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. Look for incontinence products, please visit https://ielder.asia/collections/incontinence
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