Assessing the patient undergoing pelvic rehabilitation for urinary incontinence: From theory to practice

Abstract

Urinary incontinence is linked to pelvic floor dysfunction; the delicate balance between bones, muscles, tendons, and nerves is fundamental for continence and can be altered for numerous reasons, also linked to anatomical areas other than the pelvis. The assessment of the patient is at the basis of treatment choices; the literature reports the need to assess the patient's postural, respiratory, muscular and neurological components. To date, however, there are no studies that provide the nurse with a compendium of evidence in the form of a practical guide to assessment. To present literature evidence regarding the assessment of patients with urinary incontinence, undergoing pelvic conservative rehabilitation and to discuss the practical implications. This evaluation refers to the first contact with the patient and aims to understand how to set up the rehabilitation pathway and whether specific investigations or consultations are needed before starting rehabilitation. Narrative reviews of the literature on the PubMed, CINAHL, Cochrane Library, EMBASE, Scopus, Web of Science, PEDro database. We included studies published in the last 10 years, with no design restrictions, on the topic of assessment criteria for patients with urinary incontinence undergoing pelvic floor conservation rehabilitation, with regard to the role of the nurse. Thirty‐two references were retrieved including two systematic reviews. Assessment should focus on physical activity, bowel habits, spine and posture, nutrition and food habits, breathing and clinical history. Physical examination is aimed at (1) collecting data for establishing the correct rehabilitation programme and (2) excluding the need for evaluation/intervention by other healthcare professionals. Nurses play a key role in pelvic rehabilitation teams. Assessment and decision making about rehabilitation methods are complex tasks which require specialistic education. This paper summarizes the key points of both areas. Conservative rehabilitation of urinary incontinence requires a complex assessment in order to correctly set up the rehabilitation pathway. Aspects to be assessed include muscular, postural, respiratory, neurological and medical history. There are no works in the literature offering a compendium of the information to be considered. A complete overview of the evaluation phases and their characteristics including a practical description of the nursing assessment of the patient undergoing pelvic rehabilitation for urinary incontinence.

Nurses' role in the management of persons with chronic urogenital pelvic pain syndromes: A scoping review

“…noncontracting pelvic floor) and is not suitable for nonrelaxing muscles, which have the opposite problem. Some authors 22 have suggested a broader spectrum of criteria including detailed history that considers the main characteristics of pain. Musculoskeletal, neurologic, and visceral history should be taken as usually done for persons presenting with urinary incontinence or other pelvic dysfunction 22 .…”

“…Some authors 22 have suggested a broader spectrum of criteria including detailed history that considers the main characteristics of pain. Musculoskeletal, neurologic, and visceral history should be taken as usually done for persons presenting with urinary incontinence or other pelvic dysfunction 22 . Other areas of interest include sexual activity and sexual history including abuses; psychological condition, alexithymia (inability to give a name to one's own discomfort), 23 pathologic breathing patterns, and diet.…”

“…There are no standard criteria for the diagnosis of trigger points; the most important aspect is the identification of the painful point and the irradiation pathway. The presence of trigger points should be sought in all patients with CPP 22 …”

“…Musculoskeletal, neurologic, and visceral history should be taken as usually done for persons presenting with urinary incontinence or other pelvic dysfunction. 22 Other areas of interest include sexual activity and sexual history including abuses; psychological condition, alexithymia (inability to give a…”

“…The presence of trigger points should be sought in all patients with CPP. 22 Clinical history and physical examination can narrow the field of differential diagnosis and further guide laboratory testing. Many people presenting for primary care for pelvic pain have more than one concomitant diagnosis; it is important to investigate all factors contributing to persistent pain including psychological, social, and behavioral factors.…”