Kegel exercise for pregnant women

Urinary incontinence

Urinary incontinence (UI), also known as involuntary urination, is any leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life.It is twice as common in women as in men. Pregnancy, childbirth, and menopause are major risk factors. It has been identified as an important issue in geriatric health care.Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners. 

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Urinary incontinence exercises for females

There are four main types of incontinence:

• Urge incontinence due to an overactive bladder


• Stress incontinence due to poor closure of the bladder


• Overflow incontinence due to either poor bladder contraction or blockage of the urethra


• Functional incontinence due to medications or health problems making it difficult to reach the bathroom

Treatments include pelvic floor muscle training, bladder training, and electrical stimulation. The benefit of medications is small and long term safety is unclear.

Diagnosis

Women with incontinence should be referred to a medical practitioner specializing in this field. Urologists specialize in the urinary tract, and some urologists further specialize in the female urinary tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Family physicians and internists see patients for all kinds of complaints, and are well trained to diagnose and treat this common problem. These primary care specialists can refer patients to urology specialists if needed.

A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.

The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.

Other tests include:

• Stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.


• Urinalysis – urine is tested for evidence of infection, urinary stones, or other contributing causes.


• Blood tests – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.


• Ultrasound – sound waves are used to visualize the kidneys, ureters, bladder, and urethra.


• Cystoscopy – a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.


• Urodynamics – various techniques measure pressure in the bladder and the flow of urine.

Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.

Research projects that assess the efficacy of anti-incontinence therapies often quantify the extent of urinary incontinence. The methods include the 1-h pad test, measuring leakage volume; using a voiding diary, counting the number of incontinence episodes (leakage episodes) per day; and assessing of the strength of pelvic floor muscles, measuring the maximum vaginal squeeze pressure.

Types

• Stress incontinence, also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles to prevent the passage of urine, especially during activities that increase intra-abdominal pressure, such as coughing, sneezing, or bearing down.


• Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.


• Overflow incontinence: Sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine. It is as if their bladders were constantly overflowing, hence the general name overflow incontinence.


• Mixed incontinence is not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.


• Structural incontinence: Rarely, structural problems can cause incontinence, usually diagnosed in childhood (for example, an ectopic ureter). Fistulas caused by obstetric and gynecologic trauma or injury are commonly known as obstetric fistulas and can lead to incontinence. These types of vaginal fistulas include, most commonly, vesicovaginal fistula and, more rarely, ureterovaginal fistula. These may be difficult to diagnose. The use of standard techniques along with a vaginogram or radiologically viewing the vaginal vault with instillation of contrast media.


• Functional incontinence occurs when a person recognizes the need to urinate but cannot make it to the bathroom. The loss of urine may be large. There are several causes of functional incontinence including confusion, dementia, poor eyesight, mobility or dexterity, unwillingness to toilet because of depression or anxiety or inebriation due to alcohol. Functional incontinence can also occur in certain circumstances where no biological or medical problem is present. For example, a person may recognise the need to urinate but may be in a situation where there is no toilet nearby or access to a toilet is restricted.


• Nocturnal enuresis is episodic UI while asleep. It is normal in young children.


• Transient incontinence is a temporary incontinence most often seen in pregnant women when it subsequently resolves after the birth of the child.


• Giggle incontinence is an involuntary response to laughter. It usually affects children.


• Double incontinence. There is also a related condition for defecation known as fecal incontinence. Due to involvement of the same muscle group (levator ani) in bladder and bowel continence, patients with urinary incontinence are more likely to have fecal incontinence in addition. This is sometimes termed "double incontinence".


• Post-void dribbling is the phenomenon where urine remaining in the urethra after voiding the bladder slowly leaks out after urination.


• Coital incontinence (CI) is urinary leakage that occurs during either penetration or orgasm and can occur with a sexual partner or with masturbation. It has been reported to occur in 10% to 24% of sexually active women with pelvic floor disorders.

Management

Treatment options range from conservative treatment, behavior management, bladder retraining, pelvic floor therapy, medications and surgery. The success of treatment depends on the correct diagnoses. Weight loss is recommended in those who are obese.

Exercises

Exercising the muscles of the pelvis such as with Kegel exercises are a first line treatment for women with stress incontinence. Efforts to increase the time between urination, known as bladder training, is recommended in those with urge incontinence. Both these may be used in those with mixed incontinence.

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Small vaginal cones of increasing weight may be used to help with exercise. They seem to be better than no active treatment in women with stress urinary incontinence, and have similar effects to training of pelvic floor muscles or electrostimulation.

Biofeedback uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Time voiding while urinating and bladder training are techniques that use biofeedback. In time voiding, the patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak. Biofeedback and muscle conditioning, known as bladder training, can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.

A 2013 randomized controlled trial found no benefit of adding biofeedback to pelvic floor muscle exercise in stress urinary incontinence, but observing improvements in both groups. In another randomized controlled trial the addition of biofeedback to the training of pelvic floor muscles for the treatment of stress urinary incontinence, improved pelvic floor muscle function, reduced urinary symptoms, and improved of the quality of life.

Preoperative pelvic floor muscle training (PFMT) in men undergoing radical prostatectomy was not effective in reducing urinary incontinence.

Alternative exercises have been studied for stress urinary incontinence in women. Evidence was insufficient to support the use of Paula method, abdominal muscle training, Pilates, Tai Chi, breathing exercises, postural training, and generalized fitness.

Devices

Individuals who continue to experience urinary incontinence need to find a management solution that matches their individual situation. The use of devices has not been well studied in women as of 2014.

• Absorbent products (include shields, undergarments, protective underwear, briefs, diapers, adult diapers and underpants) are the best known product types to manage incontinence. They are generally easy to get hold of in pharmacies or supermarkets. The advantages of using these are that they barely need any fitting or introduction by a health care specialist. The disadvantages with absorbent products are that they can be bulky, leak, have odors and can cause skin breakdown.


• Indwelling catheters (also known as foleys) are very often used in hospital settings or if the user is not able to handle any of the above solutions himself. The indwelling catheter is typically connected to a urine bag that can be worn on the leg or hang on the side of the bed. Indwelling catheters need to be changed on a regular basis by a health care professional. The advantage of indwelling catheters are, that the urine gets funneled away from the body keeping the skin dry. The disadvantage, however, is that it is very common to get urinary tract infections when using indwelling catheters.


• Intermittent catheters are single use catheters that are inserted into the bladder to empty it, and once the bladder is empty they are removed and discarded. Intermittent catheters are primarily used for retention (inability to empty the bladder) but for some people can be used to reduce / avoid incontinence.

The best way to treat the urinary incontinence is exercise with Pelvic Floor Exerciser

Clinical data showed that 80% of women with pelvic floor training and exercise a month later, the symptoms were significantly reduced, after three months, will return to normal(mild).

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