STRESS INCONTINENCE- MANAGEMENT

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.

 

THANK YOU

BY PHYSIOFEEDS.

FOLLOW ME IN SOCIAL MEDIA
PHYSIOFEEDS

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top