Continence Physiotherapy service
Incontinence, which can be defined as the involuntary loss of urine or faeces, affects a large number of people, both men and women, although it is more common in women. It can be very distressing and humiliating and can have a catastrophic effect on the quality of life of the sufferer.
Female Urine incontinence
There are two main types:
- Stress incontinence: where there is leakage during coughing, sneezing, laughing, running, etc. Weak pelvic floor muscles cannot cope with the increased intra-abdominal pressure during these activities
- Urgency and urge incontinence: urge incontinence is the involuntary passing of urine associated with a strong desire to void and leaking before they arrive at the toilet. Urgency is often described as “overactive bladder” and is commonly associated with frequency of passing urine.
Is the inappropriate leakage of faeces and difficulty controlling flatulence. Contributing factors include: anal sphincter dysfunction, childbirth and surgery.
How can physiotherapy help with incontinence problems?
Physiotherapists are trained in anatomy, physiology as well as electrotherapy. With this musculoskeletal background, physiotherapists have the skills required to play a vital role in the management of continence, particularly rehabilitation of the pelvic floor muscles.
Weakness of the pelvic floor muscles may be due to many factors including: pregnancy and childbirth, chronic cough, eg asthma, constipation, obesity and high impact exercise.
This will be carried out by a Chartered Physiotherapist specialising in incontinence problems.
It will start with a full assessment of the specific problem and can take up to an hour. The assessment will include discussion of lifestyle, diet (including fluid intake), work, medical and surgical history as well as a physical examination. Provided patient consent is given, a digital examination will assess the strength and endurance of the pelvic floor muscles.
Following the assessment, the physiotherapist will discuss the clinical diagnosis, the cause of incontinence and treatment programme. All treatment is individual and the length of treatment varies depending on the symptoms of incontinence. Throughout the treatment, the patient will be involved in any decisions that need to be made and his/ her doctor/consultant will be informed of progress.
Treatment can include:
- Bladder charts – the treatment may include the patient keeping a frequency volume chart: How much urine the bladder holds and how much fluid has been drunk in 24 hours and any leakage that may occur.
- Bladder retraining (or drill) – is used in the management of urgency and frequency. The aim is to help patients to reduce frequency and control the urges that cause the dash to the toilet by using deferment techniques.
- Exercises – pelvic floor muscle exercises can be very effective in the management of incontinence. The physiotherapist will explain the functions of the pelvic floor, the anatomy and physiology of the pelvic floor muscles and how to contract the muscles and how to strengthen them with daily exercises. Each patient will have their own specific exercise programme.
- General advice on lifestyle and helpful advice to aid the treatment programme.
- Other aids that can help with the treatment programme include:
- Biofeedback – visual feedback will demonstrate to patients how well they are progressing with their exercise programme.
- Electrical stimulation – to stimulate the pelvic floor muscles with electrotherapy if patients are unable to contract their own muscles.
- Vaginal cone – a weighted cone, the size and shape of a tampon, is inserted into the vagina. This is used to help exercise the pelvic floor muscles whilst performing activities such as housework, walking etc.