Stress urinary incontinence is common among women worldwide and is mainly caused by obstetric trauma to the pelvic floor muscles or lack of oestrogen after menopause. Oestrogen treatment usually improves the condition for postmenopausal women. Stress incontinence is characterized by leakage of urine when the intra-abdominal pressure rises as in coughing, sneezing, lifting, jumping or other forms of physical activity including abdominal exercises. The leakage can be anything from drops to teaspoons either daily or weekly depending on activity level. Obesity or a chronic cough may increase leakage. Furthermore, pelvic floor weakness can lead to prolapse of the uterus or vaginal walls or anal incontinence.
The foremost choice of treatment for stress urinary incontinence is pelvic floor or kegel exercises. The effect of pelvic floor exercises is well documented and has a cure or improvement rate of around 70%.
Increasing pelvic floor strength by pelvic floor exercises has no side effects and is a riskfree, lowcost treatment for stress urinary incontinence. EMG biofeedback may also be useful in pelvic floor re-education.
Studies show that many women, by verbal instruction alone, are uncertain as to the exact location and correct contraction of their pelvic floor muscles. Up to 50 % perform an incorrect contraction. Lack of visualization of this internal and hidden muscle group may lead to ineffecient pelvic floor training. It can even cause more leakage by incorrect use as in bearing down or straining movements.
During pelvic floor contractions, the deep stabilizing abdominal muscle Transversus Abdominis is being activated through co-contraction. You can also increase Transversus strength and awareness by tightening the lower abdomen below the belly button, keeping your lumbar spine straight and still. Hold for 10 sec while breathing normally, repeat 10 times daily.
In cases where pelvic floor re-education has no effect on amount or frequency of leakage, ligamentous laxity or a hypermobile urethra may be corrected by surgery.
Urge incontinence is characterized by a sudden and often irresistable urge to void combined with bladder emptying, and is caused by overactivity in the nerves controlling the bladder muscle – the detrusor.
Some women have a combination of stress and urge incontinence with one dominant component.
Bladder training, electrical stimulation and medicin designed to depress bladder activity are different choices of treatment. Pelvic floor exercises and strength also help in retaining the urge until you reach the toilet.
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