parameters, and ten repetitions per series in different positions.^[40]

PFMT for urgency incontinence[edit | edit source]

PFMT has been shown to improve or cure symptoms of urge urinary incontinence. ^[41] In addition to PFMT, behavioural therapies and bladder training (described below) may be beneficial in this population.^[45][46]

Behavioral Therapy[edit | edit source]

The focus of behavioral therapy is on lifestyle changes such as fluid or diet management, weight control, and bowel regulation. Education about bladder irritants, like caffeine, is an important consideration. Also, discussing bowel habits to determine if constipation is an issue as it is important to educate the patient about avoiding straining.^[45] Education and explanation about normal lower urinary tract function is also included. Patients should understand the role of the bladder and the pelvic floor muscles.^[47] A randomized clinical trial examined the effects of a group-administered behavioural therapy for urinary incontinence in older women and found it to be a modestly effective treatment for reducing symptoms of urinary incontinence. The group behavioural therapy included a one-time, two hour bladder health class, including written material and an audio CD. ^[48]

Bladder Training[edit | edit source]

The information gathered from the bladder diary is used to guide decision making for bladder re-training, including a voiding schedule if necessary to increase the capacity of the bladder for people with frequency issues. Bladder training attempts to break the cycle by teaching patients to void on a schedule, rather than in response to urgency. Urge suppression techniques are taught, such as distraction and relaxation. It is also important to teach the patient to contract the pelvic floor to cause detrusor inhibition. A voluntary contraction of the pelvic floor muscles helps increase pressure in the urethra, inhibit detrusor contractions, and control urinary leakage.^[45][47]

Multi-channel urodynamics testing is the gold standard for making a condition-specific diagnosis. This testing is typically done in secondary care, not in primary care or physical therapy.^[29]

A systematic review published in the Annals of Internal Medicine in 2008^[49] found good evidence that pelvic floor muscle training and bladder training resolved urinary incontinence in women. However, the effects of electrostimulation, medical devices, injectable bulking agents, and local estrogen therapy were inconsistent.^[49]

The study suggests surface electromyographic (sEMG) assisted biofeedback training and Pilates exercises have positive outcomes on the pelvic floor muscles in women with stress urinary incontinence^[50].

Physiopedia’s Clinical Guidelines: Pelvic Health Page

Websites[edit | edit source]

Presentations[edit | edit source]

