Physical therapy helps symptoms of urinary incontinence in women

Mar 20 2008

A study published in the Annals of Internal Medicine (March 18, 2008) reports that pelvic floor muscle training, in conjunction with bladder training, resolved the symptoms of urinary incontinence in women.

According to the American Physical Therapy Association (APTA), proper preventive measures and treatment by a physical therapist can help patients manage, if not alleviate, this often debilitating condition.

The study, which included 96 randomized controlled trials and 3 systematic reviews from 1990 through 2007, concluded that pelvic floor muscles training and bladder training resolved urinary incontinence in women, as compared to drug therapy, electrostimulation, medical devices, injectable bulking agents, and local estrogen therapy.

"This study is significant for many reasons, none more so than because it provides the highest levels of evidence to support the importance of intervention by a physical therapist who specializes in treating urinary incontinence," says Cynthia E Neville, PT, BCIA-PMDB, director of Women's Health Rehabilitation at the Rehabilitation Institute of Chicago.

Urinary incontinence, or involuntary loss of bladder control, isn't something that just happens to older patients. In fact, the condition affects men and women alike, young and old. More than 25 million* Americans have urinary incontinence, and the experience can leave them feeling ashamed, socially isolated, and depressed.

Patricia J Jenkyns, a physical therapist at the Department of Rehabilitation Services at Boston's Brigham and Women's Hospital, says that physical therapists are crucial in treating urinary incontinence because of their role in both assessing and treating musculoskeletal conditions. "Patients often think that because of age or medical history, incontinence is something they have to learn to live with, but in reality that couldn't be further from the truth," she says. "Health care professionals need to be aware of the role that physical therapists play in treating incontinence so that their patients know about alternatives to diapers, medication, or surgery."

Jenkyns notes that physical therapists use a variety of methods to help patients correct pelvic floor dysfunction. The initial patient evaluation requires determining the type of incontinence (stress, urge, or both), the extent of incontinence, assessing the strength, motor control and endurance of pelvic floor muscles, and screening for any other musculoskeletal issues, then developing an individualized exercise treatment program, and making sure patients understand their role in the treatment program.

In a case study published in the New England Journal of Medicine (March 6, 2008) regarding urinary incontinence in women, it is noted that "first-line treatment for stress incontinence includes pelvic floor muscle training." Affirming the Annals of Internal Medicine results, this second study points out that women unable to identify their pelvic floor muscles "may benefit from seeing a physical therapist trained in pelvic floor therapy."

Kegel exercises, or pelvic floor muscle exercises that involve contracting, holding, and releasing pelvic floor muscles, are the most effective weapon in the fight against stress incontinence. "Once patients have correctly identified these muscles, a physical therapist will train how to enhance pelvic floor muscle function, coordinate with abdominal muscle exercises and bring these exercises and awareness into functional activities," says Jenkyns. She notes that these exercises need to be brought into daily activities, and can be done when sitting at your desk or on the toilet, while driving, or at the gym. For those with very weak muscles, she recommends starting the exercises while lying down.

Jenkyns always reminds her patients who experience stress incontinence to "squeeze as you sneeze," or to coordinate pelvic floor and abdominal muscles before doing the activity that causes leakage, (eg, sneezing, coughing, laughing, lifting, etc). Physical therapists can also offer tips on lifestyle changes that will help make the bladder less irritable: avoiding common bladder irritants, retraining the bladder, keeping a bladder diary and lifting, moving, and exercising correctly, particularly by avoiding improper sit-up techniques.

Since 2006, the APTA Section on Women's Health has offered members a Certificate of Achievement in Pelvic Physical Therapy. Known as CAPP, the program provides standardized training for this highly specialized field and currently has 400 members in the certification process.

APTA offers a free brochure to help consumers understand what incontinence is and the different kinds of treatment options physical therapists can provide to manage the condition, or in some cases, regain complete continence. It can be found on the APTA Web site at www.apta.org/consumer.

Physical therapists are health care professionals who diagnose and manage individuals of all ages who have musculoskeletal problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.