Tips to improve urinary incontinence

Types of urinary incontinence (symptom): Complaint of involuntary loss of urine
1. Stress urinary incontinence: Complaint of involuntary loss of urine on effort or physical exertion (e.g. sporting activities), or on sneezing or coughing.
2. Urgency urinary incontinence: Complaint of involuntary loss of urine associated with urgency.
3. Mixed urinary incontinence: Complaint of involuntary loss of urine associated with urgency and also effort or physical exertion or on sneezing or coughing.
4. Urgency: Complaint of a sudden, compelling desire to pass urine which is difficult to defer.

Management/treatment for urinary leakage:
1. The Knack maneuver
-The Knack maneuver essentially is a voluntary contraction performed in response to a specific situation.
- Teach a voluntary contraction of the pelvic floor muscles with appropriate timing.
- For example, hold/squeeze the muscle just prior to a cough or sneeze.
- It is a useful strategy in patients with stress urinary incontinence.

2. Pelvic Floor Muscle Training (Kegel Exercise)
- Patient specific training is necessary to ensure a proper contraction for muscle that support the bladder and urethra.
- It is also essential to train both the fast and slow-twitch muscle fibers.
-Also, training must include instruction in volitional contractions before and during an activity that may cause incontinence, such as coughing, sneezing, and lifting.
-Patients are typically recommended to perform the exercises four to five times daily.

3. Behavioural therapy/education
-The focus of behavioral therapy is on lifestyle changes such as fluid or diet management, weight control, and bowel regulation.
-Education about bladder irritants, like avoid caffeine, quit smoking, carry out physical activities, is an important consideration.
-Also, discussing bowel habits to determine if constipation is an issue as it is important to educate the patient about avoiding straining.

4. Bladder training
-The decision making for bladder re-training, including a voiding schedule if necessary to increase the capacity of the bladder for people with frequency issues.
-Bladder training attempts to break the cycle by teaching patients to void on a schedule, rather than in response to urgency.
-Urge suppression techniques are taught, such as distraction and relaxation.
-A voluntary contraction of the pelvic floor muscles helps increase pressure in the urethra, and control urinary leakage.

Reference:
International Continence Society (ICS)
Miller JM, Sampselle C, Ashton-Miller J, Son Hong G-R, De Lancey JOL. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Int Urogynecol J 2008;19:773-782.

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