1. ↑ Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. International urogynecology journal. 2012 Aug 1;23(8):1087-93.
2. ↑ Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Scandinavian journal of primary health care. 2002 Jan 1;20(2):102-7.
3. ↑ University of Michigan. National poll on healthy aging. Available from: https://www.healthyagingpoll.org/sites/default/files/2018-11/NPHA_Incontinence-Report_FINAL-110118.pdf
4. ↑ Griffith Health Physiotherapy for Urinary Incontinence – Griffith Physiotherapy Clinic Available from: https://www.youtube.com/watch?v=lg3PnVQ21Bs (last accessed 298.11.2019)
5. ↑ Barry MJ, Link CL, McNaughton‐Collins MF, McKinlay JB, Boston Area Community Health (BACH) Investigators. Overlap of different urological symptom complexes in a racially and ethnically diverse, community‐based population of men and women. BJU international. 2008 Jan;101(1):45-51.
6. ↑ Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003 Jan 1;61(1):37-49.
7. ↑ Minassian VA, Drutz HP, Al‐Badr A. Urinary incontinence as a worldwide problem. International Journal of Gynecology & Obstetrics. 2003 Sep;82(3):327-38.
8. ↑ ^8.08.1 Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C, Laycck J, Huat-Chye Lim P, van Lunsen R, Lycklama a Nijeholt G, Pemberton J, Wang A, Watier A, Van Kerrebrocck P. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 2005;24:374-380.
9. ↑ Natural Childbirth. Childbirth and your pelvic floor. http://childbirth.amuchbetterway.com/childbirth-and-your-pelvic-floor/ (accessed 15 March 2011).
10. ↑ Pirpiris A, Shek KL, Dietz HP. Urethral mobility and urinary incontinence. Ultrasound in Obstetrics and Gynecology. 2010 Oct;36(4):507-11.
11. ↑ International Urogynecological Association. Stress urinary incontinence. Available from: https://www.yourpelvicfloor.org/media/Stress_Urinary_Incontinence_RV1.pdf
12. ↑ McGuire EJ. Pathophysiology of stress urinary incontinence. Reviews in urology. 2004;6(Suppl 5):S11.
13. ↑ Lim YN, Dwyer PL. Effectiveness of midurethral slings in intrinsic sphincteric-related stress urinary incontinence. Current Opinion in Obstetrics and Gynecology. 2009 Oct 1;21(5):428-33.
14. ↑ Pizzoferrato AC, Fauconnier A, Fritel X, Bader G, Dompeyre P. Urethral closure pressure at stress: A predictive measure for the diagnosis and severity of urinary incontinence in women. International neurourology journal. 2017 Jun;21(2):121.
15. ↑ Schneeweiss J, Koch M, Umek W. The human urinary microbiome and how it relates to urogynecology. International urogynecology journal. 2016 Sep 1;27(9):1307-12.
16. ↑ Pearce MM, Zilliox MJ, Rosenfeld AB, Thomas-White KJ, Richter HE, Nager CW, Visco AG, Nygaard IE, Barber MD, Schaffer J, Moalli P. The female urinary microbiome in urgency urinary incontinence. American journal of obstetrics and gynecology. 2015 Sep 1;213(3):347-e1.
17. ↑ Steers WD. Pathophysiology of overactive bladder and urge urinary incontinence. Reviews in urology. 2002;4(Suppl 4):S7.
18. ↑ Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, Markland AD. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstetrics and gynecology. 2014 Jan;123(1):141.
19. ↑ ^19.019.1 Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ, Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. Jama. 2008 Sep 17;300(11):1311-6.
20. ↑ Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstetrics & Gynecology. 2008 Mar 1;111(3):678-85.
21. ↑ ^21.021.1 Lawrence JM, Lukacz ES, Liu IL, Nager CW, Luber KM. Pelvic floor disorders, diabetes, and obesity in women: findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care. 2007 Oct 1;30(10):2536-3541.
22. ↑ ^22.022.1 Othman JA, Åkervall S, Milsom I, Gyhagen M. Urinary incontinence in nulliparous women aged 25-64 years: a national survey. American journal of obstetrics and gynecology. 2017 Feb 1;216(2):149-e1.
23. ↑ Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstetrics & Gynecology. 2006 Jun 1;107(6):1253-60.
24. ↑ Hutton EK, Hannah ME, Willan AR, Ross S, Allen AC, Armson BA, Gafni A, Joseph KS, Mangoff K, Ohlsson A, Sanchez JJ. Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2018 Dec;125(13):1682-90.
25. ↑ Hannestad YS, Lie RT, Rortveit G, Hunskaar S. Familial risk of urinary incontinence in women: population based cross sectional study. Bmj. 2004 Oct 14;329(7471):889-91.
26. ↑ Wennberg AL, Altman D, Lundholm C, Klint Å, Iliadou A, Peeker R, Fall M, Pedersen NL, Milsom I. Genetic influences are important for most but not all lower urinary tract symptoms: a population-based survey in a cohort of adult Swedish twins. European urology. 2011 Jun 1;59(6):1032-8.
27. ↑ Phelan S, Grodstein F, Brown JS. Clinical research in diabetes and urinary incontinence: what we know and need to know. The Journal of urology. 2009 Dec 1;182(6):S14-7.
28. ↑ Matthews CA, Whitehead WE, Townsend MK, Grodstein F. Risk factors for urinary, fecal or dual incontinence in the Nurses’ Health Study. Obstetrics and gynecology. 2013 Sep;122(3):539.
29. ↑ ^{29.029.129.229.329.429.5} Martin JL, Williams KS, Sutton AJ, Abrams KR, Assassa RP. Systematic review and meta-analysis of methods of diagnostic assessment for urinary incontinence. Neurourol Dynam 2006;25:674-683.
30. ↑ ^{30.030.130.230.330.4} Laycock J. Pelvic muscle exercises: physiotherapy for the pelvic floor. Urologic Nursing 1994;14:136-40.
31. ↑ Krhut J, Zachoval R, Smith PP, Rosier PF, Valanský L, Martan A, Zvara P. Pad weight testing in the evaluation of urinary incontinence. Neurourology and urodynamics. 2014 Jun;33(5):507-10.
32. ↑ Ferreira CH, Bø K. The Pad Test for urinary incontinence in women. Journal of physiotherapy. 2015 Mar 3;61(2):98-.
33. ↑ The National Institute for Diabetes and Digestive and Kidney Diseases Bladder Diary. Available from: https://www.niddk.nih. gov/health-information/urologic-diseases/bladder-control-problems/diagnosis. [last accessed 17/8/2018]
34. ↑ M Kenway Physical Therapist Pelvic Floor Exercises for Beginners Available from: https://www.youtube.com/watch?v=kQKR5uLkeUM (last accessed 28.11.2019)
35. ↑ Doughty DB. Promoting continence: simple strategies with major impact. Ostomy Wound Management 2003;49:46-52.
36. ↑ Alewijnse D, Metsemakers JFM, Mesters I, van den Borne. Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long-term adherence among women with urinary incontinence. Neurology and Urodynamics 2003;22:284-295.
37. ↑ Ersin A, Demirbas SB, Tarhan F. Short term effects of home-based bladder training and pelvic floor muscle training in symptoms of urinary incontinence. Archivio Italiano di Urologia e Andrologia. 2020 Jun 24;92(2).
38. ↑ Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay‐Smith EJ. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. 2017(12).
39. ↑ Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014 Feb 1;48(4):299-310.
40. ↑ ^40.040.1 Oliveira M, Ferreira M, Azevedo MJ, Firmino-Machado J, Santos PC. Pelvic floor muscle training protocol for stress urinary incontinence in women: A systematic review. Revista da Associação Médica Brasileira. 2017 Jul;63(7):642-50.
41. ↑ ^41.041.1 Dumoulin C, Cacciari LP, Hay‐Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018(10).
42. ↑ Titman SC, Radley SC, Gray TG. Self-management in women with stress incontinence: strategies, outcomes and integration into clinical care. Research and reports in urology. 2019;11:111.
43. ↑ Weber-Rajek M, Strączyńska A, Strojek K, Piekorz Z, Pilarska B, Podhorecka M, Sobieralska-Michalak K, Goch A, Radzimińska A. Assessment of the Effectiveness of Pelvic Floor Muscle Training (PFMT) and Extracorporeal Magnetic Innervation (ExMI) in Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial. BioMed Research International. 2020;2020.
44. ↑ Ptak M, Ciećwież S, Brodowska A, Starczewski A, Nawrocka-Rutkowska J, Diaz-Mohedo E, Rotter I. The Effect of Pelvic Floor Muscles Exercise on Quality of Life in Women with Stress Urinary Incontinence and Its Relationship with Vaginal Deliveries: A Randomized Trial. BioMed research international. 2019;2019.
45. ↑ ^45.045.145.2 Burgio KL. Current perspectives on management of urgency using bladder and behavioral training. J Am Academy Nurse Pract 2004;16:4-7.
46. ↑ The Canadian Continence Foundation. Treating incontinence. Available from: http://www.canadiancontinence.ca/EN/treatment.php
47. ↑ ^47.047.1 Payne CK. Behavioral therapy for overactive bladder. Urology 2000;55:3-6.
48. ↑ Diokno AC, Newman DK, Low LK, Griebling TL, Maddens ME, Goode PS, Raghunathan TE, Subak LL, Sampselle CM, Boura JA, Robinson AE. Effect of Group-Administered Behavioral Treatment on Urinary Incontinence in Older Women: A Randomized Clinical Trial. JAMA internal medicine. 2018 Oct 1;178(10):1333-41.
49. ↑ ^49.049.1 Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med 2008;148:459-474.
50. ↑ Chmielewska D, Stania M, Kucab–Klich K, Błaszczak E, Kwaśna K, Smykla A, Hudziak D, Dolibog P. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises. PloS one. 2019;14(12).

How Physical Therapy Can Help Bladder Control Issues

An estimated 13 million Americans suffer from bladder control issues, also known as urinary incontinence, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Treatment ranges from medication to surgery, which can sometimes feel daunting. That’s why some people are turning to physical therapy to find relief – and it’s working.

