KNGF-Guideline

for Physical Therapy in patients Royal Dutch Society for Physical Therapy

with Stress urinary incontinence identifying problem categories I, II and III

treatment plan for men with stress urinary incontinence

disorder I II III
SUI with pelvic floor dysfunction SUI without SUI + general factors
men with prostate problems at - history-taking
men with urinary incontinence pelvic floor impeding recovery or
risk for urinary incontinence - physical examination no voluntary control no involuntary voluntary control + unfavorable
- other examinations dysfunction adjustment processes
control present influence on
- e.g. urinalysis
- micturition diary pelvic floor muscle
- PVR (estimating flow rate, function due
uroflowmetry)
to respiratory
- digital rectal palpation continence
dysfunction,
nurse
dysfunction

(pelvic)
of parts of
family physician family physician advice physical therapist musculoskeletal
(primary care) (primary care) (direct access) system
components,
voiding posture,
no red flags? toileting regime
and behavior

problem problem simple no goal recovering voluntary control compensation or – recovering PF – recovering PF – compensation - recovering PF function
identification: identification problem
adjustment function function – optimizing PF - optimizing PF
prostate
carcinoma? – optimizing PF – optimizing PF - adaptation and
- pathology, type of UI unclear PVR < 100 mL
compensation of
- recurrent UI no evidence collect patient’s
of reduced medical data restrictions (as much as
- UI with pain, blood in urine
- recurrent UTI flow rate (with their possible)
- (severe?) micturition problems permission)
- urinary tract obstruction strategy achieving voluntary control compensation single to multiple single to multiple single to single to multiple to fully
- PF radiation treatment through voluntary to fully automatic to fully automatic multiple to fully automatic task
- radical PF surgery
control, and im- tasks tasks automatic tasks
stop, wait medical proving voluntary
until available data control

history-taking therapy - verbal instruction and/or – practicing the – PFMT if – exercises to – PFMT – addressing impeding
complex
physical examination yes
problem biofeedback ‘Knack’ while insufficient address un- factors if possible
other examinations:
- urine culture - digital palpation by patient coughing progress favorable factors Note: full
- uroflowmetry or PT recovery not – informing patient
- cystoscopy (P)PT
+/- – PFMT during – PFPT to speed up – PFMT possible about possibilities and
PVR • 100 mL - (m)UDT
- PVR incontinence products only PPT (invasive procedures): trunk progress impossibilities
reduced
flow rate - electrostimulation (with stabilization if insufficient
Identifying impairments, limitations PFMT) progress: PFPT to – education
and participation restrictions:
- nature of incontinence, differentiate diagnostic process - electrostimulation (only) speed up progress
from UTI for
- PFPT in case of doubt about – exercise therapy
- nature of disorder physical therapy
patient’s ability to contract
referral to specialist referral to specialist - severity of disorder
(secondary care) (secondary care) PF muscles – PFMT
by:
- history-taking: nature, severity (VAS,
techniques: – +/- PFPT, depending
PRAFAB, PSC), questions on risk factors,
PFPT prior ideas, views (‘illness beliefs’) – tugging PF on speed of recovery
yes
to surgery - physical examination: inspection at – tapping
rest, during movement, general, local
– digital vibration
- anal palpation (only by PPT), testing
diagnosis of diagnosis pelvic floor function
surgery no voluntary no voluntary
prostate of USUI - voiding posture and toileting behavior
carcinoma control control
Further examinations
measurement instruments: PFMT refer to
PFPT after surgery yes - micturition diary
surgery:
family
yes - pad test
radical doctor or
analysis,
prostatectomy medical
no evaluation
specialist/
USUI? referring
doctor
identifying problem categories I, II and III
analysis, identifying modifiable prognostic factors, trial therapy (6 sessions)
no stop degree of modifiability
evaluation
favorable result no result
v v
PF = pelvic floor; PFPT = pelvic floor physical therapy; (P)PT= (pelvic) physical therapist; UI = urinary incontinence; USUI = urodynamic stress urinary incontinence; continue contact referring doctor
UTI = urinary tract infection; PVR = post-voidal residue; (m)UDT = (mobile) urodynamic testing; VAS = visual analog scale; GPE = global perceived effect;
PSC = patient-specific complaints evaluation evaluate result: PRAFAB, GPE, PSC, VAS (pad test, micturition diary)

