INCONTINENCE Flashcards
What is SUI?
Stress Urinary continence - Is the Complaint of involuntary leakage on effort or exertion, or an sneezing or coughing
How to diagnose SUI?
- Subjective Ax
- 1 hour pad weight test
- Bladder neck descent (US)
- Urodynamic testing
Indicators of SUI
- Leakage on coughing, sneezing - increased IAP causing leaking
- Leakage when walking
- Vaginal examination showing weak pelvic floor, thus meaning higher chance of SUI and leakage
- Incontinence with activities that increase IAP (cough, walking)
SUI and PFMT and WHY?
- PFMT program based on PERFECT assessment or RTUS results.
- P - Power 0/5 as of MMT
- E - Endurance - Time rep held
- R - Repititions - No. of reps
- F - Fast contractions - No. of fast 1 second contractions
ECT- Every contraction times - 12 weeks minimum but ideally 6 months
- Teach the Knack - Lifting of PF before activity ie coughing/sneezing
- Performed either lying on bed or flat surface where patient can have their feet flat on the surface with knees and hips flexed
- Progression over time
why? Evidence for PFMT and SUI Increase hypertrophy, strength and endurance, or PFM – therefore PFM resists downward movement of bladder neck with increases in IAP
Types of Incontinence:
- Urinary incontinence (symptom): Complaint of involuntary loss of urine.
- Stress urinary incontinence: Complaint of involuntary loss of urine on effort or physical exertion (e.g. sporting activities), or on sneezing or coughing.
- Urgency urinary incontinence: Complaint of involuntary loss of urine associated with urgency.
- Mixed urinary incontinence: Complaint of involuntary loss of urine associated with urgency and also effort or physical exertion or on sneezing or coughing.
- Urgency: Complaint of a sudden, compelling desire to pass urine which is difficult to defer.
- Overactive bladder (OAB, Urgency) syndrome: Urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.
SUI and PFMT/TA
Combining PFMT + TA for SUI is extremely important. TA plays a role in the pelvic floor and diaphragm. Together the 3 create a cylinder that all work together to control the effects of IAP. By strengthening TA and PF together helps to decrease the risk of Leakage
- Don’t start TA activation straight away, need to work on PF activation and then include TA activation and exercises
Role of TA
- Deep trunk muscles form a functional unit to balance changes in intra-abdominal pressure and stabilize the spine
- Work in combination with PF and Diaphragm to create a cylinder.
Possible treatments for SUI?
- PFMT
- PFMT + TA
- Pessary
- Decrease BMI
- Bulking agent injections to help bladder neck
- Surgery
Exercise Program for PFMT
- R reps x E secs
- 2 x F reps
- 3 x daily with progression self-according to fatigue
- Completed for a minimum of 12 weeks, ideally 6 months. Program can be completed on bed or any flat surface where you can lie on your back with knees up o the bottom of your feet is on the flat surface
- Continue progressing how many reps and length of contraction/hold
What is Overactive Bladder Syndrome?
- Provoked or unprovoked detrusor overactivity. Causing Urinary urgency/incontinence
- Incomplete bladder emptying
- stimulants such as running of water or key in the door
- low void levels
What are the causes of OAB?
- Poor bladder habits
- Caffeine/alcohol
- Stress
- Medical conditions
- Dehydration
- Weak PFM
- Pelvic organ prolapse
- Certain medications
- UTI
- Painful urination
- ## Highly important to test to clear risk
OAB treatment
- Bladder diary to analyze diary over 3 days to be certain about diagnosis
- Fluid diet management
- PFE biofeedback
- Time voiding
- Education reinforcement
- Reducing stimulants in diet
- Hold onto PFM when urgent
- PFMT
- Anticholinergics
What is Pelvic organs prolapse?
Organs sitting in wrong position.
Graded:
Symptoms of POP:
- A heavy sensation of dragging in vagina
- Something coming down
- Sexual problems of pain or less sensation
- Bladder not emptying
- UTI
- Difficulty emptying bowels
- Lower abdominal or back ache
Treatment for POP:
- PFMT
- Ergonomics – lifting heavy
- Reduce constipation
- BMI issue
- Pessary
- Prolapse surgery (ant, post and hysterectomy)
