Silent Health Issue Affects Substantial Proportion of American Women, According to JAMA
ALEXANDRIA, VA, September 17, 2008 — In response to a new study
published in the Journal of the American Medical Association
showing that pelvic floor disorders, such as urinary incontinence, affect up to one-quarter of American
women, the American Physical Therapy Association (APTA) is urging women
who suffer from this widespread disorder to consider examination and
treatment from a physical therapist.
Recent research has demonstrated physical therapy's effectiveness at
treating the symptoms of urinary incontinence. A study published in the
Annals of Internal Medicine (March 18, 2008) reports that pelvic
floor muscle training, in conjunction with bladder training, resolved
the symptoms of urinary incontinence in women. According to APTA, proper
preventive measures and examination and treatment by a physical
therapist can help patients manage, if not alleviate, this often
debilitating condition.
The study, which included 96 randomized controlled trials and 3
systematic reviews from 1990 through 2007, concluded that pelvic floor
muscles training and bladder training resolved urinary incontinence in
women, as compared to drug therapy, electrostimulation, medical devices,
injectable bulking agents, and local estrogen therapy.
"The Annals of Internal Medicine study is significant for many
reasons, none more so than because it provides the highest levels of
evidence to support the importance of intervention by a physical
therapist who specializes in treating urinary incontinence," says
Cynthia E Neville, PT, BCIA-PMDB, director of Women's Health
Rehabilitation at the Rehabilitation Institute of Chicago.
Urinary incontinence, or involuntary loss of bladder control, isn't
something that just happens to older patients. In fact, the condition
affects men and women alike, young and old. More than 25 million*
Americans have urinary incontinence, and the experience can leave them
feeling ashamed, socially isolated, and depressed.
Patricia J Jenkyns, a physical therapist at the Department of
Rehabilitation Services at Boston's Brigham and Women's Hospital, says
that physical therapists are crucial in treating urinary incontinence
because of their role in both assessing and treating musculoskeletal
conditions. "Patients often think that because of age or medical
history, incontinence is something they have to learn to live with, but
in reality that couldn't be further from the truth," she says. "Health
care professionals need to be aware of the role that physical therapists
play in treating incontinence so that their patients know about
alternatives to diapers, medication, or surgery."
Jenkyns notes that physical therapists use a variety of methods to
help patients correct pelvic floor dysfunction. The initial patient
evaluation requires determining the type of incontinence (stress, urge,
or both), the extent of incontinence, assessing the strength, motor
control and endurance of pelvic floor muscles, and screening for any
other musculoskeletal issues, then developing an individualized exercise
treatment program, and making sure patients understand their role in the
treatment program.
In a case study published in the New England Journal of
Medicine (March 6, 2008) regarding urinary incontinence in women, it
is noted that "first-line treatment for stress incontinence includes
pelvic floor muscle training." Affirming the Annals of Internal
Medicine results, this second study points out that women unable to
identify their pelvic floor muscles "may benefit from seeing a physical
therapist trained in pelvic floor therapy."
Kegel exercises, or pelvic floor muscle exercises that involve
contracting, holding, and releasing pelvic floor muscles, are the most
effective weapon in the fight against stress incontinence. "Once
patients have correctly identified these muscles, a physical therapist
will train how to enhance pelvic floor muscle function, coordinate with
abdominal muscle exercises and bring these exercises and awareness into
functional activities," says Jenkyns. She notes that these exercises
need to be brought into daily activities, and can be done when sitting
at your desk or on the toilet, while driving, or at the gym. For those
with very weak muscles, she recommends starting the exercises while
lying down.
Jenkyns always reminds her patients who experience stress
incontinence to "squeeze as you sneeze," or to coordinate pelvic floor
and abdominal muscles before doing the activity that causes leakage,
(eg, sneezing, coughing, laughing, lifting, etc). Physical therapists
can also offer tips on lifestyle changes that will help make the bladder
less irritable: avoiding common bladder irritants, retraining the
bladder, keeping a bladder diary and lifting, moving, and exercising
correctly, particularly by avoiding improper sit-up techniques.
Since 2006, the APTA Section on Women's Health has offered members a
Certificate of Achievement in Pelvic Physical Therapy. Known as CAPP,
the program provides standardized training for this highly specialized
field and currently has 400 members in the certification process.
APTA offers a free brochure to help consumers understand what
incontinence is and the different kinds of treatment options physical
therapists can provide to manage the condition, or in some cases, regain
complete continence. It can be found on the APTA Consumer Web site atwww.moveforwardpt.com.
Physical therapists are health care professionals who diagnose and
manage individuals of all ages who have musculoskeletal problems or
other health-related conditions that limit their abilities to move and
perform functional activities in their daily lives. Physical therapists
examine each individual and develop a plan of care using treatment
techniques to promote the ability to move, reduce pain, restore
function, and prevent disability. Physical therapists also work with
individuals to prevent the loss of mobility by developing fitness- and
wellness-oriented programs for healthier and more active lifestyles.
APTA (www.apta.org) is a national organization representing physical
therapists, physical therapist assistants, and students nationwide. Its
goal is to foster advancements in physical therapist education,
practice, and research. Consumers can visit www.findapt.us to find
a physical therapist in their area, as well as www.moveforwardpt.com for physical therapy news and
information. Also, for more information on women's health conditions,
visit www.womenshealthapta.org.
* National Association for Continence (NAFC)