monitoring check-up + reminder (if necessary) t therapy (if required) u

V-02/2011 The complete guideline is available from www.kngfrichtlijnen.nl © KNGF
KNGF-Guideline
for Physical Therapy in patients Royal Dutch Society for Physical Therapy
with Stress urinary incontinence
- history-taking women with urinary incontinence identifying problem categories I, II and III
- physical
examination treatment plan for women with stress urinary incontinence
- other examinations
- e.g. urinalysis
- micturition diary
disorder I II III
SUI with pelvic floor dysfunction SUI without SUI + general factors
continence nurse pelvic floor impeding recovery or
no voluntary control no involuntary voluntary control + unfavorable dysfunction adjustment processes
control present influence on
(pelvic) physical therapist pelvic floor muscle
family physician (direct access)
advice function due
(primary care)
to respiratory
dysfunction,
dysfunction
red flags? of parts of
no
problem simple problem musculoskeletal
identification system
no
components,
voiding posture,
- pathology, type of UI unclear collect patient’s toileting regime
- recurrent UI medical data
- UI with pain, blood in urine and behavior
(with their
- recurrent UTI permission)
- (severe?) micturition problems goal recovering voluntary control compensation or – recovering PF – recovering PF – compensation – recovering PF function
- urinary tract obstruction adjustment function function – optimizing PF – optimizing PF
- PF radiation treatment
- radical PF surgery medical data – optimizing PF – optimizing PF
stop, wait available
until available strategy achieving voluntary control compensation single to multiple single to multiple single to single to multiple to fully
complex through voluntary to fully automatic to fully automatic multiple to fully automatic tasks
yes
problem control, and tasks tasks automatic tasks
improving
(P)PT +/- voluntary control
history-taking incontinence
physical examination products
other examinations: therapy verbal instruction and/or – practicing the – PFMT if insuf- – exercises to – PFMT – addressing impeding
- urine culture biofeedback ‘Knack’ while ficient progress address un- factors if possible
- uroflowmetry
- cystoscopy Identifying impairments, limitations and coughing favorable factors Note: full
participation restrictions: diagnostic process
- (m)UDT for physical only PPT (invasive procedures): – PFPT to speed up – PFMT recovery not – informing patient
- PVR - nature of incontinence, differentiate
from UTI therapy - electrostimulation (with – PFMT during progress possible about possibilities and
- nature of disorder PFMT) trunk if insufficient impossibilities
- severity of disorder - electrostimulation (only) stabilization progress: PFPT to
referral to specialist
(secondary care) - PFPT in case of doubt about speed up progress – education
by: patient’s ability to contract
- history-taking: nature, severity (VAS, PF muscles – exercise therapy
PRAFAB, PSC), questions on risk factors,
PFPT prior ideas, views (‘illness beliefs’)
to surgery yes - physical examination: inspection at rest, techniques: – PFMT
during movement, general, local
- tugging PF
- vaginal/anal palpation (only by PPT),
testing pelvic floor function - tapping – +/- PFPT, depending
- voiding posture and toileting behavior - digital vibration on speed of recovery
diagnosis of USUI surgery no

voluntary no voluntary
Further examinations
measurement instruments: control control
PFPT after yes
surgery - micturition diary
- pad test PFMT refer to
family
no analysis, doctor or
evaluation medical
specialist/
referring
stop
doctor

identifying problem categories I, II and III trial therapy (6 sessions)

identifying modifiable prognostic factors,
degree of modifiability
favorable result no result
v v
continue contact referring doctor
PF = pelvic floor; PFPT = pelvic floor physical therapy; (P)PT= (pelvic) physical therapist; UI = urinary incontinence; USUI = urodynamic stress urinary incontinence;
UTI = urinary tract infection; PVR = post-voidal residue; (m)UDT = (mobile) urodynamic testing; VAS = visual analog scale; GPE = global perceived effect; evaluation evaluatie resultaat: vragenlijsten PRAFAB, GEE, PSK, VAS (padtest, mictielijsten)
PSC = patient-specific complaints
monitoring check-up + reminder (if necessary) t therapy (if required) u

V-02/2011 The complete guideline is available from www.kngfrichtlijnen.nl © KNGF