Urinary incontinence

Urinary incontinence in bronchiectasis

Urinary incontinence in non-CF bronchiectasis has been reported to affect between 47 to 55% of females with this condition (Rees 2013, Prys-Picard 2006) and is a more common problem compared to the general population.

Symptoms of urinary incontinence may be present at least weekly and may have been experienced for several years (5-10 years). It is not known whether males with bronchiectasis suffer from symptoms of urinary incontinence, but it is an issue in men with other chronic lung conditions and may be a concern for men with bronchiectasis (Gumery 2002, Burge 2015).

Urinary incontinence has been linked to a poorer quality of life, the severity of which in females may be influenced by menopausal status and previous vaginal delivery in post-partum individuals (Vella 2009, Rees 2015).

Physiotherapy implications

A physiotherapist should enquire about the presence of symptoms of incontinence for both females and males.Common screening questions which may be asked are:

Do you have problems with leakage of urine in your pants during the day? (If yes, ask further questions to identify the type of incontinence)
If you have problems with leakage, does it occur when you sneeze, cough, or lift heavy objects? (if yes, the patient may have symptoms of stress incontinence)
If you have problems with leakage, is it associated with urgency symptoms or ‘busting to wee’? (if yes, the patient may have symptoms of urge incontinence)
If you have problems with leakage, do you void less than 4 times per day, and tend to ‘hold on’ when you feel the need to void? (if yes, the patient may have incontinence due to voiding postponement)

Further assessment of urinary incontinence and its impact could be undertaken using the following screening tools:

Incontinence Impact questionnaire

The Questionnaire for female Urinary Incontinence Diagnosis – Bradley et al 2010

International Consultation on Incontinence-short form (ICIQ-SF) – Avery 2004

If a patient reports significant symptoms or meet the clinical criteria for significant scores (as defined by the screening tool), referral to a continence specialist for further investigation and treatment is recommended.For any patient diagnosed with urinary incontinence, the physiotherapist should follow up with the specific treatment options and advice as provided by a continence specialist. These may need to be integrated into an airway clearance and/or exercise routine. Treatment options include:

**1.Teaching ‘The Knack’.**

The Knack’ exercise is a well-timed contraction of the pelvic floor muscles, to assist with bladder leaks (Miller 1998) and has been applied in people with bronchiectasis (Duignan et al 2014). It can be used with events or activities that increase downward pressure upon the pelvic floor such as:

Coughing (including airway clearance therapy) or sneezing

Lifting weights or rising into standing from sitting

Stepping down heavily

How to do ‘The Knack’ Exercise?

Sit away from the back of the chair or stand tall with the chest lifted and the normal inward curve in the low back

Lift and squeeze the muscles in and around all three pelvic openings (urethra, vagina and anus) immediately before a cough, sneeze or lift

Contract around all three pelvic openings at once, with a strong inward lift and squeeze of the pelvic floor muscles

Maintain this pelvic floor muscle contraction whilst doing a small cough

After a cough, relax the pelvic floor muscles back to normal resting level.

Progress this exercise with a more forceful cough, or repeating a couple of coughs in a row maintaining the pelvic floor contraction throughout.

Go to The Knack for an instruction video of The Knack for women.

Other treatment options which could be prescribed:

2. Postural exercises to reinforce optimal posture for airway clearance techniques (maintaining a normal lumbar lordosis rather than lumbar flexion to maximise pelvic floor muscle function and provide upper limb support).

3. Trunk stabilisation exercises

Prescription of airway clearance therapy may need to consider techniques which impose minimal stress on the pelvic floor muscles (eg autogenic drainage). Alternatively, prescribing pelvic floor exercises such as “The Knack” during airway clearance therapy may assist in minimising episodes of incontinence.

For further information, health professional resources and patient leaflets visit: Continence Foundation of Australia

References