Urinary Incontinence: The Distressing Problem (original) (raw)
Related papers
Urinary Incontinence: Revisited
Journal of SAFOG, 2014
The prevalence of urinary incontinence (UI) in India is as high as 30%. Since, patients do not directly report the problem of incontinence leading questions regarding incontinence should be a routine part of history taking in gynecology.
Rehabilitation of Women with Stress urinary incontinence: A case report
Introduction: Urinary incontinence can be evident in women, after multiple child birth or with increasing age. The nonsurgical management is considered as the first line of management, the preliminary management of simple SUI includes a variety of noninvasive interventions, including behavioral modification, Pelvic Floor Exercises (PFEs) with or without biofeedback, and other accessory teaching aids. Case Report: The purpose of the present study is to find out if repetition of pelvic stabilization exercise impacts upon the management of stress urinary incontinence. For the management of Urinary incontinence, she has been treated by A Bangla booklet on urinary incontinence, Kegal exercises and pelvic floor exercises in a booklet instruction in Bangla, an exercise log book to maintain exercise. All the pelvic floor exercise started by 10 repetitions of exercise each, increasing 10% of exercise in each week for 4 weeks duration. After 4 weeks clinically significant improvements found in strength and endurance of pelvic floor muscles and ICIQ- UI questionnaire (brief). Conclusion: Stress urinary incontinence can degrade patient’s physical, functional and daily living status. Structured exercise therapy determined by physiotherapists contributes to the improvement of muscle function, function of genito-urinary system and quality of life for these patients.
Urinary incontinence-pathophysiology and management outline
Australian family physician, 2008
Urinary incontinence is common in the community and may impact significantly on quality of life; yet only one-third of sufferers seek medical attention. There are many treatment options for patients suffering with urinary incontinence. This article aims to aid general practitioners in the management urinary incontinence. We outline the pathophysiology of urinary incontinence in women and provide a primary care treatment paradigm. Suggestions for when specialist referral would be of benefit are also discussed. Most urinary incontinence can be evaluated and treated in the primary care setting after careful history and simple clinical assessment. Initial treatment, for both urge urinary incontinence and stress urinary incontinence, is lifestyle modification and pelvic floor muscle treatment. Urinary urgency responds to bladder training and pharmacotherapy with anticholinergic medication. Pharmacotherapy has a limited place in stress incontinence. If there is complex symptomatology or p...
Diagnosis and management of adult female stress urinary incontinence
Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}.
Clinical management of urinary incontinence in women
PubMed, 2013
Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. A stepped-care approach that advances from least invasive (behavioral modification) to more invasive (surgery) interventions is recommended. Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence. Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy. Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects, these agents are not recommended in older adults. Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA. Sacral nerve stimulators, which are surgically implanted, have also been shown to improve symptoms of urge incontinence. Pelvic floor muscle exercises are considered first-line treatment for stress incontinence. Noninvasive electrical and magnetic stimulation devices are also available. Alternatives for treating stress incontinence include vaginal inserts, such as pessaries, and urethral plugs. Limited or conflicting evidence exists for the use of medications for stress incontinence; no medications are approved by the U.S. Food and Drug Administration for this condition. Minimally invasive procedures, including radiofrequency denaturation of the urethra and injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments. Surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments.
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.10\_Oct2017/IJHSR\_Abstract.019.html, 2017
Background: Urinary Incontinence is widely prevalent in females but poorly diagnosed. Several studies all around the world have already proven the effect of physiotherapy management in females with stress urinary incontinence. In India, since last 10 years the awareness and education regarding physiotherapy in SUI has increased. Still limited evidences in India, and acceptance of this problem by majority of females lead to low level of evidence based practice. The cultural, economic and religious scenario of Indian women is very different than that of western or other developed countries. So there is immense need to work on these areas, define a protocol of exercise for them and to see the efficacy of this protocol on incontinence episodes in women with SUI. Aim: To evaluate the effect of Pelvic Floor Muscle Training (PFMT) based on severity of incontinence on incontinence episodes in women with Stress Urinary Incontinence. Materials and Methods: Total 65 subjects were recruited according to inclusion criteria for an experimental study which was set up at SBB College of Physiotherapy, V.S.General Hospital Campus and Shruti nursing home, Naranpura, Ahmedabad. Each subject received 6 weeks of home based PFMT based on severity of incontinence which was decided by Incontinence Severity Index. Pre and post data were taken and further analysis was done using SPSS 21.0. The outcome measure used was voiding diary (Number of incontinence episodes per week and frequency of micturition per day). Results and Discussion: Level of significance was set at 5%. Wilcoxon test was used to compare the pre and post data for all the subjects. The hypothesis is proven with Z =-5.566 and Z =-6.167 for frequency and number of leakages respectively. p < 0.001 shows highly significant difference between two groups. Conclusions: Six weeks home based PFMT based on severity of incontinence is effective in reducing no. of leakages per week and frequency of micturition per day in female with SUI.
