Definition: Involuntary loss of urine which is
objectively demonstrable and is a social or hygienic problem.
Aims:
·
To restore
the function of urethrovesicle muscles
·
Strengthening
the support of the uterus
·
Advise obese
patient to control diet
Means of treatment
a. Pelvic floor contractions: Sitting position or leaning forward to support the forearm on knees
e.g.
·
Stopping
passing urine
·
stopping
passing breaking wind
·
Stopping
yourself blowing off/farting
·
Fasting and
slow contractions
·
Bracing
exercises
Duration
As long as the muscles becomes weak and fatigued.
b. Perinometer/Kegel’s exercise
·
Kegel device
is a pneumatic device which helps to measure the pressure inside the vagina and
to motivate the women to practice pelvic floor exercises
·
A
compressible air filled rubber cuff was inserted into the vagina which is
connected to a manometer by a rubber tubing
·
Ask the
women to contract her pelvic floor several times and note the highest reading
in the dial. Also, note the length of time for which she could hold her
contractions.
·
It is useful
as biofeedback and for motivation
·
Take care
that intra-abdominal pressure is not measured rather than pelvic floor
c. Foley’s catheter
·
An air
filled catheter is inserted into the vagina and the patient is asked to contract
and hold the catheter against the traction given by the therapist
d. Vaginal cones
·
It consists
of 5-9 small cones or cylinders ranging from 10 gm to 100 gm
·
They are made
up of lead coated with plastic and a nylon string is attached at one of the
tapered ends
·
It is a size
of a tampon
·
The lightest
cone is inserted first and ask the patient to hold and walk for 15 min
·
Once the
cone is retained for 15 min without slipping progression is made to the next
cone
·
This helps
to activate the motor units to support the cones and to increase woman‘s
awareness of her ability to contract the pelvic floor muscles voluntarily.
e. Elevator exercises: Ask the patient to imagine going up in an elevator and contract her pelvic floor by gradually increasing the intensity as the lift goes up by and floor and then to relax gradually as the lift comes down by floor
·
Pelvic
tilting with rotations in supine position.
·
About 8-12
fast contractions followed by 3-4 slow –short contractions can be done.
f. General exercises
·
Pelvic
tilting
·
Pelvic
rotation
·
Pelvic
rocking
·
Functional
training
·
Squatting
exercise
·
Postural
correction exercise
g. Faradism: Faradism (surged) is used in re-education of pelvic floor muscles
·
Levator ani
muscles can be contracted using vaginal or anal electrode
·
Pulse width:
0.1 – 7 m/s
·
Frequency:
0.5 – 40 Hz
h. Interferential therapy: It improves patient‘s cortical awareness and ability to perform voluntary contractions For genuine stress incontinence parameters:
·
Sweep: 10
-40 Hz
·
Carrier
wave: 2000 Hz
·
Duration: 15
mins
·
Intensity:
maximally tolerable
Parameters for urge or frequent incontinence
·
Sweep: 5 -10
Hz
·
Carrier
wave: 2000 Hz
·
Duration: 30
mins
·
Intensity:
maximum
Four pole method
·
Two
electrodes are applied on abdomen just above the lateral portion of inguinal
ligament (A1, B1)
·
Two
electrodes are applied on medial to the ischial tuberosity on either side of
the anus (A2, B2)
Two pole method
·
One medium
size electrode over the anus covering the posterior fibers of levator ani
muscle.
·
2nd
small size electrode is placed centrally below the pubic symphysis.
i. Bladder retraining
·
It is used
in frequency urgency without leakage incontinence
·
Contract
pelvic floor muscles every time before voiding
·
Distraction
by companion, games TV, music
·
Perineal
pressure by hand
·
Cross leg
standing
·
Maximus
gluteus contractions in standing
No comments:
Post a Comment