Effectivnesss of Physiotherapy Interventions on Stress Urinary Incontinence in Female Dancers - Open Journal Systems
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Indian Journal of Public Health Research & Development, June 2020, Vol. 11, No. 6 911
Effectivnesss of Physiotherapy Interventions on Stress Urinary
Incontinence in Female Dancers
Rima Musale1, Ujwal Yeole2, Mansi Jain3, Swarada Mahatre3, Chinmoyee Panigrahy4
1
Associate Professor, 2Principal, 3Student, 4Assistant Professor, Department of Physiotherapy,
Tilak Maharashtra Vidyapeeth, Pune
Abstract
Background: Dancing involves high as well as moderate impact activities, interplay between aesthetic
and physical demands which collectively increases intra-abdominal pressure responsible for stress urinary
incontinence in female dancers. Practicing Kegel’s and Behavioural Intervention therapy can minimize
severity of problem. Objectives: To find out effectiveness of Kegel’s exercises, Behavioural intervention
therapy and combination of both on stress urinary incontinence in female dancers using IIQ and Pad test
Methodology: Permission was taken from institutional ethical committee. 90 female dancers were assessed
using QUID and dancers having stress urinary incontinence aged 18-25 years; practicing since 5 years were
selected. Pre intervention evaluation was followed by Kegel’s exercise for Group A, behavioral intervention
therapy for Group B and combination of Kegel’s exercise along with behavioral intervention therapy for
Group C. Post intervention assessment was carried out. Results: Data was statistically analyzed using
Wilcoxon test for within the groups and among the groups by using Kruskal-wallis test. IIQ for group A
pre-intervention mean was 5.5± 1.45 and post intervention mean was 4.7±1.04 with p912 Indian Journal of Public Health Research & Development, June 2020, Vol. 11, No. 6
There have been a large number of surveys done where urethra and increases the urethral pressure and the
questionnaires are the primary tool for evaluating the abdominal pressure6.
presence of incontinence3.
Different behavioral interventions are mentioned
Urinary stress incontinence is a serious medical to overcome from stress incontinence. Behavioral
condition that it can lead to urinary tract infections, interventions are a group of treatments that improve
pressure ulcers, perineal rash or any social problem urinary symptoms by altering bladder habits and
creating embarrassment and negative self-perception. teaching new skills. They have been used to improve
Urinary stress incontinence reduce both social incontinence and other lower urinary tract symptoms
interactions and physical activities and it is also in women of all ages. Behavioural intervention therapy
associated with poor self-related problems4. include patient education, bladder training, voiding
schedules, fluid management etc. Patient education
It is important to have concern about Urinary plays important role, includes an explanation of anatomy
incontinence in female dancers, as there are various and physiology of continence and Pelvic floor muscles
dance forms like western (hip-hop, ballet, contemporary, orientation Bladder training was originally developed
etc.) as well as classical (Kathak, Bharatanatyam,) for treatment of urgency incontinence. The reason
which involve moderate to high impact activities as well behind giving bladder training is that frequent voiding
as steady postures required for long period of the time. can reduce bladder over activity which ultimately cause
To stabilize different postures while dancing it involves bladder overactivity7. The goal of bladder training is to
both the activation of abdominal pressure and pelvic floor reduce voiding frequency, increase bladder capacity.
muscles, which give rise to increase in intra-abdominal Changes in fluid intake with proper knowledge is
pressure and due to practicing dance over long time of beneficial for e.g. avoiding excess of consumption of
period there might be increase in the flexibility of lower fluid (>2100 ml/day), reducing fluid intake will help with
extremity which may be the another cause for urinary sudden fullness of bladder8. Caffeine is also one of the
incontinence2. bladder irritant for many women. Studies has shown that
Dancers have to perform moderate as well as high caffeine increases detrusor pressure and is a risk factor
impact activities in the form of dance. Strengthening of for detrusor overactivity9.caffeine should be reduced
pelvic floor muscle can minimize the severity of stress gradually and caffeinated beverages should be replaced
urinary incontinence in high impact activities. with decaffeinated one. Obesity is one of the risk factor
for developing stress incontinence, weight control is
Kegel’s exercises were first descried by Dr Arnold must10. Behavioural intervention therapy contains group
Kegel in 1948 to prevent urinary incontinence especially of treatments to improve stress urinary incontinence and
in postpartum female, and these exercises we can very few studies are available.
consider as one of the safest without any side effects
and complications. The teaching of PFM contractions is In this study, we aimed to find out effect of
the most difficult task because muscles aren’t directly Physiotherapy interventions (Kegel’s exercise,
visible, requires a high level of skill particularly in behavioural intervention therapy and combination of
communication. Visualization: A large diagram of the both Kegel’s and both behavioural intervention therapy)
pelvis, pelvic organs, PFM. Throughout the teaching on stress urinary incontinence in female dancers.