What Is Urinary Incontinence?

Urinary incontinence is the loss of bladder control or leaking urine. This problem can range from occasionally leaking urine when coughing or sneezing to suddenly having the urge to urinate and not being able to get to a toilet in time.

What Causes Urinary Incontinence?

This condition impacts twice as many women than men due to their unique reproductive health. Women can experience bladder control issues because of:

• Pregnancy: The hormonal changes experienced during pregnancy can lead to stress incontinence, which is when urine leaks because of coughing, sneezing, laughing, exercising or heavy lifting.
• Childbirth: Having a vaginal delivery can weaken the muscles needed for bladder control – sometimes leading to a dropped pelvic floor.
• Hysterectomy: Any surgery involving a woman’s reproductive system can damage the pelvic floor muscles.
• Menopause: Women produce less estrogen during this time. Estrogen helps keep the urethra and lining of the bladder healthy – so when estrogen levels decrease, the deterioration of these tissues can cause incontinence.

That said, both men and women can experience urinary incontinence due to a range of other issues, including :

• Age: As bladder muscles age, the bladder’s capacity to store urine can decrease. In addition, involuntary bladder contractions can occur more often as you get older.
• Enlarged prostate: This condition – which blocks the flow of urine through the urethra – especially impacts older men.
• Prostate cancer: Bladder control issues can happen because of untreated prostate cancer, but are more often a side effect of prostate cancer treatments.
• Neurological disorders: Parkinson’s disease, stroke, multiple sclerosis, a brain tumor or a spinal injury can cause urinary incontinence.

How Can PT Help?

Based on your individual evaluation, a physical therapist will create an individualized treatment program to improve your pelvic-floor muscle function. Physical therapy can help gain control over symptoms, and reduce the need for pads and special undergarments, incontinence medications, and possibly surgery.

Physical therapy teaches patient how to sense the movement of pelvic-floor muscles by tensing and releasing them, and to strengthen them using Kegel exercises. In addition, a physical therapist may recommend strengthening your back and core to help your pelvic muscles work better.

Every case is unique. At Countryside Orthopaedics and Physical Therapy, your physical therapist can design a specialized program to help address your specific bladder control needs.

Physical Therapy for Incontinence & Prolapse | CU Urogynecology

Pelvic floor physical therapy at a glance

• The pelvic floor is the group of muscles stretching from a woman’s tailbone (back) to pubic bone (front) that serve as a physical support to local organs.
• Over time, weakness of the pelvic floor muscle can adversely affect urination, bowel function and sexual intercourse.
• Pelvic floor physical therapy offers a series of nonsurgical interventions.
• Physical therapists help women to retrain their pelvic floor muscles through outpatient sessions to improve function and strength, typically within six to eight weeks.

Benefits of pelvic floor physical therapy

This pelvic floor acts as a support structure to the bladder, uterus, rectum and urethra, which aids bladder retention. The ability to relax and contract the pelvic floor allows for healthy function of the bladder and bowels.

The pelvic floor can become weak or damaged resulting in a pelvic floor disorder, such as pelvic organ prolapse, urinary or fecal incontinence, and other storage and evacuation problems. When this occurs, pelvic floor therapy can help to “rewire” the brain and muscles to control the coordination of key muscle groups.

Every patient undergoing pelvic floor physical therapy will have a specialized program built around the level and frequency of rehabilitation needed.

What pelvic floor dysfunctions does the therapy address?

Pelvic floor therapy can be used to address a variety of conditions such as:

Pelvic floor therapy can also help improve other conditions such as rectal pain, painful intercourse, chronic pelvic pain, endometriosis, vaginismus, and menopause symptoms.

Physical therapy treatments for incontinence, prolapse and the pelvic floor

We offer multiple types of treatment options for someone who is suffering from a pelvic floor disorder. When the physicians at CU Urogynecology feel that physical therapy would be the ideal treatment option, they will refer the patient to the physical therapy department. The physical therapists will find the best type of therapy for each patient depending on the condition, her medical history and the desired outcome.

Learn about the primary treatment options offered at the UCHealth physical therapy offices below.

Pelvic floor exercises

Physical therapists teach patients how to properly do Kegels and other exercises to contract and relax pelvic floor muscles. They will also teach breathing and timing techniques to make the exercises the patient is learning more effective. The goal of these exercises is to stretch tight muscles, strengthen weak muscles and improve flexibility.

Manual therapy

A physical therapist may use soft tissue mobilization techniques to help with muscle tightness, function and posture of the pelvic floor. Our physical therapists may also show patients how to use a vaginal dilator during this time. A vaginal dilator is a tube-shaped device that can help women learn to relax their pelvic muscles to allow for easier penetration or help women who have been treated for gynecologic cancers.

Bladder training

A physical therapist can help patients learn how to extend the time between voiding. This can be done through scheduling times to use the bathroom and managing the overwhelming urges to urinate.

Biofeedback therapy

Biofeedback therapy involves placing a sensor near the pelvic floor muscles, which transmits the amount of force the woman is exerting to a computer. The computer displays the results on a monitor so the patient can immediately see whether she is using the correct muscles. Once she gets a sense of how to properly do the exercises, she can continue doing them without biofeedback therapy.

Electrical stimulation

At CU Urogynecology we work with the physical therapists to provide our patients with percutaneous tibial nerve stimulation (PTNS) as the main external electrical stimulation device. This low voltage electrical current is sent up from the ankle to the pelvic floor via the tibial nerve.

Learn more about PTNS

Physical therapy follow-up

• Following the initial evaluation, the therapist will put together an exercise program and schedule follow-up appointments to assess muscle coordination, strength and overall function.
• Patients typically will experience improvement in pelvic floor function 3-4 weeks following strength training.

Where to receive physical therapy treatment for the pelvic floor

If a patient needs to be seen by a physical therapist, the providers at CU Urogynecology work with her to find the closest location to receive treatment. We have 12 locations all over the Denver metro area for easy access, no matter what part of town a woman lives in.

We also offer physical therapy services in our Anschutz office. This can be a great option for before or after appointments with our providers.

Contact us to request an appointment with one of our urogynecologists to learn if this nonsurgical therapy is an option to treat a pelvic floor disorder.

