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Urinary incontinence in women (Urgency urinary incontinence (Physio…
Urinary incontinence in women
Stress urinary incontinence
urethral pressure
too low
involuntary leakage on effort of exertion on sneezing and coughing
coughing and sneezing
causes increase in intra visceral pressure
Treatment
Aimed
increasing urethral pressure
PF muscle training
Correct contrction of PF muscles
Squeeze around urethra
Cues
imagine stopping flowing water
OBs , Palp, RTUS
Inward lift at the perineum
Facilitate co-contraction with TA
Neuromuscular E-Stim
Facilitation of contraction
increasing strength and tone of PF
Frequency
PF sessions a day / week
Intensity
Squeezing PF for duration of time / Reptiton
Specificity
Slow twitch
Long duration
Slow activation
mainteinence for activities like bicep curls
Fast twitch
short duration
Fast maximal contraction
For fast onset like sneezing
Coordination
The KNACK
Functional use of PF
Management of Prolapse
Tensioning the PF muscles during increase of IAP
Limitations
Temporarily support in short duration in increase of IAP
not suitable for longer durations / activities
Jogging
Exercise class
increase Functional use of PF in increase IVP
Symptom management
Devices
Continence Dish/ POP pessary with knob
fittited professionally
can remain in for 3 - 6 / 12
Can be used for prolapse
Cheap
Contiform
can be purchased over the counter
designed to be inserted / removed by individual
3 different sizes
Vaginal sponge / tampon
no evidence proving which is better
both helps
Urgency urinary incontinence
detrusor overactivity
Contracts causing an over sensation of urgency
Treatment aims
Controlling and preventing bladder spasms
Physio options
Pelvic floor Muscle training
Increase strength
reduce leakage in episodes
inhibition of detrusor overactivity
Lifestyle advice
Fluid intake
High
fast diuresis
Increased detrusor activity
Low
dehydration
irritant dure to concentrated urine
Removing of bladder irritants
Caffine, Artificial sweeteners
Carbonated drinks
E-STIM
V E-STIM
Sacral Tens
good for paeds
TN STIM
Showed sig imprivement in QOL and UUI parameters
Should be offered to older women
Bladder retraining
response to sudden sensation of UUI
further increase of pressure
increase chance of incontinence
increased anxiety
stronger urge
Learning to allow urgency to pass
rather than reacting
Go to toilet at time of lower risk
delay voiding until a later time
Reduction in urinary frequency
Explain
Urinary system
Expansion of walls of urethra
Bladder sensation in response to stretch
Educate
Detrusor overactivity
Bladder spasms
Explain UUI and racing to toilet
strionger urge
Instruct
avoid responding to instinctive desire to race to toilet
sit down and attempt to reduce detrusor activity
Urge suppression strategies
Application of pressure to the perineum
Pudental Nv that inhibits detrusor activity
PF contraction
Activation of Posterior TNv
Toe curling and calf contraction
Facilitation of frontal lobe
Distraction
relaxed breathing
either calming walk to the toilet or wait a certain of time
after the urge reduces
Prevalence
Women
Old
2.3 times have LBP with UI
YOung
Elite athlete
21% experienced
90% never told ppl
Younger athletes
aged 15
75% discussed with parents
2.5 times to have LBP with UI
Severe UI
More likely to be insufficiently active
1 in 7 experience UI in PA
See it as barrier to exercise
Chronic Respiratory Conditions
80 to 100% of women with Cyctic fibrosis by 35 years old
mid aged
2.3 times more likely to have LBP w UI
Nocturia
waking in the middle of the night to void
generally 1 to 2 per night
Problems associated
Sleep deprivation
Depression
Risk of falls and hip #
Nocturnal Polyuria
excessively high urine production overnight
33% of 24 hr output
Causes
high fluid intake 3 hrs before bed
diuretic medications / BP medications before bed
Poor venous / LL fluid pooling through the day
treatment
Elevate and circulatory exercises in the last 2 hrs before bed
Compression stockings
sleep apnoea
Treatment
CPAP
continous Passive airway pressure