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New Study Reports That Physical Therapy Treatment Resolves Symptoms Of Urinary Incontinence In Women
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
http://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.
The American Physical Therapy Association (http://www.apta.org) is a national
organization representing physical therapists, physical therapist
assistants, and students nationwide. Its goal is to foster advancements in
physical therapist education, practice, and research. Consumers can access
"Find a PT" to find a physical therapist in their area, as well as physical
therapy news and information at http://www.apta.org/consumer.
American Physical Therapy Association
http://www.apta.org
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