Women’s Pelvic Control Therapy | Genesis Healthcare System

Genesis Rehabilitation Services is one of the few healthcare providers in Southeastern Ohio offering pelvic control therapy. Pelvic control therapy is a specialized physical therapy that focuses on improving pelvic floor muscles through exercises or modifying behavior. Our pelvic control therapists have advanced training to offer this unique therapy.

Patients who successfully complete pelvic floor therapy often have a better quality of life because they don’t have to worry about frequent urination, can exercise without the urge to pee and may find they can experience sexual activity without pain.

Conditions we treat

You might feel as if your incontinence symptoms and overactive bladder are a part of the aging or childbirth process. However, quietly dealing with frequent urination, pain in the abdomen, constipation or painful intercourse is not your only option. Pelvic pain and urinary incontinence are common and these symptoms and conditions can be successfully treated with physical therapy:

Treatments and procedures

Pelvic physical therapy sessions are with a specially trained physical therapist in a private one-on-one setting.

Treatments for female incontinence and pelvic pain include manual techniques, lifestyle and behavioral modifications, and medical technology to improve pelvic floor muscle awareness and strength. bladder retraining, core strengthening exercises and electrical stimulation or other methods to reduce pain. An electrodiagnostic (EMG) technique might also be used to evaluate and record electrical activity by skeletal muscles to get biofeedback of pelvic floor muscles for strengthening and relaxation exercises.

Five conditions that benefit from pelvic physical therapy

Talk with your physician about your symptoms to see if you could benefit from pelvic control therapy. You shouldn’t have to suffer with pain or incontinence because of age or childbirth.

Urinary and stress incontinence

Urinary incontinence is the involuntary loss of urine and leaking. Stress incontinence happens when you cough, sneeze, laugh, jump or exercise and can be helped with pelvic control therapy.

Urge incontinence

What if you have a need to rush to the bathroom? Urge incontinence or overactive bladder is a sudden and significant need to urinate resulting in urinary frequency or loss of control of urine. Pelvic physical therapy can help reduce the urge to use the bathroom.

Pelvic pain

Women sometimes experience pain in the pelvic region with activities such as using a tampon, sexual intercourse, gynecological exams or prolonged sitting. This pain may be related to tight muscles in the pelvic floor that can be successfully treated with physical therapy.

Pain during prenatal/postpartum

Pregnancy and post-partum are a common and natural part of the female life span that can cause pain, weakness and pelvic floor instability. Many of the disorders during this time can be successfully treated in physical therapy to decrease pain, improve core strength and stability.

Pelvic Organ Prolapse

Signs of pelvic organ prolapse include the sensations of heaviness or vaginal bulging, frequent urinary tract infections or difficulty emptying the bowel or bladder. When women experience childbirth, their bodies change. With pelvic organ prolapse, the pelvic organs move down toward the vaginal opening causing symptoms of pelvic pain or pressure. These symptoms can be addressed with pelvic control therapy.

Make an appointment

Together with your physical therapist, a plan of care will be established to best treat your symptoms. For more information about female functional incontinence, physical therapy for bladder control, and pelvic control therapy at Genesis, call us today.

When Stress Incontinence Hits, Physical Therapy Could be Your Answer

Taking time to work out the muscles that control your urinary tract is often a first step in treating stress incontinence. McLeod Pelvic Floor Physical Therapist Taylor Holmes specializes in helping women taking control of their lives. This is what she told a gathering of more than 100 women during McLeod Women’s Health “Straight Talk”:

Here are key points from Taylor’s response:

Physical therapy can be a great treatment for urinary incontinence. The pelvic muscles support the pelvic floor. If they’re not working properly, it can trigger incontinence.

THE EVALUATION

If you came to me for a physical therapy evaluation, I would test the pelvic muscles the same way that I would test your arms muscles (biceps) or your thigh muscles (quadriceps) – or any other muscle that you want to strengthen.

I would see how well you can lift with that muscle and how much you can give support to your pelvic floor. Then, I would work to strengthen your muscles.

I’ve been specializing in Pelvic Health for about one-and-a-half years. While it doesn’t help some people, I’ve seen a good bit of success with women, even one who had been leaking for 20 years. At the end of 12 weeks, they were not leaking any more. Now, you have to keep up the exercises. Like any muscle, if you don’t use it, the muscle will get weak.

EXERCISES

I think a lot of people have heard of Kegel exercises, where you squeeze your pelvic floor muscle like you are trying to hold in your urine or stop a stream of urine.

A lot of women come to see me because they’ve tried to do the Kegels, but the exercises don’t seem to work. They might not be doing the exercises correctly or even pushing the wrong way. As a physical therapist trained in pelvic health, I can see if you are doing the exercises correctly. If not, I can show you how.

About half the women I see will take my cues and then they can do it correctly. Some women will have difficulty contracting those muscles. The length of time a woman can hold those muscles varies greatly. Some can only hold it for 2 seconds. Some, for 15 seconds. So we start simply and work from there.

It’s good to try it by yourself at first. But if that’s no working, you may want to see a physical therapist. The treatment is outpatient. The length of time depends on the severity of the issue. Some women see me once or twice a week for about 8-12 weeks.

Here’s one way to determine if you’re doing the Kegel exercises correctly. As you are sitting down to void, try to stop the flow of urine without contracting your abdominal muscles. If you can do that, you are contracting the correct muscles.

With a referral from your personal physician, you can contact a pelvic physical therapist by calling McLeod Outpatient Rehabilitation at (843) 777-3199 to schedule your evaluation and treatment.

You may also find these articles helpful:

Talk to your OB/GYN about Incontinence

Quit Stressing over Stress Incontinence…with these Treatments.

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What is physiotherapy for urinary incontinence in women?

