Urinary incontinence - a new approach to an old problem
A recent systematic review that looked at non-surgical treatment for women with stress urinary incontinence identified that such treatments are effective and could potentially be cost effective.
However, the review concluded that although pelvic floor muscle treatment (PFMT) improved symptoms there was no evidence that PFMT alone led to a resolution of the problem (Imamura et al 2010). As pelvic floor therapy is a commonly used first line intervention for stress incontinence this may have implications for practice.
Further exploration as to why this treatment on its own does not lead to significant cure identified a correlation between women with urinary incontinence (UI), who failed to get complete resolution of their problems, and who also experienced lower back pain (LBP). As early as 1994 Eisenstein et al discussed a hypothetic relationship between LBP and UI and concluded that this association should be recognised. A later study by Eliasson et al (2008) reported that 78% of the women with LBP also reported UI.
Current evidence has suggested that women with UI have increased activity of the of the abdominal and pelvic floor muscles in response to challenges in postural control in the lumbo-pelvic region (Smith 2007). Further studies have also suggested a link between UI and balance (Smith et al 2008).
A more recent study (Kim et al 2010) looked at the correlation between the severity of urinary incontinence in women and concomitant morbidities. They concluded that UI correlates negatively with LBP discomfort, LBP disability and static balance ability and made recommendations on the development of therapeutic strategies to manage this condition. The current economic climate within the NHS provides another impetus to provide effective treatment outcomes.
A quick literature search identified a few studies that had looked at posture re-education and retraining of diaphragmatic, deep abdominal and pelvic floor muscles for women with UI which all showed improved outcomes over PFMT alone (Fozzatti 2008, Hung 2010) giving some credence to the concept.
PromoCon has now linked in with an organisation, Health Is, to work towards raising awareness of a revolutionary new treatment programme for UI and LBP that people can do independently in their own home. Health Is is a scientific research organisation specialising in musculo-skeletal dysfunction with particular interest in pain relief and incontinence. They have developed a software programme that contains a revolutionary high UI screening, rehabilitation and management exercise programme designed for people with both UI and LBP, which allows them to rehabilitate and treat, by non-invasive methods, their UI.
The initial concept was based on extensive research involving more than 4,000 patient/laboratory tests and studies. The findings were then cross related with hands-on procedures to determine the most accurate tests and treatments people could conduct on themselves. Initial measured outcomes using this programme have proved very successful and work is now being carried out to enable the programme to be accessed free of charge by a wider audience.
- Nick Barrow, a chartered physiotherapist involved with developing the programme, is running a workshop about the programme at the forthcoming PromoCon Continence Symposium on 15 March. For further information, contact PromoCon on 0161 834 2001.
Eisenstein SM, Engelbrecht DJ, el Masry WS (1994) Low Back pain and urinary incontinence. A hypothetical relationship. Spine; 19(10):1148-52
Eliasson K, Elfving B, Nordgren B et al (2008) Urinary incontinence in women with low back pain. Manual Therapies;13(3):206-12
Fozzatti MC, Palma P, Herrmann V et al (2008) Impact of global postural re-education for treatment of female stress urinary incontinence. Rev Assoc Med Bras;54(1):17-22
Hung HC, Hsiao SM, Chih SY et al (2010) An alternative intervention for urinary incontinence: retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Manual Therapy;15(3):273-9
Imamura M, Abrams P, Bain C et al (2010) Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technology Assessment;14:40. DOI: 10.3310/hta14400
Smith MD, Coppieters MW, Hodges PW (2007) Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Nuerourol Urodyn; 26:377-85
Smith MD, Coppieters MW, Hodges PW (2008) Is balance different in women with and without stress urinary incontinence? Neurourol Urodyn;27:71-80