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CONTINENCE AND WOMENS HEALTH (TREATMENT (General - Dependent on type/cause…
CONTINENCE AND WOMENS HEALTH
DEFINTION
Prevalence: Stress UI most common. Occurs in 1/3 women who have had children. 50% prolapse risk if over 40 years old
Causes
Overactive bladder/pelvic floor
Hypo/hypertonic detrussor muscle
Neurological
Idiopathic
MSK
Behavioural
Trauma
Prolapses
Infections ie UTIs
Risk Factors
Modifiable
Weak muscles (core, PF)
LBP
High impact activity / loading
Chronic constipation
BMI
Smoking
Non-Modifiable
Respiratory disorders
Age
Gender
Menopause
Parity
Delivery type
Traumatic birth / use of equipment
Connective tissue disorders / tissue type
Previous Surgeries ie Hysterectomies
Other previous trauma ie sexual
Types
Stress
Frequency
Urge
Mixed (stress and urgency)
Overflow
Functional
Environmental
Cognitive
Physical
Prognosis - avulsions poor prognosis, 4B tears poor prognosis urinary and faecal incontinence. Overall cure rates 56-84%
ASSESSMENT
Subjective
MHx
Sexual activity
Bladder / bowel function
Toileting behaviours / routine
Fluid intake
Symptoms - duration, onset, worsening, etc
Red flags
Pregnancy status
Objective
Rectus Diastasis Ax
TA palpation
Internal/digital examination - Looking for damage, avulsion, recruitment pattern, strength, duration, resting tone, functional recruitment
Observation
BMI calculation
Functional recruitment
Paper towel/pad test
US
Other
Pads / liners
Continence Hx Assessment Form - various
Bristol Stool Chart
Bladder Diary
Bladder function tests
Urinalysis, MCU studies
Modified Oxford Scale
Internal continence society 4 point scale
Perineometer
Documentation
PERFECT - Power, Endurance, Reps, Fast, Every Contraction Timed
TREATMENT
General - Dependent on type/cause
Biofeedback - US, Pressure cuffs/pads
Core training
Strength Training
Bladder Retraining
PF Education
Address risk factors/comorbidities
TA co contraction training
Electrical stimulation
Urge
Complete emptying education
Diversion
Timing
Positioning
Mixed (combo of treatments)
Frequency
Education
Proprioception/muscle bulk education
Distraction
Fluid intake/outtake
Stress
Pelvic FLoor Muscle Training
Education
Constipation
Fluid intake/outake
Load Management
Teach 'The Knack'
Functional Recruitment
Insertional Devices/weights
Prolapse
Pessary (needs Dr referral and fitting)
Resources
Pelvic Floor Essentials Book
Apps - Continence.org, Pelvic floor first
Hospital handouts
Traumatic Birth Website support
MEDICAL
Medication
Surgical
Mesh Repair
Sling
PREVENTION - Bladder bowel habits taught, Drink 1.5 to 2L water, reduce caffeine/alcohol, dont excessively defer/hold it, fibre in diet, exercise, dont ignore first urge to deficate, perfect poo position
EVIDENCE: 10x10x10 gold standard in PFMT. Everyone should do PFMT. PFMT for stress, urge or mixed incontinence should be offered as a first line management strategy. Level 1A evidence. 3 sets 8-12 a week, 12 weeks minimum evidence
Gaps in Knowledge
Medications
Surgeries
Causes of frequency, especially neurological
TRAINING
APA Womens Health Level 1 course
5 day training course - need qualification for internal examinations
Clinical supervision