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The effect of physiotherapy for urinary incontinence in women

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Enuresis is a condition that can be accompanied by symptoms of nighttime urinary incontinence in children, adolescents or adults. The process of violation of urinary incontinence occurred during the onset of menopause in women. Associated with a decrease in the amount of the hormone responsible for. Often after childbirth, a woman is faced with the problem of urinary incontinence.According to statistics, to one degree or another, every fifth woman aged 35–45 suffers from this. With age, there are more of them. fecal incontinence; in women – menstrual irregularities, decreased libido and other dysfunctions of the reproductive system. Also, for urinary incontinence, urethral and rectal stimulation of the bladder neck is used. Carrying out it is reasonable only if it is preserved. Physiotherapy as a treatment for stress urinary incontinence in women. If the exercise does not bring the expected results or it is not possible to make the necessary movements, then electrical stimulation is used.The main effect of this procedure is to strengthen the muscles. In the course. Prevention and correction of urinary incontinence in women using the EMSELLA apparatus. … Left unchecked, urinary incontinence can progress and significantly affect a woman’s quality of life and sexual satisfaction. In addition, it is important to find the cause of this condition, which. The International Committee on Urinary Incontinence (IM) defines the designated pathology as the involuntary discharge of urine, which is a social or hygienic problem.Urinary incontinence in women. Make an appointment with a doctor Make an appointment for hospitalization. Content. Reading time: 5 minutes, 18 seconds. Urinary incontinence in women. The reasons for the appearance and how to eliminate this disease with the help of a TVT sling. Urinary incontinence (UM) is n. Urinary incontinence (incontinence) is the inability to hold urine by force of will, which causes it to flow involuntarily. A characteristic feature of urinary incontinence is the relationship of this disorder with the gender and age of patients. In the age category up to 45 years old.Violation of urination. Women and men who suffer from urinary incontinence when coughing, sneezing, laughing or exercising. Some people feel an intolerable urge to urinate even when the bladder is empty. Others, on the other hand, have difficulty urinating.

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I started taking Diforol when a delicate problem for me appeared – urinary incontinence, pain and cramps when urinating, frequent urge. The disease did not start, and she began treatment within 1 month, as the symptoms appeared.I decided to start with a herbal preparation. It has a complex effect on solving the problem. Relieves inflammation, destroys infection, strengthens local immunity. It has a healing effect on the genitourinary system. Now I started getting enough sleep, since I don’t have to get up at night to use the toilet. I feel confident when traveling. There is no need to restrict fluid intake. She began to drink a lot of water and urinate within normal limits.

physiotherapy for urinary incontinence in women

Diforol is a unique combination of extracts, herbal and plant extracts, which have long been known to folk medicine.Quickly and gently suppresses infection in the urinary system, relieves inflammation, and prevents the progression of urological pathologies in the future.

If we talk about the treatment of urinary incontinence, urologists, as a rule, prescribe exercises with a muscle stimulator in conjunction with Kegel exercises – such an integrated approach brings the best and fastest results. Also, women who use myostimulants are less likely to experience urinary incontinence and do not experience pain during sex.Among other things, strong intimate muscles are less susceptible to mechanical ones. Buy Kegel trainer, goods for women, online courses for women. Miostimulants. The muscles contract and relax as needed. Stress urinary incontinence with and without prolapse. Gaping genital fissure and / or. Weakening of the pelvic floor muscles, perineal prolapse and urinary incontinence. When using muscle stimulants, you need to monitor your feelings. … In gynecology, electrical stimulation of the pelvic floor muscles is used in women with the following pathologies: weakness of the muscle tissue of the perineum.Myostimulator for pelvic floor muscles Tonis is one of the latest generation devices designed for the prevention and treatment of urinary incontinence in women, solving problems of the sexual sphere and intimate health. Muscle stimulators and vibration trainers with biofeedback. … If a woman has a prolapse of the pelvic organs, regular intimate. 6660. A pessary for urinary incontinence will help solve a delicate problem. 8297. Share. The Elise muscle stimulator is a very famous simulator. When I was reading information about him, I came across not only the British website of the manufacturer, but even the Thai office.In principle, it is no secret that Thailand is considered one of the. urinary incontinence; vascular disease; diseases of the musculoskeletal system. Miostimulants for women. Positive effects are observed after a course of using the device for electromyostimulation. There are several types of urinary incontinence – stress, urgent or mixed. … The devices are so reliable that they are trusted at the state level: without a myostimulator for the vagina, you will not be discharged from the hospital. MioKegel is a leading English professional manufacturer.With urinary incontinence. Analgesics pain relievers. … Massagers and myostimulators. Physio and magnetic therapy devices. … Preparations: antibiotic for the genitourinary system of men – pills for genitourinary infections in women. October 23. Throat antimicrobials.

Urinary incontinence is a delicate problem that cannot be hushed up

Why does the pelvic organs prolapse?

Descent of the pelvic organs , otherwise called prolapse or pelvic floor dysfunction is a situation in which the bladder, rectum and / and uterus seem to “bulge” outward through the vagina due to a decrease in the support of muscles, fascia (a sort of muscle “covers”) and pelvic floor ligaments.

There are many reasons for such disorders, but the main one is increased intra-abdominal pressure , for example, during childbirth, if the patient is overweight, with chronic cough (bronchial asthma, smoking) or if the patient is engaged in weightlifting. In all these cases, it is necessary to additionally strain the muscles of the abdomen, which, in turn, presses on all organs of the small pelvis and stretches the muscles and ligaments that support these organs.

Decreased levels of estrogen, a female hormone, eg after menopause , reduces the synthesis of collagen and elastin, fibers that also help keep the pelvic organs in an anatomically correct position.Plus, by itself heavy, long and / or multiple labor predispose to prolapse, stretching the walls of the vagina and injuring the pelvic floor.

If we talk about urinary incontinence, it is important to highlight that it is precisely stress urinary incontinence that develops from a weakened pelvic day – when, with little physical exertion – coughing, sneezing, jumping, laughing – situations in which intra-abdominal, and therefore intravesical pressure increases the patient spontaneously flows (leaks) urine.It is the only of the three types of incontinence (stress, urgency and mixed), which is associated exclusively with a violation of the normal anatomy of the small pelvis.

With an imperative or so-called overactive bladder syndrome , the problem is a sharp, strong, uncontrollable desire to go to urinate (including at night), in which the patient does not have time to reach the toilet. With this type of incontinence, the point is not in a weakened pelvic floor, but in a willful contraction of the bladder, in the problems of its innervation.Well, in the case of mixed incontinence, the problem is complex: both in innervation and in violation of anatomical structures.

What symptoms can there be?

