Incontinence is the involuntary loss of urine and around 10 – 68 per cent people in India are affected by urinary incontinence. Usually females are afflicted with incontinence during their adult life, but males too are affected.
The Sphincter muscle that holds stored urine in the bladder relaxes and the bladder muscle (the detrusor) contracts leading to the passing of urine from the bladder out of the body through the urethra. The main causes of incontinence is a chronic cough, prostate gland dysfunction, neurological impairments. Additionally, females are susceptible to incontinence, post pregnancy.
The Five Types Of Incontinence
- Stress incontinence
- Urge incontinence
- Mixed incontinence
- Overflow incontinence
- Functional incontinence
Pelvic floor exercises are good to control incontinence and anti- incontinence exercises are designed to strengthen the pelvic floor muscles. These exercises can be done unaccompanied or with vaginal cones, biofeedback therapy or electrical stimulation.
This is a rehabilitation technique used to tighten and tone the pelvic floor muscles by contracting the urinary sphincter muscle that in turn makes the bladder muscle relax. Kegel exercises are used to reprogram the urinary bladder to decrease the frequency of incontinence episodes.
Start this exercise by lying down with keeping your knees bent and a little apart. Now, try to squeeze your pelvic floor muscles in a way similar to that of trying to stop the flow of urine and hold this position for five to ten seconds. Repeat for 10-15 repetitions. As you progress, this same procedure can be performed while sitting, standing and walking.
Vaginal Devices For Incontinence
- Hydrophilic polyurethane tampons
- Introl prosthesis
- Fern assistdevice
- Urethral patch
- Reliance urinary control insert or urethral plug
These devices can be worn externally to the urethral meatus or inserted into the urethra. They help in voiding and control leakage.
Commonly Used Biofeedback Techniques
Tactile And Verbal Feedback
The utilization of proprioceptive, kinesthetic and tactile sensation is an inexpensive and readily available technique to develop ‘contraction awareness.’ Proprioception to encourage the ‘squeeze’ component of a pelvic floor muscle (PFM) contraction can be provided by applying a gentle stretch to the PFM by parting the inserted fingers laterally, or in the ventral and dorsocaudal direction and encouraging the patient to ‘pull the examining fingers in an upward direction.’This method is used to provide the resistance.
Simple visual biofeedback can be provided using a hand mirror to watch the PFMs as they contract, elevate the perineum and narrow the genital hiatus.
Weighted vaginal cones are inserted intravaginally above the level of the PFM, while the woman performs all her daily activities. Feedback occurs when the cone begins to slip downwards in the vagina, causing the woman to contract her PFM in order to prevent the cone from escaping the vagina.
The electrical activity of motor units is generated by depolarization, registered as motor unit action potentials that can be recorded in EMG studies. Electromyographic signals are picked up using fine wire electrodes implanted within a muscle. Alternatively, surface electrodes can be used, but they are considered less specific than fine wire electrodes.
Manometric Visual Biofeedback
The perineometer records changes in vaginal pressure during PFM contraction. Depending on the design and position of the probe, it will also detect increased abdominal pressure during straining or coughing.
Electrotherapy aims at developing PFM awareness, increasing PFM bulk, strengthening the perineal closure reflex, or inhibiting detrusor over activity. Treatment period lasts around 20 minutes and is applied daily, to once per week for a period of at least 12 weeks.
Pilates incorporates cognitive activation of the deep abdominal muscles and pelvic floor muscles on stability, balance, body alignment and awareness. As the transversus abdominis and the pelvic floor muscles (PFMs) are part of the local stability system of the lumbopelvic region, certain movements and exercises result in increased pelvic floor activity.
Voiding Habits And Schedules To Control Incontinence
- Increase voiding frequency to maintain an empty bladder
- Train your bladder by habituating the frequency of urination by scheduled time intervals and gradually increase the interval period
- Empty the bladder completely because after passing urine, a few drops may trickle out.
- But the best way to deal with this is to push out the last few drops by squeezing your pelvic floor muscles tightly after voiding.
- Consume an adequate amount of fluid in a day
- Lose weight
- Avoid smoking and caffeine consumption
- Nocturia or frequent urination during the night can be controlled by avoiding fluids three to four hours before sleeping.