Physical therapy options in treatment of female stress urinary incontinence

The International Continence Society (ICS) revised its definition of urinary incontinence to be the complaint of any involuntary leakage of urine. Stress urinary incontinence (SUI) presents the involuntary loss of coughing, sneezing, or physical activity. Gender, childbirth and obesity are the predominant risk factors associated with SUI. SUI is the most common type in females. The introductory part of the therapy is educational. The patients are informed about the function of pelvic floor muscles (PFM) with the use of anatomical models and illustrations. They are educated about the pathogenesis and different types of incontinence, as well as the effect of respiration, movement, body weight, and stress on pelvic floor function. Another important preparation for a successful training program is the development of the kinaesthetic feeling for the correct tension and relaxation of PFM. Then, the patients progress to the specific pelvic floor muscle exercises (PFME). Later on, the exercises are carried out under various daily situations, such as stair climbing, singing, hiking, and power walking. Biofeedback is an adjunct to training, measuring the response from single PFM contraction. In the area of PFME, both vaginal and anal surface EMG, and urethral and vaginal squeeze pressure measurements have been used in order to make the patients more aware of muscle function and to enhance and motivate patient's effort during training. Weighted vaginal cones can also be used to strengthen the PFME and may be particularly helpful in learning to identify the muscles of the pelvic floor. The aim of the electrical stimulation for SUI is to strengthen the PFM in the same way as with training. In the case of PFM weakness an improvement can be had using intracavitary or external electrodes at a frequency of 30-50 Hz. In addition reflexotherapy may be applied. Reflexotherapy options include manual therapy, osteopathy, massage, neural therapy, acupuncture and thermotherapy. The success of the SUI therapy and rehabilitation highly depends on the patient's individual motivation and activity.