STRESS INCONTINENCE
DEFINITION
– Stress incontinence is defined as involuntary urine loss due to stress/ strain such as increase in intra- abdominal pressure on coughing, sneezing and lifting.
• Etiology
√ Trauma
√ Post – operative muscle weakness
√ Post – menopausal women
√ Pregnancy
√ Obesity
√ Hormonal changes
• Tests for incontinence
1) Frequency / volume chart
– The women is asked to note the time and volume of urine voided each time she goes to toilet
– It is recorded in special chart
– Helps to determine ;
√ actual frequency of micturition
√ Degree of nocturia
√ How much fluid is drunk
√ determine bladder capacity
2) Visual analog scale
– It is mainly to determine the severity of symptoms during incontinence and pain measurement.
– 1 determines no pain, no incontinence and no problem
– 10 determines always wet, total incontinence and massive problem.
3) Pad test
4) Manual grading of pelvic floor muscle contraction.
– The therapist insert his index finger into the vagina and ask the patient to contract the pelvic floor muscles.
• PT management
Aims :
√ To restore the function of urethrovesicle muscles
√ Strengthening the support of uterus
√ Advise obese patient to control diet
• Means of treatment
(A) Pelvic floor contractions
– Sitting position or leaning forward to support the forearm on knees.
– Stopping passive urine
– Stopping passing breathing wind
– Stopping yourself or blowing off
– Fasting and slow contraction
– Bracing exercise.
(B) Perinometer/ kegel’s exercise
– Kegel devise is a pneumatic device helps to measure presshre inside the vagina and to motivate the women to practice pelvic floor execises
– A compressive air filled rubber cuff was inserted into vagina which is connected to a manometer by a rubber tubing
– Ask women to contract her pelvic floor several times and note the highest reading .
– Also note the length of time which she can hold contraction
– It is useful for biofeedback
– Take care that intra abdominal pressure is not measured rather than pelvic floor.
(C) Foley’s catheter
– An air filled catheter is used and is inserted into vagina and then ask the patient to contract and hold the catheter against traction given by therapist.
(D) Vaginal cones
– Consists of 5-9 small cones
– It is a size of tampon
– lightest cone is inserted first and ask patient to hold and walk for 15 min
– Once cone is retained for 15 min without slipping progression is made .
– This helps to activate motor unit to support cones and to increase woman’s awareness of her ability to contract muscle voluntarily
(E) Elevator exercise
(F) General exercises
– Pelvic tilting
– pelvic rotation
– Pelvic rocking
– Functional training
– Squatting exercise
– Postural correction exercise.
(G) Faradism
– Surged Faradism is used in re – education of pelvic floor
– Levator ani muscles can be contracted using vaginal or anal electrode
(H) Interferential therapy
– Improves patient’s cortical awareness and ability to perform voluntary contractions .
( I ) Bladder retraining
– It is used in frequency urgency without leakage incontinence
– Contract pelvic floor muscles every time before voiding
– Distraction by companion , games , tv , music
– Perineal pressure by hand
– Cross leg standing
– Maximus gluteus contractions in standing.
