This original abstract takes a closer look at patient Physiological Load (PL) and its relationship with stress urinary incontinence (SUI). This conservative management approach has shown to be useful in improving the patient’s quality of life (QOL) and give them the confidence to take part in children and adult sporting activities.

SUI affects more women (and men) in varying degrees today than in recent years and continues to negatively impact their daily activities and QOL. In 2013 statistics stated that 3 – 6 million people in the UK suffered some degree of SUI {1}. But a more recent study shows that almost half – 1-2 of women (48%) now suffer (2). When the study asked how suffering incontinence makes them feel, the majority of women (72%) say they feel embarrassed, 55% less confident and 49% felt unsexy. As a result of these feelings and the fear of a leak, many women now avoid enjoyable activities such as exercise. With almost half (43%) saying they actively avoid exercise classes and 33% avoid going out for a run. 
A further study looked closely at 54 patient’s physiological load (PL) in relation to pelvic floor muscle strength (PFMS) urethral stability (US) and continence. The study first addressed the mental/emotional and hormonal relationships and neurological/sensory inhibition. Vaginal stimulation and sensory strengthening were significantly improved when the patient understood the relationship between physical and environmental stressors and altered breathing patterns associated with what is termed ‘nervous bladder’ (NB). By coaching the patient and referencing such material as the Cochrane report (3), which recognised conservative treatment has the advantage of being time centred, patients felt more confident that there could be a medical acknowledgement to a holistic approach. This encouraged them to continue supervised sessions, which in turn helped them to regain the QOL, they believed they had lost and the confidence to initially return to activities with mild impact without the fear of a leak.

54 women when able to identify their PL were able to reduce their levels of SUI by 73% and with pelvic floor muscle training (PFMT) they were able to reduce levels by a further 25% within 16 weeks. Almost half (47%) of the women were amazed at how their management of everyday lifestyle stressors directly affected their breath to the point that with increased intra-abdominal pressure (IAP)  they were unable to maintain continence even in the lightest activity such as laughter. For these women especially, QOL and relationships significantly improved, once they were able adjust their breathing. 21% reported better bladder control with improved respiratory, postural and digestive improvements, reducing ligamentous stress and sluggish colons. Women with milder SUI (35%) were guided through a 12 week programme and the remaining women a 24 week programme. Both sets of women reporting significant changes in confidence within the first six weeks; whether laughing without a loss of urine or making it to the toilet without an accident. The principle for both programmes remained the same; identify the primary physiological stress and undo and/or reverse it. Improve sensory communication and where necessary help damaged muscles fibres assimilate new ones. Once this was achieved the use of vaginal devices and electrical stimulus have a much better effect on pelvic floor muscle training (PFMT) since the patient was able to play a conscious role in activating the muscles in response to electromagnetic pulse (EMG) and load. Results from these pelvic floor aids especially the manual products give better real-time results when sensory awareness is improved and incorporated with functional movement patterns where IAP is greatest and SUI is most common.

Addressing PL in relation to SUI is a far more comprehensive way of tackling pelvic floor muscle weakness (PFMW). By helping the patient identify which stressors contribute to their SUI they are able to reverse the damage and take back control with confidence. They are able to have the faith that PFMW is merely a symptom of imbalance within their body that can be rectified and that their QOL can once again be enjoyed and experienced. It still remains the better choice for both the patient and public healthcare system.

QOL can be measured in many ways with the emotional cost for many usually being the most expensive. Giving the patient the ultimate responsibility for their own intimate and urinary health is one of the most empowering tools we have to hand today as healthcare professionals. If the patient is able to understand that the tangible rewards of strengthening their PFM are much more than just avoiding SUI, they are more likely to remain compliant and thus help to ease the pressure on the National Health Service (NHS) or mainstream public healthcare – helping to save millions of pounds annually in the process.

http://www.bladder-control.co.uk/definition/facts-statistics/index.html
Research amongst 2,002 women suffering with incontinence, conducted by Censuswide in January 2020 on behalf of Boots Stay Dry Continence Pads.
http://www.cochrane.org/CD009508/INCONT_comparisons-of-approaches-to-pelvic-floor-muscle-training-for-urinaryincontinence-in-women