Urinary Incontinence: An Update
Journal of South Asian Development
Patients usually under-report symptoms of incontinence. Therefore, improved physician-patient communication is vital . Most urinary incontinence can be evaluated and treated after careful history and simple clinical assessment. Initial treatment, for both urge urinary incontinence and stress urinary incontinence, is lifestyle modification and pelvic floor muscle exercises.
Management of stress incontinence in older women
2019
Introduction: Stress incontinence is a problem increasingly affecting older people. This discomfort has an impact on women as a greater extent. Stress urinary incontinence is described as involuntary leakage of urine during even minor efforts: sneezing, coughing, rapid gait. At the beginning inconspicuous loss of a few drops of urine is often not alarming for women. The problem is significant because women often go to a specialist very late and the reason for this is shame. Many people think that this is an accident of old age and it can't be stopped. Nothing could be more wrong, it can be dealt with. Material and methods: Articles in the EBSCO database have been analysed using keywords: stress incontinence, problems of old age, physiotherapy in urology, older women. Results: The incidence of stress incontinence in women increases with age. The main reason is muscular weakness, which is caused, among other things by pregnancies and labours. Another reason may be hormonal disorders and genetic predisposition. Statistics show that obese women are more likely to suffer from SUI. The progress of medicine and pharmacology is also increasingly effective in the treatment of stress urinary incontinence. First, after finding the problem, conservative treatment is introduced. Treatment is adapted to each patient individually. Age, existing diseases, weight are important factors in the process of treatment. In pharmacology Duloxetine is used. The use of this drug does not completely eliminate the symptoms of stress urinary incontinence. Due to the possibility of side effects i.e. nausea, the drug is used very carefully. In recent years, physiotherapy has been highly 210 valued in the treatment of stress urinary incontinence. The most important is kinesitherapy here. Strengthening the pelvic floor muscles brings the most beneficial effects. Active exercises are supported by: electrostimulation, magnetotherapy and vibro-therapy. The final form of SUI treatment is surgical treatment. However, this do not always bring the expected results. In order to increase the effectiveness of therapy for patients with SUI, the interdisciplinary cooperation of the medical team should be used. Treatment of stress urinary incontinence primarily leads to improved quality of life for patients. Conclusions: Urinary incontinence is a social disease. Women struggle with this problem twice as often than men. Stress incontinence accounts for 63% of all forms of urinary incontinence in women in Poland. The incidence of incontinence increases with age. Problems with stress urinary incontinence become a reason for isolation from society. The patients are not aware of the treatment possibilities, which often results in late inclusion of treatment and rehabilitation. There is a wide range of SUI treatment options. Therefore it is necessary to personalise rehabilitation process to best fit to each patient.
International Urogynecology Journal, 2007
Assessment of patient expectation, and social and economical factors are important in choosing treatment. Lifestyle adjustment, behavioral modifications, and dietary management may benefit some patients. History General history, including drug, obstetrical, surgical, bowel and neurological evaluation should be part of the exam. The type of incontinence determined from taking the history, whether stress, urge, or mixed, is used to direct treatment. There is low correlation between urodynamic findings and symptoms of urge incontinence. However, women with pure stress incontinence symptoms are also unlikely to have detrusor overactivity on urodynamics [1]. Physical examination Genitourinary examination should include determination of estrogenic status of the vagina, caliber, description of interstitial or vaginal masses, and neurological examination. Sensation and bulbo-cavernosus reflex should be checked. Imaging Imaging is not routinely recommended. It is indicated when upper urinary tract pathology is suspected. Specific indications include neurogenic bladder, chronic high-grade pelvic organ prolapse, low compliance of the bladder, or high residual urine volumes.