PHYSIOTHERAPY MANAGEMENT IN
FEMALE STRESS URINARY
INCONTINENCE
BY
V.DIVYA EVANGELINE
BPT FINAL YEAR
INTRODUCTION:
Urinary incontinence is defined as the
involuntary loss of urine. It is a common and distressing
problem which may have a large impact on quality of life.
The involuntary loss of urine can affect someones
participation in social life to varying extent and leads to
psychological and social problems such as depression,
social isolation, reduced self confidence and other related
health problems.
Types of incontinence:
• STRESS INCONTINENCE
• URGE INCONTINENCE
• OVERFLOW INCONTINENCE
• MIXED INCONTINENCE
• STRUCTURAL INCONTINENCE
• FUNCTIONAL INCONTINENCE
• TRANSIENT INCONTINENCE
• GIGGLE INCONTINENCE
STRESS URINARY INCONTINENCE:
Urinary stress incontinence is as the complaint of
involuntary leakage of urine due to an effort on exertion or
on sneezing or coughing.
ANATOMY:
PELVIS:
The pelvis of the women and men differ in number of ways.
The pelvic inlet of the women is circular and the angle formed by
two arms of the pubic arch is larger in women. The ischial spines
generally do not project as far medially into the pelvic cavity.
PELVIC FLOOR:
The pelvic floor is formed by the pelvic diaphragm and in the
anterior midline, the perineal membrane and the muscles in the
deep perineal pouch
The pelvic diaphragm is the muscular part of the pelvic floor,
formed by the levator ani and coccygeus muscles
The pelvic floor separates the pelvic cavity above from the
perineum below.
Pelvic floor muscles:
The pelvic floor muscles or pelvic diaphragm is
composed of two groups of muscles.
Piriformis and obturator internus
Levator ani and coccygeus
Pubococcygeus
Iliococcygeus
External anal sphincter
Bulbospongiosus
Ischiocavernous
Sphincter urethrae
URINARY BLADDER:
The bladder is the most anterior element of the
pelvic viscera, although it is entirely situated in pelvic
cavity when it is full. The empty bladder is shaped like a
three- sided pyramid that has tipped over to lie on one of
its margin.
UTERUS:
The uterus is a thick walled muscular organ in the
midline between the bladder and rectum. Implantation of
the blastocyst normally occurs in the body of the uterus.
During pregnancy, the uterus dramatically expands
superiorly into the abdominal cavity.
PHYSIOLOGY:
MICTURITION:
Micturition is a process by which urine is voided
from the urinary bladder. It is a reflex process. Micturition
is fundamentally a spinobulbospinal reflex facilitated and
inhibited by higher brain centres such as the pontine
micturation centres and is subjected to voluntary
facilitation and inhibition.
In health individuals the lower urinary tract has two discrete
phases of activity
storage phase- urine stored in the bladder
voiding phase- urine is released through the urethra.
CAUSES:
• Child birth
• Age
• Hysterctomy
• Menopause
• Pelvic floor muscles weakness
PATHOPHYSIOLOGY:
Two major factors are responsible.
1. urethral hypermobility due to loss of support of
urethra and bladder
2. intrinsic sphincter deficiency
RISK FACTORS:
• Obesity
• Smokimg
• Diabetes
• Medication
• Urinary tract infection
INVESTIGATION:
• History
• Physical examination
• Cough stress test
• Voiding diary
• Post- void residual urine volume
• Urinalysis
• Cystoscopy
• Pelvic ultrasound
• Finger test
• Urodynamics
FINGER TEST:
The index finger is introduced upto the
proximal interphalengeal joint, and then the finger is
moved about normally, until it meets resistance in all
directions. When the pubococcygeus is atrophied, the
middle third of the vagina is roomy; the wall are thin and
is felt as though detached from the surrounding
structures, particularly anteriorly and laterally.
Normal patients can voluntarily contract
the pubococcygeus firmly around the palpating finger.
When atrophy has occurred, no such contraction is
elicited.
STRESS INCONTINENCE GRADE
• GRADE 0- Continent.
• GRADE 1 – Patient loses urine with sudden increase in
abdominal pressure but not spine.
• GRADE 2 – Patient loses urine with physical stress
( walking, jogging, sneezing, coughing).
• GRADE 3 – Patient with total incontinence urine loses
unrelated to physical activity position.
MANAGEMENT:
• Physiotherapy management
• Medical management.
PHYSIOTHERAPY MANAGEMENT
• Kegels exercise
• Electrical stimulation
• IFT
• Biofeedback
KEGEL EXERCISE
DR.Arnold kegel described a pelvic floor
exercise more commonly called kegel exercise consists of
repeatedly contracting and relaxing the muscles that form
the part of pelvic floor. Kegel exercise is said to be effective
for the management of urinary incontinence.
Squeeze the pelvic muscles tight and hold the
contraction for 5 seconds. Then relax for 10 seconds before
starting the next
Repeat this sequence of squeezing for 5 seconds
and resting for 10 seconds.
do not contract the abdominal muscles or glutei
muscles.
BENEFITS OF KEGEL EXERCISE
• Strengthen the pubococcygeus muscle
• Increase blood flow and nerve supply to pelvic region
• Restoration of vaginal muscle tone and improved vaginal
health
• Increase thickness of vaginal walls
• Recover from physical stress of childbirth
• Improve sexual response and function
• Prevention and treatment of stress urinary incontinence.
