Regardless of sex, individuals with Urinary Incontinence (UI) face significant challenges resulting in a strong impact on their quality of life and social activities, such as depression and anxiety, decreased sexual pleasure and activity, among other factors.
UI is highly prevalent and is estimated to affect more than 50% of women and nearly 14% of men. It is more prevalent in Caucasians, the elderly, females, obesity patients, after childbirth, and among people with recurrent urinary tract infections.
There are several types of UI, the most common being Effort or Stress UI, Urgent UI, and Mixed UI. Loss of urine during coughing and sneezing or during demanding physical activity is usually indicative of Stress UI, whereas loss of urine immediately after urination, during sleep or for no obvious reason indicates Urgent UI.
Of all the various approaches to UI, physiotherapy is one of the alternatives which is less expensive, less invasive and obtains greater success. Its strategy of intervention include, but are not limited to, pelvic floor muscle re-education, muscle strengthening and lifestyle changes (behaviour and dietary changes).
Re-education and muscle strengthening are achieved through specific techniques and approaches that include manual therapy, biofeedback and neuromuscular electrical stimulation (not recommended on its own). Muscle strengthening exercises are strongly recommended in all types of UI, but to be effective, they require the patient’s perseverance and collaboration.
Biofeedback is referred to as one of the best methods for women in obtaining pelvic floor muscle control and is considered one of the most effective techniques. Scientific evidence also shows that more intensive and supervised programs obtain better results than unsupervised programs.
It is now known that tones, strength and contraction capacity of the pelvic floor muscles are important factors for the vagina’s response during intercourse, with an impact on orgasm to both women and also to men.
Up to 58% prevalence of pelvic floor disorders associated with sexual dysfunction were found in primiparous women (having given birth for the first time). The main complications were: insufficient lubrication, abnormal vaginal sensation, laxity (decreased strength and vaginal tone), dyspareunia (difficult or painful intercourse) and intercourse incontinence.
There is to date an international consensus that re-education and strengthening of the pelvic floor muscle should be part of the first approach in the treatment of Stress UI, as well as in the treatment of Uterine and Vaginal Prolapse.
One of the main shortcomings in the clinical practice of physiotherapy is that not all physiotherapists have specific training in UI intervention. Correct referral and professional specialisation are essential to its success. Given the high prevalence of UI in the general population, we dare to say that the rate of patients treated in Outpatient Physiotherapy for pelvic floor dysfunction, extends far beyond those who seek help and treatment.
By Inês Ribeiro
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Inês Ribeiro is a Physiotherapist, Specialist in Pediatric Rehabilitation and Women’s Health working at the Hospital Particular in Gambelas
