– 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.





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