The
International Continence Society (ICS) defines Urinary Incontinence as the
involuntary loss of urine resulting in social or hygienic complications [1].
More specifically, Urinary Stress Incontinence (USI) is a disruptive condition
in which subjects complain of leakage on moments of exertion such as sneezing,
coughing or running [4]. The condition has been found to affect 15%
of the ambulatory population, an indication of its clinical relevance [3].
A physiotherapist is often needed for the management of this condition as it
essentially of a musculoskeletal nature. The aim of this blog is to provide
information about the specific therapies for USI and also to provide you with a
thorough understanding of the application of Interferential Therapy in this
condition. Part 1 of this 4-part blog focuses on the prevalence, aetiology and
management of USI.
USI is generally considered a gender specific condition, affecting 35%
of women over the age of 60 [5], however it is also prevalent in the
male population affecting 17% of men the same age [6]. The condition has been found to be more
common in the elderly population affecting only 8.5% of women and 1.6% of men under the age of 65 [7]. Common
Risk factors for the condition include: age, pregnancy, childbirth, cognitive
and functional impairment and obesity [6]. Women who have four or
more children have been found to be more susceptible to the condition [7].
Risks associated with a more clinical nature include stroke, dementia, bladder
cancer, reduced mobility, diabetes, chronic cough and some medications.
Specific to men is incontinence following the treatment of prostate diseases.
30% of men experienced periods of incontinence after they’d had a prostatectomy
[6]. The aetiology of the condition commonly
involves weakness of pelvic floor muscles (PFM), as they provide primary
support for the bladder and preserve urinary continence by providing urethral
closure pressure [4]. The figure below represents the PFM as a
dotted red line, estimating the anatomical location of the muscles (Urinary incontinence, n.d.).
In a healthy
person, contraction of the PFM blocks the flow of urine by compressing the
pressure rise in the urethra [2]. For this reason, activation of the
PFM is fundamental in the treatment and prevention of USI.
Various methods
of activation are performed including: Kegel Exercises, Biofeedback, Vaginal
Cones and Electrical Stimulation. Kegel exercises involve active control of the
PFM, which may prove to be a challenge for some patients as it is usually a
reflex activation requiring no conscious control. This is the main premise for
using biofeedback as a treatment intervention, as it provides the patient with
a greater proprioceptive input in order to target the correct muscle groups.
Biofeedback, however, involves the insertion of an intravaginal probe and may
be cause patient discomfort. Vaginal Cones are a system of free weights help in
the vagina in order to isometrically train the pelvic floor. Adherence to this
form of rehabilitation is its main disadvantage as although the system is
technically non-invasive, patient comfort is compromised. The advantages of
electrical stimulation are that it is non-invasive, has no known negative side
effects and is relatively user-friendly.
References
1.
Abrams, P., Blaivas, J. G.,
Stanton S. L. & Anderson J. T. (1988). The standardization of terminology
of lower urinary tract function. Scandinavian
Journal of Urology and Nephrology, 114, 5-19.
2.
Berghmans, L. C. M., Hendriks,
H. J. M., Bo, K., Hay-Smith, E. J., De Bies, R. A. & Van Waalwijk, E. S. C.
(1998). Conservative treatment of stress urinary incontinence in women: A
systemic review of randomized clinical trials. British Journal of Urology, 82, 181-191.
3.
Cutner, A. & Cardozo, L.
(1990). Urinary Incontinence: Clinical Findings, Practitioner, 234, 1018.
4.
Demirturk,
F., Akbayrak, T., Karakaya, I. C., Yuksel, I., Kirdi, N., Demirturk, F., Kaya,
S., Ergen, A., Beksac, S. (2008). Interferential current versus biofeedback
results in urinary stress incontinence. Swiss
Medical Weekly, 138(21-22), 317-321.
5.
Fantl, J. A., Wyman, J. F.
& McClish, D. K. (1991). Efficacy of bladder training in older women with
urinary incontinence. Journal of the
American Medical Association, 265, 609-13.
6.
Litwin, M. S. & Saigal, C.
S. (2004). Urinary incontinence in men. Urologic
Diseases In America, 107-137.
7.
Thomas, T.
M., Plymat, K. R., Blannin, J. & Meade, T. W. (1980). Prevalence of urinary
incontinence. British Medical Journal,
281, 1243-1245.
8.
Urinary incontinence [Image] (n.d.) Retrieved from http://www.ccmurology.com/images/disease/stress_incontinence.gif