The most common complaint during prolapse is a foreign body sensation in the vagina . Often it is also pulling pains in the lower abdomen , and in the vaginal area, which can become more pronounced with long walking. More specific symptoms are characteristic of the prolapse of specific organs.So, if the wall of the bladder descends (such a problem is called “ cystocele “), urinary incontinence or, conversely, the inability to urinate without additional action – without “filling” the descent back is typical. The same with rectal prolapse (“ rectocele “) – feeling of constant urge to use the toilet, gas and stool incontinence, constipation .

It is possible that there are no symptoms at all – the patient just visually notices the prolapse and goes to the doctor.

How to diagnose the problem?

There are no problems with the diagnosis of prolapse – this is done during the pelvic exam . It is important to determine the degree of omission according to a special classification system so that you can individually approach the treatment of each patient.

So, the first stage is a situation in which the lowest point of prolapse does not reach 1 cm to the threshold of the vagina, and it can be noticeable only if the patient is pushing.The second, when the prolapse is on the eve of the vagina or goes beyond its limits 1-1.5 cm – in this case, the patient can visually see it herself. The third, when the prolapse comes out even lower and the fourth – when there is a complete prolapse of the entire length of the vagina.

In the presence of urinary incontinence, before planning treatment, it is worth undergoing an urodynamic examination – this is done by the urologist, and by the way the bladder is emptied, a differential diagnosis can be made between stress incontinence associated with a decreased pelvic floor tone, neurological, requiring exclusively drug treatment, and mixed, when the problem must be approached from different angles.

ultrasonography of the urinary bladder and defecography are also done to assess the condition of the rectum and bladder.

How to treat the disease?

The main treatment for prolapse and prolapse of the pelvic organs is surgical. Today the “gold standard” is laparoscopic sacrocolpopexy : an operation in which 3-4 small incisions (no more than a centimeter in diameter) are made in the patient’s abdomen under general anesthesia, through which a camera and instruments are inserted into the abdominal cavity.After such an operation, the patient stays in the hospital for 2-3 days, including the operating day, and then is discharged home.

During the operation, a special mesh prosthesis is installed around the vagina, strengthening its walls and restoring the anatomical position of the vagina.

The second option – operation through the vagina , when the nets are installed separately on the anterior and posterior walls. This method is more often used for elderly women, for whom laparoscopy may be contraindicated for various reasons.But the “vaginal” mesh more often observed such complications after surgery as pain syndrome (especially during sexual intercourse), so the indications for this type of surgery are narrower.

It should be borne in mind that after the installation of the mesh-prosthesis in one way or another vaginal delivery is impossible .

Talking about surgical treatment of stress urinary incontinence – according to the same principle as in the case of prolapse, synthetic material is used – a small tape that plays the role of a supporting hammock.This tape is placed under the urethra, restoring the correct anatomy. Usually, on the very day of the operation, the patient can go to the toilet, and the next day she is discharged home.

Since this is a reconstructive operation, there are peculiarities of the postoperative period, for example, the patient should refrain from physical activity (playing sports, sex life). But on the other hand, the effectiveness of the operation remains for many years.

If the operation is contraindicated, as an alternative method of treatment for both incontinence and prolapse, you can use the installation of vaginal pessaries – a kind of silicone ring, individually selected according to the shape and size of each patient.It is inserted into the vagina, mechanically ensuring the “correct” position of the pelvic organs.

Also with stress urinary incontinence vaginal injections of hyaluronic acid can help. The result after injections is achieved due to the effect of volume, filling the tissues near the urethra. True, it lasts about 12-18 months, after which the injections must be repeated.

How to prevent prolapse of organs?

Speaking about pelvic floor dysfunction and stress urinary incontinence, prevention of the problem in the risk group (women of more mature age and after childbirth) is a must. In both cases, physiotherapy is such prevention.

The most common method of pelvic physiotherapy is Kegel Exercise . By themselves, they are simple, but require a certain learning process, therefore, in order to learn how to “correctly” perform the exercises, the patient should definitely contact a physiotherapist.

Or biofeedback therapy (biofeedback), in which a special device inserted into the vagina records muscle contractions, displaying them on the screen – thus the patient learns “correctly”, to strain the necessary muscles in isolation, increasing the overall tone of the pelvic floor muscles …This also happens through contact with a physical therapist.

Classical physiotherapy can be combined with innovative methods: for example, there is a high-frequency magnetic therapy device – a special chair that strengthens the pelvic floor muscles. This is a painless procedure in which the patient (in clothes) sits on the apparatus for 28 minutes, during which, under the action of a focused magnetic wave, the contraction and relaxation of the pelvic muscles is stimulated.

Physiotherapy, like a medical procedure, should be carried out after consultation with a specialist and is a preventive and additional method to the main treatment that can help in the initial stages.

But, if the problem progresses, if the complaints become more distinct, then physiotherapy, alas, will not be able to help. In this case, it is imperative to contact a specialist for more serious treatment!

Urinary incontinence in women: causes and treatments

Urinary incontinence is one of the most delicate problems with which women are embarrassed to see a doctor. Trying only to veil it, they voluntarily shield themselves from society and only aggravate their condition.

As a result, the disease, which began as urine leakage when coughing, develops into a complete absence of urge and the release of a large amount of urine, imperceptible by the woman. Although, with timely access to specialists, it is possible not only to prevent the development of the disease, but also in many cases to completely get rid of the problem.

Causes of occurrence:

– childbirth and the puerperium

– perimenopausal age (when the level of estrogens – female sex hormones that are responsible for the consistency of the pelvic floor muscles) sharply decreases

– menopausal period

– overactive bladder

– chronic infections

– bladder cancer

– prolapse of the pelvic organs

– diabetes mellitus

– overweight, obesity

– abnormal structure of the genitourinary system

Problem diagnosis:

It is necessary to consult a gynecologist.At the reception, they find out whether the problem is gynecological, since urinary incontinence can be associated with other diseases. In this case, the patient is referred to the required specialist.

Treatment methods:

Treatment of urinary incontinence in women occurs in two ways – conservative and operative.

The conservative method includes:

– Kegel gymnastics with various equipment

– gynecological pessary (in “Avicenna” modern pessaries Dr.Arabin with individual selection). You can learn more about this technique here.

