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Masaryk University Masaryk University Faculty of Sports Studies Department of Health Promotion Fyzioterapie u pacientů s močovou inkontinencí Physiotherapy in Patients with Urinary Incontinence Bachelor thesis Supervisor: Mgr. Michaela Bobrová Author: Bc. Veronika Körnerová Physiotherapy Brno, 2020 I hereby declare I wrote this thesis on my own with the supervision of Mgr. Michaela Bobrová, I have acknowledged all sources used and have cited these in the reference section. In Brno ...................................... Signature I would like to thank my supervisor Mgr. Michaela Bobrová for her guidance, encouragement, support and valuable comments. My sincere thanks also go to the patient who allowed me to do the therapy of such a sensitive subject. Bibliografical identification Author's first name and surname: Veronika Körnerová Title of the bachelor thesis: Physiotherapy in Patients with Urinary Incontinence Department: Department of Health Promotion Supervisor: Mgr. Michaela Bobrová The year of submission of the final thesis: 2020 Annotation: In the bachelor thesis, I deal with the effect of physiotherapy in young female athlete suffering urinary incontinence. The thesis is split into theoretical and practical parts. Firstly, theoretical knowledge about the given issues is described. Then the practical part deals with the description of the therapies and appraisal of its effect. Keywords: athlete, female, pelvic floor, physiotherapy, rehabilitation, urinary incontinence Content List Of Abbreviations ....................................................................................................... 8 Introduction ....................................................................................................................... 9 1 Anatomy and Physiology of Female Pelvic Floor and Lower Urinary Tract ......... 10 1.1 Passive Structures............................................................................................. 10 1.1.1 Bones ........................................................................................................ 11 1.1.2 Fascias ....................................................................................................... 11 1.2 Active Structures .............................................................................................. 12 1.2.1 Diaphragma Pelvis .................................................................................... 13 1.2.2 Membrana Perinei ..................................................................................... 15 1.3 Pelvic Organs ................................................................................................... 17 1.3.1 Urinary Bladder ........................................................................................ 17 1.3.2 Urethra ...................................................................................................... 19 1.3.3 Vagina ....................................................................................................... 20 1.4 Nerve Supply .................................................................................................... 22 1.4.1 Micturition Reflex Pathways .................................................................... 23 1.5 Viscero-Somatic, Viscero-Visceral & Somato-Visceral Convergence ............ 25 1.6 Pelvic Floor Muscle Activity During Postural Changes and Physical Activity 27 2 Urinary Incontinence .............................................................................................. 29 2.1 Types of Chronic Urinary Incontinence ........................................................... 29 2.1.1 Stress Urinary Incontinence ...................................................................... 29 2.1.2 Urgency Urinary Incontinence / Overactive Bladder ............................... 30 2.1.3 Mixed Urinary Incontinence ..................................................................... 31 2.2 Prevalence ........................................................................................................ 31 2.3 Risk Factors ...................................................................................................... 32 2.3.1 Internal Factors ......................................................................................... 32 2.3.2 External Factors ........................................................................................ 33 3 Diagnostic methods ................................................................................................. 39 3.1 Patient History .................................................................................................. 39 3.1.1 Standardized Incontinence Questionnaires ............................................... 40 3.2 Urological Tests ............................................................................................... 41 3.2.1 Ultrasound Imaging .................................................................................. 41 3.2.2 Cough Stress Test ..................................................................................... 41 3.2.3 Voiding Diary ........................................................................................... 41 3.2.4 Pad Test ..................................................................................................... 41 3.3 Physical Examination ....................................................................................... 41 4 Physiotherapy .......................................................................................................... 43 4.1 The Mojzis Method .......................................................................................... 44 4.2 Ostrava Concept ............................................................................................... 44 4.3 Kegel Exercises ................................................................................................ 44 4.4 Dynamic Neuromuscular Stabilization ............................................................ 44 4.5 Psychosomatic Approach ................................................................................. 45 4.6 Yoga ................................................................................................................. 46 5 Case Report ............................................................................................................. 47 5.1 Patient History .................................................................................................. 47 5.2 Initial Assessment ............................................................................................ 49 5.2.1 Static Stand Assessment ........................................................................... 49 5.2.2 Dynamic Tests in Standing ....................................................................... 50 5.2.3 Spinal Mobility Assessment ..................................................................... 50 5.2.4 Sitting Assessment .................................................................................... 51 5.2.5 Supine Position Assessment ..................................................................... 51 5.2.6 Prone Position Assessment ....................................................................... 51 5.2.7 Other tests ................................................................................................. 52 5.3 Short-Term Rehabilitation plan ........................................................................ 54 5.4 Long-Term Rehabilitation Plan........................................................................ 54 5.5 Therapies .......................................................................................................... 54 5.5.1 The First Therapy ...................................................................................... 54 5.5.2 The Second Therapy ................................................................................. 55 5.5.3 The Third Therapy .................................................................................... 56 5.5.4 The Fourth Therapy .................................................................................. 56 5.5.5 The Fifth Therapy ..................................................................................... 58 5.5.6 The Sixth Therapy .................................................................................... 59 5.5.7 The Seventh Therapy ................................................................................ 59 5.6 Final Assessment .............................................................................................. 60 6 Discussion ............................................................................................................... 62 7 Conclusion .............................................................................................................. 65 References ....................................................................................................................... 66 List Of Attachments ........................................................................................................ 82 LIST OF ABBREVIATIONS CNS Central nervous system DNS Dynamic Neuromuscular Stabilization ICQ-UI SF International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form ICS International Continence Society ISSS Integrated spinal stabilizing system MUI Mixed urinary incontinence OAB Overactive bladder OAB-q Overactive Bladder Questionnaire PAG Periaqueductal gray PFM Pelvic floor muscles PFMT Pelvic floor
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