URINARY INCONTINENCE PHYSIOTHERAPY MANAGEMENT FOR FALLS PREVENTION by Susan Elms P.T. Elms Physiotherapy
OR How to avoid the mad dash to the bathroom!
INCONTINENCE INFORMATION TALK What is incontinence? What impact does incontinence have on Falls Prevention? What can you do about it?
INCONTINENCE IS COMMON One in four women One in ten men -of all ages and lifestyles experience incontinence Prevalence in: young adulthood is 20-30% middle age is 30-40% elderly is 30-50% (Hannestad, 2000)
What is Incontinence? A storage symptom defined as the complaint of an involuntary loss of urine that is a social or hygienic problem (Abrams, 2002)
MYTHS ABOUT INCONTINENCE Leaking a little with a cough isn t really incontinence Incontinence is a normal part of aging You just have to learn to live with it. You are too old to do anything about it!!
STUDIES REGARDING INCREASED RISK OF FALLS DUE TO U.I. 1) Study by OP Fractures Research Group in England determined that UUI and rushing to the BR to avoid leaking episodes was most likely to result in an increased risk of falling which then can result in fractures.
(continued) 2) Another study from the Australian Journal Of PT researching Do sleep problems or UI predict falls in elderly women? The results were affirmative. Both studies suggested that early diagnosis and appropriate treatment of UI may decrease the risk of falling and subsequently fracture.
EFFECTS OF INCONTINENCE Avoiding activities/social isolation Increased risk of falls Anxiety Shame/Embarassment Avoidance of sexual relations Economic burden-approx. $1000/yr for incontinence products
URGE INCONTINENCE WHAT IS IT? When you can t make it to the toilet in time WHY? You might feel urgency When: You hear water running You approach the door when you re coming home Bladder
CAUSES OF URGE INCONTINENCE Bladder Irritants Medication Constipation Not drinking enough Just-in-case voiding leading to frequency Reduced estrogen Prolapse Prostate surgery
BLADDER IRRITANTS Tea/coffee Alcohol Tomatoes & Acidic fruits Chocolate Bladder Irritants Pop Vitamin C Vinegar Honey, Sugar & Artificial sweeteners
PELVIC FLOOR MUSCLES Where are they? In the pelvis forming a floor from the pubic bone to the coccyx How do they work? they clamp the urethra prop up the bladder calm the bladder
FEMALE ANATOMY
MALE ANATOMY
HOW CAN PHYSIOTHERAPY HELP? Determine the cause of incontinence or pain Assess what treatment would be best Help the patient strengthen their pelvic floor muscles using exercises, and sometimes neurostimulation and biofeedback Help the patient establish healthy bladder and/or bowel habits Education regarding how and when to use their pelvic floor muscles (PFM)
URGE CONTROL TECHNIQUES Mind over bladder Minimal fluid after supper Decreased bladder irritants Stop and Sit. Press on perineum Distraction Walk to the toilet, don t run Exercises Rise up on toes
REFERRAL SOURCES Obstetricians and gynecologists Urologists Family Doctors Nurse Practitioners* Physiotherapists Self
PREVIOUS TREATMENT First line treatment of incontinence has traditionally been a bladder sling done by a urologist or else medication. However, we are trying to educate the medical profession as well as the public to have a trial of P.T. first. In 85% of the cases, it resolves the problem. inisa.edu.au/researcher/issue/2005may/in continence.asp
FINDING A PHYSIOTHERAPIST It is important to find a P.T. who is trained in pelvic floor physiotherapy No longer required to have a signed Delegated Act College of Physiotherapists-lists PT s who have had training in PF physiotherapy- www.collegept.org www.pelvichealthsolutions.ca lists PT s who have taken a certain level of training in PF physiotherapy and where they are located.