Physiotherapy assessment for female urinary incontinence

Abstract

Introduction and hypothesis As noted in the 6th International Consultation on Incontinence (ICI) chapter "Initial Management of Urinary Incontinence in Women" recommendations call for including physiotherapy as a first-line therapy. Methods Building on this, checking available scientific evidence and using the International Classification of Functioning, Disabilities and Health, the following represents a holistic physiotherapist approach for initial evaluation of the health problem of urinary incontinence. Results This paper proposes a teaching module for every relevant health care professional dealing with the assessment of adult female urinary incontinence, focusing on optimal patient selection and appropriate treatment choice. Conclusion The assessment stage involves the explicit decision as to whether "physiotherapy" is the treatment indicated for the patient, based on the findings of the physiotherapy assessment and supplemented by any medical information that accompanied the referral and evaluation.

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice

“…This is concerning as the main outcome of the management of the patient should be the fulfilment of his or her normal role in society according to the ICF (WHO 2018 ). The only evidence related to social factors and PFM function is the studies investigating sexual dysfunction which relates to their social role as a spouse (Berghmans et al 2020 ). It is, however, important to remember that sexual dysfunction cannot be classified solely under any aspect of the BPSM, as it includes a complex interaction of factors overlapping all aspects of the BPSM.…”

“…The question should, however, be asked if this approach is not actually preventing us from investigating the most applicable or effective holistic approach as suggested by models such as the BPSM. Individualised care is, however, being introduced in intervention studies in the form of investigating patient-specific exercise programmes (Berghmans et al 2020 ).…”

“…A recent review by Berghmans, Seleme and Bernards ( 2020 ) on the assessment of urinary incontinence emphasises many of the above-mentioned BPSM factors as important to identify any local or general impeding or prognostic factors that can affect the recovery or adjustment processes in patients with PFD. It is important to assess patients’ movement patterns, respiration, general physical and psychological status, illness beliefs, consequences for aspects of everyday life such as work, sports participation, housekeeping, sexuality, social and family life, and contextual factors (external and personal) such as motivation and adherence (Berghmans et al 2020 ). The question, however, remains whether compartmentalisation still exists and how these factors are incorporated and viewed in current research topics, teaching and training, and clinical practice to improve the understanding, research and implementation of a holistic BPSM as applicable to patients with PFD.…”

“…This may include the role as a spouse (sexual dysfunction), mother (cannot play with children without leaking) or provider (cannot go to shops to purchase food or work), and not being able to attend social, work or sports activities amongst many others. However, these dysfunctions are also closely related to contextual (external and personal) factors such as age, gender, not being able to attend visits to health practitioners, poor adherence to management programmes and lack of motivation (Berghmans et al 2020 ; Brandt & Van Vuuren 2019 ; WHO 2018 ). Within these frameworks, reasons should, therefore, be sought for the current gaps and controversies that are still found in research and training on pelvic health.…”

Pelvic tilt in sitting: Do you see what I see? (Maybe not)

“…Many methods of examining lumbopelvic movement patterns, particularly in relation to low back pain, are described in the physiotherapy literature. However, examination of a person's ability to perform pelvic tilting, and subsequent rehabilitation of this movement, is utilised across many fields of physiotherapy -for example, musculoskeletal (Elgueta-Cancino et al, 2014), respiratory (Aramaki et al, 2021), continence (Berghmans et al, 2020), and neurology (Karthikbabu et al, 2017). In the research setting, pelvic tilt is commonly examined using electromyography and kinaesthetics (Dankaerts & O'Sullivan, 2011), which is expensive and impractical clinically.…”