What Is Urinary Incontinence(UI)?
Urinary incontinence means accidental leakage or loss of urine. The condition can occur at any age but is most prevalent in women above 50. Studies show that over 25 million adult Americans experience chronic or temporary urinary incontinence. Urinary incontinence is not only a medical issue but can also result in social problems due to associated embarrassment and negative self-perception. UI may lead to urinary tract infections, pressure ulcers, and perineal rashes. It is also related to psychological problems, emotional problems, poor self-health, poor sexual relationships, and decreased quality of life.
Physical therapy also plays a role in the management of UI.
What Are the Different Types of UI?
The different types of urinary incontinence are:
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Stress Incontinence:
Stress Urinary Incontinence (SUI) is the involuntary urine leakage due to effort or exertion activities like coughing, sneezing, lifting heavy objects, or other activities that put pressure on the bladder.
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Urgency Incontinence:
Urge Urinary Incontinence (UUI) is the accidental leakage followed by or preceded by urgency. During the filling of the bladder, abnormal bladder contractions occur, which creates a sensation of urgency that results in leakage,
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Mixed Urinary Incontinence:
Mixed Urinary Incontinence (MUI) is the accidental leakage associated with urgency and exertion (which includes coughing, sneezing, etc).
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Overflow Incontinence:
Overflow incontinence is the accidental leakage of urine due to a full bladder.
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Nocturnal Enuresis:
Nocturnal Enuresis is urine leakage during nighttime.
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Continuous Incontinence:
Continuous incontinence is the complaint of constant urinary leakage.
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Functional Incontinence:
Cognitive or physical functioning impairment results in urinary leakage.
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Total Incontinence:
Total and complete loss of urinary control.
What Are the Different Female Urinary Incontinence Rehabilitation Options?
The treatment options for female urinary incontinence range from surgical interventions to conservative treatment management (these include interventions other than surgery and drugs). Conservative management and physical therapy are beneficial, especially for women who have only mild symptoms and those who have not undergone childbearing. Strengthening the pelvic floor muscle is the first line of treatment for managing urinary incontinence in women.
The rehabilitation measures include the following:
1. Pelvic Floor Muscle Training:
Pelvic Floor Muscle Training (PFMT) is an important factor in the treatment and prevention of urinary incontinence. This therapy has minimal side effects (no significant ones) and aids in improving the symptoms. So, it is the first choice of treatment in women with urinary incontinence. It is mainly suggested for patients with MUI or stress urinary incontinence and is less commonly used in the case of UUI.
The benefits of the therapy include the following:
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Increase intraurethral pressure.
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Increase the strength of pelvic floor muscle contractions.
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Elevate the urethra to maintain continence.
Of the pelvic floor muscle fibers, 70 percent are slow-twitch type 1 (fatigue-resistant fibers), and 30 percent are fast-twitch type 2 (fatigue-prone fibers). The fatigue-prone fibers are capable of active contraction. Doing exercises increases pelvic floor muscle durability, strength, and responsiveness. Mostly the training is recommended for three months but can vary. The number of contractions varies from 8 to 12 per day to even 200 per day. The treatment postures can be sitting, lying down, standing, kneeling, and standing with legs astride.
2. Biofeedback:
Though not a therapeutic procedure, biofeedback is used to treat SUI patients. The benefits of biofeedback include the following:
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It gives an indication of pelvic floor muscle (PFM) activity both during relaxation and contraction modes.
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It also provides information on the direction of contraction and the strength of pelvic floor muscle contraction.
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It helps educate the patient on the selective contraction of pelvic floor muscles.
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It helps determine vaginal and rectal pressure by placing the electrode into the vagina or rectum.
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It helps in patient motivation to keep exercising as biofeedback helps visualize progress.
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Biofeedback and PFMT help reduce accidental urine leakage in SUI patients.
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They are helpful in the case of patients who are not able to identify their muscles with other methods.
3. Electrical Stimulation:
Physiotherapists widely use electrical stimulation (ES) to manage female urinary incontinence. These are a priority for women who initially have difficulty contracting pelvic floor muscles. This technique applies electrical stimulation to the transvaginal, sacral, suprapubic, and tibial nerves.
Electrical stimulation is helpful in the case of MUI, UUI, SUI, idiopathic urinary retention, and refractory urinary incontinence. The electrodes used in Electrical stimulation may be non-implantable or implantable, and stimulation may be short or long. The contractions produced are passive and do not require voluntary patient effort. Electrical stimulation inhibits parasympathetic motor neurons and promotes bladder relaxation.
4. Vaginal Cones:
Vaginal cones are inserted into the vagina above the level of the levatores muscle plate and help strengthen the pelvic floor muscles. When the cone is inserted into the vagina, the pelvic floor muscles contract to prevent the cone from slipping off.
The advantages of using cones over other methods include the following:
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In most cases, only single consultation is required.
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The exercise is customized for each woman.
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Time for educating patients on the procedure is less.
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Exercise is less time-consuming.
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Provide a form of biofeedback.
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The procedure can be self-taught.
5. Mechanical Devices:
Mechanical devices include vaginal support prostheses that have been used for a long time. They have milder side effects, apply to most incontinent patients, and do not require any specific testing.
6. Magnetic Stimulation:
In the magnetic stimulation technique, an electric current is passed through a metal foil to generate an electromagnetic field that produces an electric current in tissues. It stimulates the pelvic floor muscles, similar to electrical stimulation.
Conclusion
Conservative management is to be done before surgical intervention and medical management in case of urinary incontinence. Pelvic floor muscle training is the first-line therapy for women with urinary incontinence. Other therapy modalities, like electrical stimulation, biofeedback, magnetic stimulation, vaginal cones, etc., are used in women who cannot contract pelvic floor muscles, and it also helps in patient motivation. The therapist should understand the nature of urinary incontinence and the principle of therapy modalities.
