Stress incontinence: physiotherapy

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What is it about ?

We talk about urinary incontinence in case of involuntary urine leakage, regardless of the cause.

There are different types of incontinence:

  • THE’stress incontinence occurs during physical exertion such as playing sports, lifting a load, coughing, sneezing, laughing or pushing. These activities increase the pressure in the bladder, which causes urine to leak.
  • THE’urge incontinence is a sudden urge to urinate that you cannot control without physical exertion. You feel like you need to empty your bladder immediately, and you lose urine because you can’t get to the toilet on time.
  • THE’mixed incontinence is a combination of stress incontinence and urge incontinence.
  • THE’overflow incontinence results from an overflow of urine in the bladder. This is because the bladder muscle no longer works as it should and the bladder does not empty completely when urinating. Result: it continuously overflows.
This patient guide concerns stress incontinence.

Stress incontinence is caused by weakening of the pelvic floor muscles. This weakening has different possible causes: a recent childbirth, a descent (prolapse) of the bladder and / or the uterus (genital prolapse), bladder or uterine surgery, prostate surgery, obesity, etc.

The medical gymnastics of the muscles of the pelvic floor accompanied by a physiotherapist occupies a prominent place in the treatment.

By their training, the physiotherapist is not only allowed to teach exercises, but also to make a physiotherapy diagnosis regarding the type of incontinence. He can also evaluate the results of the treatment. It has a number of tools for this purpose.

How to recognize it?

Urine losses occur during activities that increase pressure in the stomach, such as lifting a load, coughing, sneezing, playing sports, making sudden movements, jumping, etc. Most often, it is only a small amount of urine. It only happens during the day, when the person is awake and active. Often the person must also urinate more often.

What tools does the physiotherapist have?

  • The 3IQ (3 Incontinence Questions) test, which consists of three questions, allows the physiotherapist to distinguish between stress incontinence and urge incontinence.
  • The POPQ (Pelvic Organ Prolaps Quantification System) test is used to check for prolapse of the bladder and / or uterus (genital prolapse) and to determine its severity. In Belgium, this examination is generally performed by the doctor.
  • The PRAFAB test (Protection, Amount, Frequency, Adjustment, Body image) is a list of scores to assess the impact of urine loss.
  • The PSK (Patiënt-Specifieke Klachten, patient-specific symptoms) selects the 3-5 most important symptoms in terms of physical activity, which are due to incontinence. We are talking about patient specific symptoms because they can be different from person to person.
  • The GEE (Globaal Ervaren Effect, experienced global effect) allows to assess what the patient thinks of the effect of the treatment.
  • The study of function allows us to take stock of the effect of breathing, posture and behavior linked to going to the toilet.
  • The person keeps a diary in which he must note all the data concerning urination and urine loss, before treatment, during treatment and after: the number of times he urinates, the amount, the number of protections -slips used, etc.

Physiotherapy

The physiotherapist will begin by explaining how the bladder works and the mechanism of urinary incontinence. Without this knowledge, it is indeed difficult to properly train the muscles involved in urinating.

Treatment is based on selective pelvic floor muscle exercises to be performed daily. Sometimes electrical stimulation of the muscles is also used. The physiotherapist teaches exercises that the person can also perform at home in everyday life. These exercises can also be carried out preventively, for example in preparation for an operation.

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Source

www.ebpnet.be