Incontinence has many causes and can affect the bladder, bowel or both. Research has shown that conservative methods can improve or sometimes cure symptoms of incontinence in the majority of people. Conservative treatment can often postpone, or even prevent, the need for drugs or surgery for what can be very embarrassing and uncomfortable symptoms.
What does a physiotherapy assessment entail?
The initial physiotherapy assessment lasts for an hour and a detailed history of the problem is taken. Bladder and bowel habits and any relevant medical history is noted and discussed in order to categorise the type of incontinence.
If consent is obtained, a digital vaginal examination or a rectal examination will take place to enable a more specific pelvic floor exercise programme to be given should this be indicated. This would occur on either the first or second appointment. It allows us to check the skin condition, muscle strength and to assess the position and condition of some internal structures. By strengthening the pelvic floor muscles you are providing an added support system to the bladder and the urethra.
What treatments are offered?
- Pelvic floor exercises and home programme
- Bladder/bowel training
- Continence aids and pelvic floor trainers
- Biofeedback and electrical muscle stimulation (via electromyography and home treatment units)
- Bowel sensitivity training
- Constipation advice/management
When should you be seen by a physiotherapist? New guidelines to improve the care and treatment of women suffering with incontinence in silence has been launched and the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Women’s and Children’s Health have published clinical guidelines on the best ways to manage urinary incontinence in women.
These guidelines make the following recommendations:
- That a trial of supervised pelvic floor muscle training of at least 3 months duration should be offered as a first line treatment to women with stress or mixed urinary incontinence.
- That there is good evidence to show that daily pelvic floor exercises continued for 3 months is a safe and effective treatment for stress and mixed urinary incontinence.
- That pelvic floor exercises should be offered as a preventative measure to all women in their first pregnancy.
- In treating urge incontinence at least 6 weeks of bladder training should be offered first.
- The use of multichannel cystometry, ambulatory urodynamics or video-urodynamics is not recommended before starting conservative treatment.
It is hoped that in these guidelines health professionals will become more informed about what treatment options are available to their patients providing them with the best possible care.