Physiotherapy and Stress Incontinence

By Ron Ayalon

Stress incontinence refers to involuntary and uncontrolled dribbling of urine when a person coughs, sneezes or laughs loudly (or performs any activity that increases intra-abdominal pressure and ultimately pressure within urinary bladder).

Under normal conditions, the urinary bladder can hold urine for extended periods until conditions are favorable and person voluntary relaxes the bladder sphincters to allow urinary flow; however, certain conditions can affect the stability of pelvic floor muscles that may affect primary position of urinary bladder within the pelvic cavity (ultimately affecting the patency of sphincters).

Any condition that can affect the stability or strength of pelvic floor muscles can lead to stress incontinence. Injury to the pelvic floor muscles decreases the strength of urinary bladder sphincters to maintain their patency in states of high abdominal pressure. This is 5 times more common in women as compared to men.

Pregnancy and vaginal delivery are the most common risk factors associated with this issue, especially multiple vaginal deliveries or a history of prolonged labor can lead to significant weakening or damage to pelvic floor muscles that may present soon after delivery or may take years to develop significant stress incontinence.

Other risk factors that increases the risk of stress incontinence includes occupations associated with lifting heavy weights like porters, chronic untreated cough, obesity, repeated straining during urination or bowel movement (for example with prostatic hyperplasia, long standing constipation or history of urinary stones) and menopause.

Stress incontinence is a common issue encountered mostly in middle-aged, elderly females, who are not ideal candidates for surgery because of the possible post-surgical complications or associated co-morbidities. Research data indicates that almost 20% of all women above 40 years of age have some degree of this issue. This can be a fairly embarrassing condition for most women and is generally under-reported.

Physiotherapy can manage stress incontinence and is perhaps the most helpful aid. Physiotherapy exercises helps in strengthening pelvic floor muscles thereby preventing stress incontinence and urinary accidents. If left untreated, stress incontinence may lead to repeated urinary tract infections, hampered social life, depression, mood issues, isolation due to embarrassing accidents and the risk of the prolapse of urinary bladder or uterus.

C. M. Castleden conducted a study on 19 female patients who reported moderate to significant stress incontinence. After just a brief period of regular physical therapy for 4 weeks, 14 of 19 patients report complete resolution of symptoms. Stress test conducted on these patients revealed no signs of dribbling or incontinence.

Klarskov conducted a comparative study on 50 women suffering from significant stress incontinence. The women were enrolled in two groups based on their preference for surgery or physiotherapy. Surgery was performed on the basis of primary nature of pathology, while 5 physiotherapy sessions/ week were advised to the other group. Results suggested that almost 42% women who underwent physiotherapy reported significant improvement in symptoms and refused for other forms of therapy.

There are a number of physiotherapy options that are reserved for patients presented with this condition; a few are the utilization of bio-feedback mechanisms and electric stimulation therapy for pelvic floor muscles to enhance the contractility, strength and stability to withstand increased abdominal pressure, pelvic floor exercises that can strengthen the pelvic fascia and tissue to provide better support to bladder and rectum against intra-abdominal pressure and bladder re-training program that may also require partial lifestyle changes to enhance the quality of results.

Physiotherapy exercises have long term benefits in managing and treating stress incontinence and are considered superior to surgical options, because weak pelvic floor is the primary pathology that leads to stress incontinence. If surgery is attempted, the symptoms may re-appear after a short interval. Weak pelvic floor is an established risk factor for the prolapse of the uterus, rectum and/ or urinary bladder.

Physiotherapy also helps in correcting the symptoms of the urge incontinence and fecal incontinence. Physical therapy is a cost- effective, simple and hazard-free method that allows women to improve their overall health without bearing the pain of surgery.

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