– laser correction of the pelvic floor muscles (laser correction is good for women of perimenopausal age, since the laser not only restores, but also gives greater elasticity to the pelvic floor muscles)

– an intimate filler (hyaluronic acid is injected at certain points, so the problem is eliminated from one to one and a half years). More information about the procedure can be found here
– Plasmolifting (the method is based on the use of the effect of platelet-rich plasma.The technique allows not only to relieve the symptoms of stress urinary incontinence, but also improves the quality of sexual life). You can learn more about the technique here.

– diet (restriction of foods that irritate the mucous membrane of the urethra and bladder)

– fighting overweight

There are several operational methods of treatment. The indication for surgery is a combination of prolapse and dysfunction of the pelvic organs. The type of operation is selected individually.

You can sign up for a consultation with a gynecologist by calling 8 (3452) 56-97-67 or through the online registration system on the website.

Treatment of nocturnal enuresis in children

Nocturnal urinary incontinence has been known to mankind for many centuries. At the present stage of development of medicine, bedwetting is understood as involuntary urination during nighttime or daytime sleep.

When a child first comes to a doctor with a complaint of bedwetting, first of all, it is necessary to exclude a malformation of the urinary tract and spine, infectious and inflammatory diseases of the urinary system, diseases of the central nervous system, diabetes.Anamnesis plays an important role in determining the etiology of enuresis and the choice of therapeutic tactics. Particular attention should be paid to the study of obstetric history, in particular, the presence of a threat of termination of pregnancy, preeclampsia, anemia, oligohydramnios, polyhydramnios, chronic intrauterine hypoxia, asphyxia during childbirth. The features of a child’s development in the first three years of life (bruises, concussions, neuroinfections, etc.) are clarified.

Great importance is attached to clarifying the style of upbringing, the requirements of parents for the formation of neatness skills in a child, the presence of leukocyturia, constipation, encopresis.Determine the genetic predisposition, the nature of urinary incontinence, the frequency of episodes; factors preceding the onset of the disease (mental trauma, nervous shock, hypothermia, acute illness with an increase in body temperature, with or without changes in urine tests), the nature of the child’s nighttime sleep, the presence of pathological sleep phenomena in the form of sleepwalking, dreaming, bruxism (teeth grinding ). A detailed, thorough history of the patient with bedwetting will avoid many unnecessary examinations.

The clinical analysis of urination plays a fundamental role in the diagnosis of bladder dysfunctions. The function of the bladder is assessed by registering the rhythm of spontaneous urination for 2-3 days, special tables are filled out to reveal the “mature type of urination” and urgency urination syndrome.

Treatment of psychogenic urinary incontinence .

When neurotic disorders are corrected, psychotherapeutic and socio-pedagogical measures come to the fore, and then pharmacotherapy.Most often, psychotherapy is carried out against the background of drug treatment: one enhances the other. Psychotherapy is used mainly in the form of suggestion in a state of doubt and in a pre-sleep state. In a state of doubt (in the first stage of a hypnotic state), suggestion is carried out to achieve a feeling of inner stability, calmness, and indifference to the mental trauma suffered. In a dormant state, one consistently suggests: 1) a state of dubiousness; 2) the elimination of certain symptoms with an emphasis on neurotic urinary incontinence; 3) the transition of a hypnotic state into a physiological sleep.

Treatment of neurosis-like involuntary urination caused by dysfunction of the urethra and bladder.

Treatment of these disorders is usually long-term, sometimes lasts for years and consists of certain physical exercises, daily regimen, diet and medication. From physical exercise – this is swimming, cycling, jumping, running. In the morning, patients should do exercises that strengthen the muscles of the small pelvis: jump, jump over a rope, etc.d.

It is necessary to limit fluid intake in the evening: approximately 2-3 hours before going to bed, do not drink fluids. In the morning and in the middle of the day, you should not limit fluid intake. Try to empty your bladder before going to bed. When urging to urinate, it is recommended to release urine fractionally: release some of the urine, stop releasing, then release it again, etc. This helps to strengthen the sphincters. For the same purpose, before releasing a portion of urine, you must be patient, not urinate.

The main thing in the treatment of urinary incontinence, caused mainly by a violation of the tone of the bladder, is physiotherapy and related methods of treatment. The main indication for them is not generally urinary incontinence, but rather bladder dysfunction. One of the most common physiotherapeutic methods for treating this type of urinary incontinence is the galvanization of the bladder area according to Shcherbak. The procedure lasts 10-12 minutes, for a course of 10-12 procedures every other day. Acupuncture is an effective way to get rid of bladder dysfunction and associated urinary incontinence.

Bedtime urinary incontinence has a detrimental effect on the psyche of the child. Children are ashamed of their “vice”, seek to hide it, react painfully to the ridicule of other children and to the reproaches of adults. They develop a desire to avoid the company of children, there is a feeling of their inferiority, they develop shyness, sensitivity, self-doubt, sometimes stubbornness, affective outbursts (pathological personality development). The wrong approach to children with urinary incontinence (when they are ashamed, forced to wash their clothes, punished) leads to an increase in the disease.

The emotional experiences of a child cannot pass without a trace for the subsequent development of a person. As one literary character put it, “everything is forgotten, but childhood is never.” It should be noted that even in persistent “chronic” cases, enuresis weakens by the age of eighteen and gradually disappears, usually the exception is children with profound mental retardation.

Head of the children’s department

OKU “LOPNB” Nikitina Olga Nikolaevna.

90,000 Treatment of urinary incontinence in men, price in St. Petersburg

Urinary incontinence is a leak of urine that cannot be controlled by the patient. It does not pose a threat to the patient’s life, but significantly disrupts his quality of life, is the most frequent complication of surgical treatment of hyperplasia and prostate cancer.

According to the most optimistic data, this condition develops in 5-6% of men who underwent radical prostatectomy, and in 2% after transurethral resection of prostatic hyperplasia.The appearance of such a complication does not always depend on the surgeon, it is often inevitable, and is associated with the failure of the urethral sphincter, changes in the length and angle of the urethra, cicatricial changes in the area of ​​surgical intervention.

Depending on the severity of symptoms, the timing after surgery and the patient’s preferences, the following methods of correcting this condition may be offered to him:

• pelvic floor muscle training,

• physiotherapy,

• using a penile clip,

• implantation of a male sling,

• installation of an artificial sphincter of the urinary bladder.

