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What is Urinary Incontinence?

Posted on Nov 25 2020
Posted by: Dr. Rozina Shaikh (PT)

The topic at hand can be viewed as a sign of embracement and a restriction to an ideal lifestyle “Urinary Incontinence” unknowingly dominates the freedom of an ideal lifestyle. As we embrace the grace of aging there are a number of changes taking place in one’s body and few grace enough to have an impact on one’s emotional and social well being luckily by the appalling results of physical rehabilitation we can see a light at the end of this dark tunnel and still optimize and leave behind the world we know in the shackles of this particular condition.

According to the American Urology Foundation, Urinary Incontinence is a condition in which the individual is unable to control the passage of urine. UI is not just a medical condition it affects the individual physiological state and effects ones personal and social life

Types of urinary incontinence

1. Stress Incontinence: Stress incontinence is a condition where there is little amount of urine leak whenever there is an increase in the intra abdominal pressure. Activities like jumping, jogging, laughing, coughing, etc which cause pressure to rise intra abdominally. As the name suggests, Stress Incontinence is the increased physical stress which leads to incontinence.
It is even contributed with the weakness of the pelvic floor muscle. Pelvic floor muscle is a hammock life structure on ehich the bladder, uterus, rectum sit. Increase in the intra abdominal pressure and weakness of pelvic floor muscle sum up to Stress Incontinence.

2. Urge Incontinence aka Overactive bladder: Urge incontinence is a condition where the individual cant hold the urine and has to urinate immediately , this is because of the over active bladder which doesn’t allow the urine to stay in and induces urge to urinate immediately.

3. Mixed incontinence: This is a condition with a combination of both the incontinence that is the stress incontinence and urge incontinence. This incontinence is mostly seen in women and in a few male after the prostate removal

4. Overflow Incontinence: This is a condition where the individual is unable to urinate completely. They may experience urine leak with or without the need to use the washroom. This is mainly because there is an obstruction in the normal flow of urine out of the bladder.

Symptoms of Urinary Incontinence:

The symptoms tell you what kind of urinary incontinence you have.
1. Urine Leaking
2. Increased Frequency of maturation
3. Increased Urge to Urinate
4. Giggle incontinence
5. Involuntary loss of urine during performing physical activity
6. Loss of urine during intercourse
7. Nocturia

Risk Factors:
1. Age
2. Obesity
3. Parity and Mode of delivery
4. Family history
5. Long term medication

Measures to prevent Urinary incontinence:
1. Diet and nutrition, to help you avoid food and drinks that may irritate the bladder
2. Changing the behaviors that make your symptoms worse
3. Techniques to decrease urinary urge and frequency, such as muscle strengthening or stretching
4. Maintaining a healthy bathroom schedule
5. Maintaining bowel regularity
6. Drinking healthy fluids regularly to maintain hydration
7. Maintaining a regular exercise regimen or active lifestyle.

How Physiotherapy will help in reducing Urinary Incontinence:
1. Gain control over your symptoms
2. Reduce the need for pads and special undergarments, incontinence medications, and possibly surgery

Mirror Biofeedback:
• The client has to lie down on her back with her knees folded. A mirror has to be placed in between her thighs from where her perineum will be visible to her. The client can keep the mirror at the raised head end of the bed and perform the contractions. She is then asked to perform 30 pelvic floor contractions which are divided in
• 10 hold and 10 relax: In this the client is asked to perform pelvic contraction where they suppose to contract and relax their pelvic floor muscles 10 times each
• 10 Holds for 10 seconds: In this the client is asked to perform the pelvic contraction and hold the contraction for 10 seconds this has to be reaped 10 times this will help in improving the endurance of the muscles
• 10 fast contraction: In this the client is asked to perform 10 quick pelvic floor contractions

Toilet post pee:
The client has to perform pelvic floor contractions after urinating. This can be performed both on a western and Indian toilet. After urinating completely, the client will have to perform 6-8 quick contractions and will have to repeat it 10-15 times.
• Performing this exercises will help in increasing the tone of the pelvic muscle
• The indicidual can grade oneseleves urinary incontinence, while urinating the individual has to stop urine mid stream and the grades are as follows

Perform the following Grade
Unable to hold urine midstream Grade 1
Able to narrow the stream the urine Grade 2
Able to hold urine midstream once Grade 3
Able to hold urine midstream and repeat it Grade 4

Perineum Hold and Relax :
• The client has to sit on a chair with distance in between her legs and has to lean forward with her forearm resting on her thighs making sure that her perineum is in contact with the base of the chair. In this position the client is asked to perform pelvic floor contractions where they are asked to contract the pelvic floor muscle hold for 10 seconds and relax for 10 seconds be repeated for 10 times, quick pelvic contraction 10 times.

 

Pelvic floor muscle strengthening using vaginal cones as biofeedback:
• When a cone is placed in the vagina, the PFMs need to be contracted to prevent the cone slipping out The sensation of losing the cones from the vagina provides a strong sensory feedback and prompts a PFM contraction in order to retain the cone. In order to keep the cone inside the vagina, these muscles are needed to be contracted. Same sized but different weighted set of VCs are given to the client and she is asked to insert a cone of increasingly heavier weight until she can hold the earlier lighter one Developing muscular overload is provided by the cones. During the exercise process, the patient inserts the selected cone intravaginally, above the level of the levatores muscle plate, using a standardised procedure, and tries to hold the cone in place for up to 15 min by contracting her PFMs If a positive result is obtained twice in a row, the training can be continued with the subsequent heavier cone. A training based on this principle is believed to strengthen the PFMs under simultaneous proprioceptive feedback.

Pelvic floor muscle strengthening using vaginal fit as biofeedback:
• When a vagina fit is placed in the vagina, the PFMs need to be contracted to prevent the vagina fit from slipping out The sensation of losing the vagina fit from the vagina provides a strong sensory feedback and prompts a PFM contraction in order to retain it. To keep the vagina fit inside the vagina, these muscles are needed to be contracted. The vagina fit is a tube like structure which contains weights inside them them. During the exercise process, the client inserts the vagina fit intravaginally, above the level of the levatores muscle plate, using a standardised procedure, and tries to hold the cone in place for up to 15 min by contracting her PFMs If a positive result is obtained twice in a row, the training can be continued by adding up the higher weight .initially the exercises is started in lying down position once the women is comfortably able to retain the vagina fit without it slipping out she can progress it to standing once the PFMs are able to retain it in standing as well then functional activities like squatting, jogging climbing up and down the stairs are added this challenges the PFMs to fire better and improve the strength and endurance of the PFMs A training based on this principle is believed to strengthen the PFMs under simultaneous proprioceptive feedback

Sexersize: Sexersize is a term which describes performing pelvic floor muscle contraction during sexual intercourse. While performing this her partner can give her feedback on how strong or week her contractions are. Sexersize can start with penetration and the women has to perform contraction of the pelvic floor and hold for 10 seconds and relax for 10 seconds, following this she can perform quick pelvic floor muscle contraction 10 times. Once this has been performed the couple can progress to performing contraction of the pelvic floor muscle during the penetrating activity while preforming all these exercises her partner can continuously give feedback on strong or week her contraction is, this will help the female to perform a better contractions.