sessions the language and employing words must be
chosen specifically i.e stopping of urine. Kegel’s can
Method
be performed in any position, but the initial position is Ethical clearance was taken from institutional ethical
sitting on a hard chair leaning forward with support from committee. 90 female dancers practicing any dance
the forearms on thighs, with the knees apart. This is the form were selected from different dance institutes with
ideal position for teaching PFM contraction as it provides convenient sampling method. Subjects were assessed
sensory stimulation feedback5. Kegel’s exercises needs using QUID to find out type of urinary incontinence11,
more of accuracy and understanding of muscles need to those who has only stress urinary incontinence, aged 18-
be contracted; avoiding unwanted contractions of gluteal 25 years, nulliparous female dancers practicing since 5
muscles, lower abdominals. Pelvic floor muscle exercise years were assessed using IIQ12 and Pad test13 before
is that a strong and fast contractions which clamp the giving physiotherapy interventions. Pre- interventionIndian Journal of Public Health Research & Development, June 2020, Vol. 11, No. 6 913
evaluation was followed by implementation of exercise as you get up in the morning. Go the bathroom at the
program in the term of Kegel’s exercises for group specific times. At night, go to the bathroom only if you
A. Behavioural intervention therapy for group B and awaken and find it necessary.
combination of Kegel’s along with bit for group c for
period of 6 weeks. Post intervention assessment was Lifestyle modification:
done It includes fluid management, reducing caffeine,
Exercise program: Bladder irritants, and weight control
Kegel’s exercise (Pelvic floor contractions): Stress management:
Starting position: sitting on a hard surface Relaxation techniques, meditation, exercise
regularly.
Hold for 7 seconds, Relaxation for 1 second and
repetitions 15-20 Kegel’s exercises and Behavioural Intervention
therapy: Combination of the treatments are given.
3 times a week for 6 weeks
Statistics
Behavioural Intervention therapy:-
The analysed data showed that it was not a normal
Stress Urinary incontinence education: distribution using Shapiro -Wilk test, hence Non
parametric Wilcoxon signed-rank test was performed
Going to the bathroom to urinate every 2 to 3 to analyse the data within the groups. Non parametric
hours, daily fluid intakes, pelvic muscle exercises, and Kruskal-Wallis test was performed to analyse the data
medications. among the groups.
Bladder training:
Requires a fixed voiding schedule, whether or not
you feel the urge to urinate. Empty your bladder as soon
Results
Incontinence Impact Questionnaire
Group A Group B Group C
Pre 5.5±1.45 5.8±1.27 5.9±1.18
Post 4.7±1.04 5.1±1.27 4.4±0.85
p Value < 0.00048914 Indian Journal of Public Health Research & Development, June 2020, Vol. 11, No. 6
Pad Test
Group A Group B Group C
Pre 7.3±1.78 7.5±1.48 7.8±1.47
Post 6.4±1.4 6.7±1.44 6.2±1.21
p Value < 0.00001 < 0.00001 < 0.00001
p ValueIndian Journal of Public Health Research & Development, June 2020, Vol. 11, No. 6 915
and Behavioural intervention therapy. therapy group showed greater improvement after 6
weeks, no significant difference were observed between
Kegel’s exercises are nothing but pelvic floor the groups.
muscle contractions; in which subject should contract
her pelvic floor muscle without contracting gluteal While comparing all the groups with the variables of
region, abdominal muscles and back muscles. It treats IIQ (p916 Indian Journal of Public Health Research & Development, June 2020, Vol. 11, No. 6
8. Swithinbank L, Hahim H, Abrams P, et al. The of urinary incontinence, 2014 ,33:507-510
effect of fluid intake on urinary symptoms in 14. Cesar A. Hincapie, Morton EJ,Cassidy JD, et al.
women. Journal of Urology 2005; 174:187-189. Musculoskeletal injuries and pain in dancers: A
9. Jura YH TM, Curhan GC, Resnick NM, Grodstein systemic review 2008; 89: 1819-29
F et al. Caffeine intake and risk of stress, urgency 15. Koutedakis et al. underwent study on the dancer
and mixed urinary incontinence. Journal of Urology as a performing athlete, sports medicine, 2004; 34:
2013; 185:1775-80. 651-661
10. Kathryn L.Burgio, Lifestyle and Behavioral 16. H H Thyssen, study on Urinary incontinence in
therapies for Urinary incontinence. Global library elite female athletes and dancers, Vol 13, 15-17
of Womens medicine 2014 2002
11. Catherrine S Bradley et al. A new Questionnaire 17. James R Balmforth, Jill Mantle, John Bdmead,
for Urinary Incontinence Diagnosis in women : et al. A prospective observational trial of pelvic
development and testing, 2004;192:66-73 floor muscle training for female stress urinary
12. Mariee Andree Harvey et al.The Incontinence incontinence, 2006, B J U International; 98: 811-
Impact questionnaire and the Urogenital distress 877.
inventory: A revisit of their validity in women 18. Diane Borello-France, Kathryn L et al, Adherence
without a urodynamic diagnosis, Am J obstet to behavioural Interventions for stress incontinence
Gynaecol 2001; 185:25-31 - rates, barriers and predictors2013; 93: 757-773.
13. Jan krhut et al. Pad weight testing in the evaluationYou can also read
