Physical Therapy for Stress Urinary Incontinence
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Questions and Answers

How many physiotherapy sessions are recommended before major gynecological surgery?

  • Six to seven sessions
  • Four to five sessions
  • One session
  • Two to three sessions (correct)

    • What is the primary objective of post-operative physiotherapy?

  • To improve breathing exercises
  • To recover as early as possible without complications (correct)
  • To increase mobility
  • To reduce pain

    • What exercise is initiated on the first day after surgery?

  • Deep Breathing exercise (correct)
  • Abdominal exercise
  • Early ambulation
  • Pelvic floor exercise

    • What is the primary goal of the bladder drill?

    <p>To restore bladder capacity to near normal levels</p> Signup and view all the answers

    What is the recommended time interval for voiding in the first week of the bladder drill?

    <p>Once every hour</p> Signup and view all the answers

    What is a possible cause of fecal incontinence?

    <p>All of the above</p> Signup and view all the answers

    How long does it take for the bladder to be trained to hold more urine?

    <p>3 or more months</p> Signup and view all the answers

    What is the minimum age for an individual to be considered as having achieved control of feces?

    <p>4 years old</p> Signup and view all the answers

    What is the primary aim of physical therapy treatment in Stress Urinary Incontinence?

    <p>To inform patients about the factors which provoke or aggravate incontinence</p> Signup and view all the answers

    What is the most common traumatic cause of Stress Urinary Incontinence?

    <p>Childbirth</p> Signup and view all the answers

    How can perineal overstretch and lacerations be avoided during the 2nd stage of labor?

    <p>By firm support of the perineum</p> Signup and view all the answers

    What is the primary approach for treating postmenopausal women with Stress Urinary Incontinence?

    <p>Hormonal replacement therapy, kegel exercise, and bladder training</p> Signup and view all the answers

    What should be done with any perineal tear or lacerations after delivery?

    <p>Repair them within 24 hours</p> Signup and view all the answers

    What is the purpose of keeping the bladder empty during the 1st stage of labor?

    <p>To avoid and minimize injury and trauma to perineum and pelvic floor structures</p> Signup and view all the answers

    What is the primary goal of strengthening exercises in post-natal care?

    <p>To strengthen the pubococcygeus muscle which may be injured during labor</p> Signup and view all the answers

    What is the treatment approach for severe and recurrent cases of Stress Urinary Incontinence?

    <p>Surgical treatment</p> Signup and view all the answers

    What is the primary goal of biofeedback therapy in the treatment of fecal incontinence?

    <p>To increase the strength and endurance of the anal sphincter</p> Signup and view all the answers

    What is the purpose of the Procon incontinence device?

    <p>To provide a temporary mechanical barrier to stool leakage</p> Signup and view all the answers

    What is the advantage of core stability training in the treatment of fecal incontinence?

    <p>It decreases the focus on pelvic floor muscles only</p> Signup and view all the answers

    What is the effect of radiofrequency energy on the anal canal?

    <p>It increases collagen deposition and tissue remodeling</p> Signup and view all the answers

    What type of contractions are used in pelvic floor exercises?

    <p>Quick flicks and submaximal sustained contractions</p> Signup and view all the answers

    What is the purpose of electrical stimulation in the treatment of fecal incontinence?

    <p>To increase the strength and endurance of the external anal sphincter</p> Signup and view all the answers

    What is the primary goal of thoraco-abdomino-pelvic muscle training?

    <p>To improve core stability and decrease the focus on pelvic floor muscles only</p> Signup and view all the answers

    What is the purpose of the rectal balloon in biofeedback therapy?

    <p>To determine the first sensation of rectal filling</p> Signup and view all the answers

    What is the normal range of anal resting pressure in anorectal manometry?

    <p>30-40 mm Hg</p> Signup and view all the answers

    According to Park's scale, what is the definition of Grade II?

    <p>Continent for solid and liquid stools but not flatus</p> Signup and view all the answers

    What is the purpose of fiber supplementation in the treatment of fecal incontinence?

    <p>To increase stool bulk when fermented</p> Signup and view all the answers

    What is the typical volume that should fill the rectum to indicate first sensation?

    <p>25-35 ml</p> Signup and view all the answers

    What is the recommended behavioral modification to improve fecal incontinence?

    <p>Cessation of smoking</p> Signup and view all the answers

    What is the purpose of loperamide in the pharmacological treatment of fecal incontinence?

    <p>To reduce diarrhea and increase internal sphincter tone</p> Signup and view all the answers

    What is the maximum tolerance for stretch in anorectal manometry?

    <p>200-300 ml</p> Signup and view all the answers

    What is the definition of Grade IV in Park's scale?

    <p>Complete incontinence</p> Signup and view all the answers

    What is the primary goal of muscle re-education of pubococcygeus muscle in treating SUI?

    <p>To strengthen the pelvic floor muscles and increase urethral closure pressure</p> Signup and view all the answers

    What is the purpose of biofeedback in physical therapy treatment for SUI?

    <p>To increase the awareness of the function of PCM</p> Signup and view all the answers

    What is the recommended frequency of quick flick exercises in the treatment of SUI?

    <p>10-20 times per week, increasing by 5 repetitions per week up to 50 repetitions maximum</p> Signup and view all the answers

    What is the purpose of using an inflated cuffed catheter and vaginal cones in the treatment of SUI?

    <p>To graduate the exercise to strengthen the PCM</p> Signup and view all the answers

    What is the normal relationship between urethral closure pressure and intra-vesical pressure at rest and in situations of increased intra-abdominal pressure?

