Imagine urinary incontinence (reference 1). Prevalence rate

Imagine you are taking a math test, but you can’t control
your urge to go to the toilet to urinate. This is a common feeling that
sufferers of urinary incontinence go through almost all the time. The burden
that urinary incontinence poses to the public, has largely remained
unquantifiable. It is one of the primary urological diseases that can occur at
any point in the course of human development. According to the UK National
Health Service (NHS), the cost associated with urinary incontinence annually
can exceed 16.5 billion pounds. (reference 7). The disease itself may be acute, chronic or even
self-limiting, but the problems it poses to the quality of life of an individual
may be catastrophic as there are various social stigmas associated with the
condition. Factors such as self-esteem,
peer-pressure, socio-economic status, the corresponding risk factors and the
influence of the media towards perceived body-image and body functions all play
a major role in the individual’s quality of living. The sufferers may not go out in public in fear of
another incontinent episode and may even spend most of their lives in solitude.
In order to understand the problem, we first need to know the basics about this
debilitating condition.

                           What is urinary

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According to the World Health Organization, urinary
incontinence is defined as “the involuntary leakage of urine”. Or to
put it in simpler terms, it means that a person urinates when he does not want
to. It is a common and distressing condition, with varying estimates of
prevalence across countries and genders. Mostly affecting women, urinary
incontinence can make the sufferer prone to depression and embarrassment as
they fail to report the problem to healthcare providers and consequently remain
unaware of the treatment options available. According to a survey, the
prevalence of urinary incontinence among Chinese and British women is 30.9% to
a staggering  40%. This means that 1 in
every 20th Chinese or British woman is suffering from urinary incontinence
(reference 1). Prevalence rate of urinary incontinence is expected to be even
higher in the developing countries such as Pakistan due to the deteriorating
efficiency of medical healthcare (reference 2). Another study done by Leyla
Kadaaslson and her crew states that the average age for women suffering from urinary
incontinence from Pakistan is 48±11 years (reference 3) contributed to large
extent by poor quality care during child birth. And in old age, the frequency
of urinary incontinence rises by 30% (reference 4) leading to UTIs and the
eventual death of the elderly.

Although urinary incontinence affects females more, men
are also not spared from this condition. UI in men is the source of substantial
burden to their lives, as well as on hospital and community resources, with the
largest impact felt on the patient’s family and their social life. A study which
was conducted by Christian Temmi and his colleagues showed that urinary
incontinence affected 5% of a total of 2,500 subjects selected for the study in
Australia. (reference 8) Males also complained of decreased sexual function and
an overall negative quality of life, signifying the repercussions of UI in the

A wide range of options are available for the treatment
of UI. The most popular of which includes surgical procedures. But although
surgeons claim success rates of 90-95% for these incontinence aiding
procedures, recent studies and publications state that long-term cure rates may
be as low as 33% (reference 5).  The
acute pelvic-floor tissue trauma caused by UI surgeries has been presumed to
cause effects that may be chronic and progressive over time. Another survey
conducted in Australia in which 700 women who had transvaginal mesh implants
surgeries performed to stop urinary incontinence, said that the implants had
caused negative side-effects. ( reference 9) This included severe chronic groin
pain, problems walking, painful intercourse leading
to marriage breakdowns. Various pharmaceutical agents offer modest benefits.
However, they are also associated with significant side effects, which are
principally anti-cholenergic, as dry mouth, dry eyes, dry skin, constipation,
retention of urine, hallucinations and even glucoma. According to a research
done by researcher Robert L. Kane,
50% of the test subjects in the study stopped taking the medicine within one
year due to having significant side effects. (reference 10) Hence, awareness of non-invasive procedures
such as pelvic floor exercises should be tried before contemplating any type of
surgery or medication. Yet, even pelvic floor exercises have limitations. Many
patients have difficulty performing these exercises as they cannot see or feel
the pelvic muscles and find it awkward to locate them. Therefore, a relatively
new type of therapy, known as biofeedback therapy can be used as a supplement
to pelvic floor exercises. The machine consists of two sensors which are placed
on either side of the anus in order to measure pelvic muscle contractility. And
another set of sensors are placed across the abdomen. The sensor are connected
to a computer screen where a graph is displayed indicating which muscles are
being used. It is an excellent way to restore urinary function by enabling the
patient to visualize the correct muscle usage and measuring muscle growth and
strength. The evidence in favour of biofeedback for the treatment of UI has
been substantial. According to a study conducted be Susan J. Middaugh, 4 male
patients who had urinary incontinence associated with stoke participated in a
4-week trial of biofeedback therapy, 2 to 5 sessions of biofeedback per week.
The results were astounding. All 4 patients had learned the ability to control their
bladder through specific muscle re-education possible by the biofeedback
machine. (reference 11) It is a great tool for physiotherapists and can help
patients who are not responding to any other treatments. Yet, the machine is
rarely used in the clinical set-up. A major reason for the non-usage of it is
due to lack of awareness. Many physiotherapists, specifically in Pakistan, are
unaware of the term biofeedback, let alone its benefits. This lack of awareness
is a serious concern, because it prevents the patients from receiving the
proper treatment which is possible if biofeedback is included in the treatment
plan. Hence, this research is designed to view the awareness of biofeedback for
the treatment of urinary incontinence among physiotherapists in Karachi. 


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