Case Study – Urinary And Faecal Incontinence and Importance Of Pelvic Floor Muscles

January 18, 2018 | By | Reply READ MORE...

– Dr Niriksha Khasgiwala

A 57-year-old female, whose main complaint was of uncontrolled passing of stools since 14 months (2016), and uncontrolled passing of urine since 2 months (early 2017). Both the symptoms were sudden in onset.

History and symptoms

  • Earlier frequency of uncontrolled passing of stools was once a month, but since the last 4 months it increased to once a week
  • Wears a pad for the same, but sometimes even the pad cannot hold the quantity of stools passed.
  • Patient earlier felt it’s due to lactose intolerance (allergy to milk products), but stopping consumption of dairy products didn’t help.
  • No complaints of any pain.

Aggravating and relieving factors

No specific factors caused relief, but she felt that she would defecate usually post lunch and during morning walks.

Lifestyle

  • Has a sedentary job but has to travel one and a half hour by local train (most difficult part of the day as she would feel really helpless when she would have a sudden uncontrollable urge to pass stool).
  • Social awkwardness and restriction present due to leaking of the pad and the fear of people noticing the foul smell.
  • Patient also emotionally disturbed due to the same.

Past surgical history

Tumour removal surgery in 2011 from L4 spine (lower back) as it was compressing the nerves and giving constant pain in the leg.

To be sure, fresh spine MRI was done in 2016 which ruled that the incontinence was NOT related to the spine surgery.

Gynaecological history

Patient had 4 normal deliveries and 1 miscarriage during 9th month of pregnancy (pelvic floor muscles weaker eventually).

Doctor consultation

Patient has consulted a lot of doctors from various fields related to her problem namely:

  • MD Physician
  • Gastroenterologist
  • Gynaecologist
  • Urologist
  • Spine specialist

Investigations done:

  • Spine MRI – normal
  • EMG – normal
  • NCV (nerve tests) – normal
  • Anorectal manometry (which diagnosed it as pelvic floor dysfunction)
  • D & C – normal
  • Colonoscopy – normal

Urinary And Faecal Incontinence

Patient was referred for physiotherapy as that’s the only way to strengthen and manage the pelvic floor muscles conservatively.

At PhysioRehab a detailed history and pelvic floor examination (with patient consent) under hygienic conditions was done and a very specific plan was charted out for retraining the pelvic floor muscles.

Urinary And Faecal Incontinence

Urinary And Faecal Incontinence

Exercise prescription and recovery

  • Physiotherapy session was once every week for 6 weeks. Gradually her exercises were progressed with minute detailing of repetitions and sets explained. Patient diligently performed the exercises at home as prescribed.
  • Within 3 weeks of treatment frequency of incontinence reduced and gradually on follow-up she could travel for more than 3-4 hours. Her confidence restored and she could travel abroad with few complaints in the next 2 months.

Counseling is of utmost importance in such patients as they need emotional support and constant reassurance.

Incontinence be it faecal or urinary in India people are still very shy to discuss about it with their family and doctors although it’s prevalent in most of middle and old aged females and sometimes it also occurs in males.

There is lack of awareness regarding the importance of physiotherapy for incontinence.

We at PhysioRehab empathize with you and understand your problem. We try our best to help you deal with these sensitive issues in an extremely professional and comfortable way. If you or your close ones are going through something similar (incontinence) please feel free to approach us we will be happy to help and guide you in the best possible way.

At PhysioRehab, our experts in Women’s Health have designed a protocol to support and treat Pelvic Floor Dysfunctions and Incontinence issues.

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Category: Case Studies

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