Physiotherapy for stress urinary continence: a guideline.

Stress urinary incontinence (SUI) is the most common form of urinary incontinence. It often severely impacts on quality of life (QOL) and is associated with high financial, social, and emotional costs. A specialized physiotherapist is the designated HCW to diagnose, educate and treat persons with SUI; this guideline provides extensive information based on state-of-the-art evidence. The biopsychosocial model assumes tat SUI involves a decrease in resilience of the pelvic floor, leading to several impairments and problems in participation. This guideline addresses the consequences of SUI, taking into account prognostic factors that may influence recovery and emphasizing the role of physical, psychological, and social factors in the development and/or persistence of SUI.

The recommendations presented in this guideline for clinical practice are as follows: 

1. Problem definition 

• Systematical identification of etiological factors.

2. Diagnostic process 

• Establishing the type of incontinence—use the 3IQ test 
• Palpation— to evaluate pelvic floor muscle function 
• Functional examination— breathing patterns, postural control, voiding posture, and toileting behavior. 
• PRAFAB questionnaire—to assess changes in the patient’s health status and the effect of physical therapy intervention 
• Quantifying the loss of urine—using the 24-h pad test 
• Patient-Specific Complaints (PSC)— to identify the health problem and to evaluate the effect of treatment 
• Global Perceived Effect (GPE)—to evaluate the health status improvement perceived by the patient 
• Micturition diary - to identify the severity of the loss of urine and to evaluate the results of treatment 

3. Therapeutic process 

• Information and advice—use of anatomical plates and pelvic phantoms, as well as other educational materials such as lifestyle advice 
• Improving general physical condition—interventions to improve the patient’s general physical condition 
• Frequency and performance of PFMT—daily PFMT with sufficient intensity and duration while paying attention to the correct performance of the exercises and integrating the exercises into activities of daily life 
• Selective contraction of PFM - combining PFM exercises with electrostimulation in patients who are unable to voluntarily and/or selectively contract their PFM. 

4. Prevention 

• PFM training to promote postoperative recovery after prostatectomy

A comprehensive state-of-the-art evidence based guideline to assist physiotherapists in providing appropiate, tailor made care.