Conservative methods (non-surgical)

They are the “first line” of therapy, and the first 6-12 months after surgery are advisable. Our Clinic successfully uses the training of muscles involved in urinary retention using the principle of biofeedback (biofeedback therapy) and peripheral magnetic neuromodulation.

If conservative therapy is ineffective, one should proceed to surgical correction, and the use of a penile forceps may be an option for a somatically burdened patient with a high risk of surgery.

Male sling – synthetic mesh implantable endoprosthesis for urinary incontinence

The mechanism of action of male urethral slings is to create partial obstruction of the urethra (moderate compression) and change the angle of the urethra.

The operation is effective only for mild to moderate stress urinary incontinence, when the patient is able to accumulate and partially retain urine, uses 3-4 urological pads a day.

Efficiency of male sling implantation up to 70%

Artificial bladder sphincter

It is a complex multicomponent implantable mechanism. It is the “gold standard” in the treatment of severe male incontinence.

Mechanism of action – concentric compression of the urethra by the cuff of the mechanism, activation and deactivation of the cuff is carried out by pressing the button-pump implanted into the scrotum.Implantation of an artificial bladder sphincter is performed for moderate to severe urinary incontinence, when the patient uses more than 4 urological pads per day, is unable to accumulate or partially retain urine, if other methods of treating urinary incontinence are ineffective. As the most high-tech and effective method of treatment, the artificial sphincter is easy to use and requires minimal tactile skills from the patient.

The effectiveness of the treatment of urinary incontinence with the installation of an artificial sphincter is more than 90%.

Installation is performed through the access on the perineum, which provides an almost invisible postoperative scar and implanted mechanism.

The team of the urological department of the Clinic of high medical technologies named afterNI Pirogova St. Petersburg State University has extensive experience in the treatment of urinary incontinence. We have in our arsenal all modern methods of diagnosis and treatment of this condition.

For all questions you can contact by mail: [email protected]

90,000 Treatment of post-stroke urinary incontinence in adults

Review Question

We wanted to evaluate the effectiveness of interventions to manage urinary incontinence in adults with stroke more than a month ago.

Relevance

Half of people hospitalized with a stroke have urinary incontinence. Along with urinary incontinence, symptoms of urinary incontinence include an uncontrollable urge to urinate (urinary incontinence) or leakage of urine when laughing or sneezing (stress urinary incontinence). These symptoms are more pronounced in stroke survivors than in other people with urinary incontinence. They cause discomfort, stress and affect people’s ability to participate in rehabilitation.Urinary incontinence lowers self-esteem and depression is common. It can also seriously affect family members and affect whether patients can return home.

Search date

Search is current as of November 1, 2017.

Characteristics of research

We identified 20 studies with 21 comparisons and 1338 participants. These studies included various behavioral therapies (eg, pelvic floor muscle training), complementary therapies (eg, manual acupuncture or electroacupuncture), and physical therapies (eg, transcutaneous electrical nerve stimulation, TESN), and drugs (eg , oxybutynin, estrogen).One clinical trial examined the effect of a nurse practitioner assessing and treating incontinence. Control groups typically included “routine care” or no treatment.

Main Findings

We found that behavioral interventions can reduce the average number of incontinence episodes per 24 hours, but they may not (or do so) affect quality of life. However, the intervention for the treatment of incontinence by a nurse practitioner did not significantly change the number of persons with resolution of incontinence three months after treatment.Complementary therapies, such as acupuncture, can increase the number of participants with resolution of post-treatment incontinence. Physical therapy, such as transcutaneous electrical nerve stimulation, can reduce the average number of incontinence episodes at 24 hours and is likely to improve functional performance.

Quality of evidence

The quality of the evidence was limited due to poor presentation of study details (especially in earlier studies) and the small number of study participants in most comparisons.More than half of the studies provided no information on side effects.

Authors’ conclusions

High quality clinical trials with more participants comparing different treatments with conventional care or no treatment are needed.

Treatment of urinary incontinence in women in Balashikha

Treatment

Urinary incontinence therapy includes both conservative methods and surgical treatment of urinary incontinence in women and men.

Physiotherapy consists of training and strengthening the pelvic floor muscles according to an individual program. For this purpose, the Smart Medical Center clinic uses the device for extracorporeal magnetic stimulation “Avantron”. It provides painless contraction of the pelvic floor muscles and organs of the genitourinary apparatus, improves microcirculation and restores rhythmic processes.

Pharmacotherapy is used for a clarified diagnosis of imperative incontinence and consists in taking anticholinergics – drugs that reduce the muscle tone of the bladder.

Non-invasive (non-surgical) laser treatment of urinary incontinence in women can be prescribed for mild to moderate stress incontinence. The procedure is painless and does not require any special training. Photothermal action improves neocollagen synthesis, strengthens the muscles of the walls of the bladder and vagina, improves tissue nutrition.

Injection therapy has proven itself in the treatment of stress urinary incontinence. Fillers of hyaluronic acid and collagen plump and stabilize the tissues of the muscles of the pelvic floor and vagina.The method has no side effects and contraindications and gives the result immediately after the procedure.

Surgery for urinary incontinence in women is performed with diagnosed prolapse of the pelvic organs. These are abdominal and laparoscopic operations with the installation of a mesh or an artificial sphincter.

The inability to control the urge to urinate is not only a physiological and hygienic problem, but also causes serious discomfort, entails a change in lifestyle.The development of incontinence may indicate serious diseases, so it is important not to postpone and undergo differential diagnosis and treatment as early as possible, without expecting complications.

Frequently Asked Questions

How to relieve urinary incontinence symptoms at home?

To strengthen the muscles of the pelvic floor, it is recommended to do daily gymnastics (Kegel exercises), replace intense training with stretching the muscles – Pilates or yoga, limit coffee and nicotine intake, drink enough water (up to 8 glasses a day), exclude physical activity and lifting weights …

How is senile urinary incontinence treated?

Comprehensive treatment of urinary incontinence in women of age includes the diagnosis and treatment of major diseases, elimination of risk factors, strengthening of the pelvic and bladder muscles.

What is an artificial sphincter placement?

An artificial sphincter is a prosthesis that is placed around the urethra at the neck of the bladder. It is established with full or partial incontinence.

How is postpartum urinary incontinence treated?

Treatment is prescribed if inflammatory processes, chronic diseases, and neurological disorders have been diagnosed.