    <p>Urethral closure pressure is higher than intra-vesical pressure</p> Signup and view all the answers

    What is the purpose of Cyriax method in physical therapy treatment for SUI?

    <p>To manually stimulate the pelvic floor muscles</p> Signup and view all the answers

    What is the recommended frequency of slow contraction exercises in the treatment of SUI?

    <p>10-20 times per week, increasing by 5 repetitions per week up to 50 repetitions maximum</p> Signup and view all the answers

    What is the importance of washing the vulva and perineum in preventing bladder infection?

    <p>It reduces the risk of bladder infection</p> Signup and view all the answers

    Study Notes

    Physical Therapy Treatment of Stress Urinary Incontinence

    • Aims of treatment:
    • Inform patients about factors that may provoke or aggravate incontinence
    • Establish awareness of and function of pubococcygeus muscle and urethral sphincter
    • Normalize pelvic support and sphincter mechanism
    • Strengthen pubococcygeus muscle

    Treatment of Stress Urinary Incontinence

    • Divided into three categories: Prophylaxis, Actual Treatment, and Surgical Treatment
    • Prophylaxis: prevent parturition (most common traumatic cause) by proper intra-natal and post-natal care
    • Proper intra-natal care:
      • Keep bladder empty during 1st stage of labor
      • Proper management of 2nd stage of labor by firm support of perineum
      • Avoid using forceps and ventose before full cervical dilatation
      • At crowning, ask the mother to stop bearing down during contractions and start to pant
      • Proper timing of episiotomy if needed
    • Proper post-natal care:
      • Repair any perineal tear or lacerations within 24 hours
      • Strengthening exercises to strengthen pubococcygeus muscle
      • Avoidance of bladder infection by washing vulva and perineum

    Curative Treatment

    • Physical therapy treatment divided into two phases:
    • Muscle re-education of pubococcygeus muscle:
      • Graduations of PCM exercises
      • Biofeedback
      • Cyriax method
    • Resistive pelvic floor exercises:
      • Inflated cuffed catheter and vaginal cones
    • Muscle re-education of pubococcygeus muscle:
    • Urethral closure pressure must be higher than intra-vesical pressure
    • Strengthening of pelvic floor muscles (PFMs) is key to treatment
    • Re-education and strengthening of PFMs can be achieved by:
      • Graduations of pubococcygeus muscle exercise
      • Quick flicks and slow contractions

    Post-operative Physiotherapy

    • Chief objective: recover as early as possible without complications
    • After recovery from anesthesia:
    • First day:
      • Deep breathing exercise
      • Supported cough and huff
      • Circulatory exercise
      • Static abdominal exercise
      • Pelvic rocking exercises
      • Pelvic floor exercise (once urethral catheter is removed)
    • Second day:
      • All the exercises above
      • Early ambulation
      • Further progression of exercises

    Bladder Drill

    • Aim: restore bladder capacity to near normal levels
    • Involves timed voiding (interval between voids is gradually increased)
    • Patient should increase time interval and try to suppress strong urge before void interval is relapsed
    • Bladder training takes 3 or more months

    Fecal Incontinence

    • Definition: uncontrolled passage of feces or gas over at least 1 month
    • Causes:
    • Muscle damage
    • Nerve damage
    • Constipation
    • Hemorrhoids
    • Surgery
    • Rectal prolapse
    • Rectocele
    • Grades:
    • Using Park's scale:
      • Grade I: normal continence
      • Grade II: continent for solid and liquid stools but not flatus
      • Grade III: continent for solid stools only
      • Grade IV: complete incontinence

    Assessment of Fecal Incontinence

    • Detailed history:
    • Incontinent symptoms
    • Medical and surgical history
    • Medications and quality of life
    • Anorectal manometry:
    • Evaluating anal resting pressure (normally around 30-40 mm Hg)
    • Anal squeeze pressure around 150% of resting pressure
    • The volume that should fill the rectum to indicate 1st sensation is 25-35 ml
    • Maximum tolerance for stretch is 200-300 ml

    Treatment of Fecal Incontinence

    • Dietary consideration:
    • Inform patients about factors that contribute to bowel disturbances and loose stool consistency
    • Fiber supplementation:
      • Fibers increase stool bulk when fermented
      • Fiber with high water content allows gel formation which normalizes stool consistency
    • Behavioral modification:
    • Weight reduction
    • Cessation of smoking
    • Avoid straining during bowel movement
    • Pharmacological treatment:
    • Loperamide to reduce diarrhea and increase internal sphincter tone
    • Oral laxatives and glycerol suppositories to treat constipation
    • Pelvic floor exercise:
    • In the form of quick flicks, sustained sphincter contraction, and submaximal sustained contractions (Kegel exercises)
    • Core stability training:
      • Strengthening the abdominal muscles, pelvic floor muscles, and diaphragm
    • Biofeedback therapy:
    • 1st approach: strength and endurance of anal sphincter using biofeedback apparatus
    • 2nd approach: using biofeedback in combination with rectal balloon
    • Electrical stimulation:
    • To enhance strength and endurance of muscles of external anal sphincter
    • Using low frequency or medium frequency current stimulation
    • Radiofrequency energy to the anal canal:
    • Increases collagen deposition and tissue remodeling
    • Mechanical inserts (Temporary):
    • Anal inserts:
      • Prevents uncontrolled loss of solid stool
    • Procon incontinence device:
      • Treatment of severe fecal incontinence (FI) who are unfit for surgery or previous surgical treatments have failed

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    Description

    This quiz covers the aims and treatment methods of physical therapy for stress urinary incontinence, including patient education and muscle strengthening exercises.

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