A 32 year old woman was referred for physiotherapy with probably stress urinary incontinence. A subjective assessment revealed that the she had been suffering from the problem for about 1 year, since the birth of her second child. Her complaint was involuntary loss of urine during coughing, exercise and sneezing. However her biggest complaint was minor leakages during sexual intercourse at the point of orgasm. This was greatly affecting her quality of life since she loves her weekly aerobic class and also limiting her intimacy with her partner.
The first thing that the women’s health physiotherapist does is take a detailed subjective history to establish the cause of the problem, any lifestyle changes that need to be made related to nutrition, drinking and caffeine intake. The physiotherapist would also be interested in the frequency of urination. Next an internal examination is done to establish the strength of the pelvic floor and determine the plan of action. This woman was found to have a very weak pelvic floor contraction and as such was started on treatment using biofeedback and electrical stimulation using an internal vaginal electrode. After about two weeks, the patient managed to regain some control of the pelvic floor and more active strengthening exercises were introduced. Leakage was almost completely controlled after about twelve weeks of training however she was advised to continue regular pelvic floor exercises to maintain the tone of her pelvic floor.