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Urinary Incontinence Through Therapeutic Intervention

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Urinary Incontinence
Through Therapeutic Intervention

Stacey Berger, PT

Urinary incontinence is a
prevalent and often functionally debilitating condition for people of
all ages. It is estimated that up to 13 million Americans may be
affected by loss of bladder or bowel control. Half of all women will
experience urinary leakage during their lifetime and as many as 63% of
men who undergo prostate surgery will report post acute urinary leakage.
Overcoming barriers to seek out appropriate help can be difficult.
Though urinary incontinence is common, an individual may feel
embarrassed to disclose or discuss these symptoms with their healthcare
provider. Others deem incontinence as a normal part of aging or
childbirth and do not seek out help or do not realize there are
treatment options available to them. . Leakage when you cough, sneeze or
hear running water is not normal and often can be cured. Lifestyle
alterations due to these symptoms can be pronounced ranging from fear
and avoidance of social situations and leisure activities to severe
vocational restrictions.

Recognizing the problem can be
done by understanding the symptoms associated with incontinence:
Abnormal ‘toilet habits include going to the bathroom more than 6-8
times each day, getting up more than once in the night to empty your
bladder, dampness or wetness in your underpants, difficulty voiding with
a steady stream without straining, and pain with urination. Any of these
symptoms can be indicative of an incontinence problem. Most common types
of incontinence can be categorized as follows:

Stress Incontinence – Leakage
when an individual coughs, sneezes, lifts, or during a exercise activity
like aerobics or tennis.

Urge Incontinence- a strong
need or urgency to pass urine caused by uncontrolled bladder
contractions.

Frequency- going to the
bathroom often to empty your bladder, and usually having to get up more
than once during the night to void.

Mixed Incontinence- Any
combination of above symptoms.

Treatment options include
medical management with assist of medications or surgical intervention,
lifestyle acceptance &/or therapeutic intervention. A common cause
of incontinence is Urinary tract Infections that can be corrected with
appropriate medications. Individuals should discuss with their physician
which treatment options are most appropriate for their individual needs.
Patients who suffer from a neuromuscular condition, such as Multiple
Sclerosis, may only be appropriate for medical management where as an
individual with a structural change, such as an intrinsic sphincter
deficiency or severe organ prolaspe, may only benefit from a surgical
approach. Therapists who specialize in the treatment of incontinence and
pelvic pain dysfunctions can provide a non-invasive, cost effective
treatment option for appropriate cases. Therapy is used to address
impaired function and can be used in conjunction to medication, as an
adjunct to conservative management or in addition to surgery to enhance
surgical outcome.

Therapeutic intervention by a
skilled Physical Therapist or Occupational Therapist can help assist
individuals in regaining control over urine loss. Therapists work in
conjunction with the individuals physician to provide optimal and
quality care. Patients are trained to functionally use their pelvic
floor muscles to prevent urine loss when the individual performs
activities that increase intra-abdominal pressure such as lifting and
sneezing or experiences uncontrollable urges. The pelvic floor muscles
function to supportively hold the pelvic organs like the bladder in
place. The pelvic floor muscles and ligaments within the pelvic cavity
attach to the boney structures of the pelvis and act like a
"hammock" in holding up the pelvic organs. Problems with
strength, soft tissue irritability, and pain can impair function.
Strength, and coordination of these muscles plays an essential role in
maintaining continence.

Biofeedback and neuromuscular
stimulation are modalities used in the clinic to educate and train
pelvic floor muscles to control leakage. Re-educating the muscles
through biofeedback gives the patient visual, auditory and sensory
feedback to assist the patients in full muscle control. Neuromuscular
stimulation may also be used to strengthen a very weak muscle or to
inhibit urgency symptoms through its effect on the bladder. Manual
therapy techniques may be incorporated to reduce soft tissue
irritability, adhesions, pain or trigger point activity.

Contributing factors
influencing symptoms are also identified and addressed in therapy.
Examples include bladder irritants from diet, and amount and types of
fluid intake. A Bladder diary will look at frequency of voiding, causes
and severity of leakage, bladder capacity and void volume as patients
habits are evaluated to assist in tracking patterns to symptoms and
their irritants. Simply reducing ones caffeine in their diet may
produce a dramatic change in frequency of symptoms. Obesity, repetitive
heavy lifting in ones job, or ones chronic habit of holding their
breath with strenuous activity are all examples of functional and
behavioral contributors that can aggravate symptoms. Smoking or the
chronic cough associated with smoking can also have an effect on the
bladder.

What are common bladder
irritants? Alcohol, caffeine, spicy foods, sugar, milk products, acidic
fruit/juice, and carbonated beverages in your diet. Modifying these
products may improve symptoms significantly. Medications can also affect
bladder irritability. These include; antihistamines, decongestants,
calcium channel blockers, diuretics, sedatives, antispasmodics,
antidepressants. Individuals who are experiencing incontinence should
discuss with their physician possibility of medication involvement and
options to reduce symptoms. In addition, therapy can provide techniques
and re-training programs to correct behavioral and functional habits
affecting symptoms. Patient instruction and education are key in
maintaining control, improving quality of life and establishing
independent management of their condition.

Taking control of the problem
helps previous sufferers return to jogging, aerobics, dancing, taking
long road trips, and feeling confident at functions such as weddings.
Therapeutic intervention helps restore an individuals freedom to
returning to their normal functional activities without fear,
embarrassment or restriction.