THERAPEUTIC OPPORTUNITIES OF NON-SURGICAL TREATMENT IN PATIENTS WITH URINARY INCONTINENCE
Authors: Мratskova Galina , Deliev Rumen 
Published: December 2021

Urinary Incontinence (UI) is a significant medical and social problem which affects both sexes. It can lead to a reduction in social contacts and physical activity, associated with poor self-assessment of the health status, impairment of emotional and mental well-being, reduction of sexual relations and depressive symptomatology. It is a significant reason for lower quality of life. In women, urinary incontinence is more common than in men. There are a number of reasons why urinary incontinence may occur: after surgery in small pelvis, pregnancy, vaginal delivery, hysterectomy, menopause, extreme obesity, chronic cough, constipation, some medications (muscle relaxants, sedative, antihypertensive agents, ACE inhibitors, antiacids) and others. Age factors leads to increased rate of incontinence, which has a large social and financial impact. It reflects the quality of life and it is a significant financial problem, both personal and for the health insurance system.The purpose of this review article is to investigate the therapeutic opportunities of non-surgical and physiotherapeutic treatment of patients with urinary incontinence.The treatment of urinary incontinence is strictly individual and depends on the type of incontinence, its severity and the reasons for its occurrence. It can be conservative and operative. The disease often does not progress over time and the conservative therapy is well tolerated, effective and safe. Non-surgical and physiotherapeutic treatment (behavioral therapy, the reduction of body mass, bladder training, lifestyle change, kinesitherapy for the pelvic floor muscles, biofeedback therapy, electrostimulation of skeletal pelvic floor muscles (ES), vaginal cones, mechanical devices, medication therapy, Botulinum toxin therapy) is the first choice and is preferred by most patients and it is well tolerated and effective. The application of physiotherapeutic methods of treatment requires the preparation of an individual rehabilitation program, which must be consistent with rehabilitation potential of the patient. The principles of gradual increase in the type and number of repetitions in therapeutic exercises, the continuity of kinesitherapy and the appropriate combination with electrostimulation procedures of the pelvic floor muscles are applied. It is considered, that the strengthening of the pelvic floor muscles is achieved through three levels of action: increasedg compression on the urethra, suppor of the bladder neck and improvement of the coordination of contractions of m. transversus abdominis and pelvic floor muscles. For electrostimulation, devices allowing percutaneous, intravaginal or intrarectal stimulation, usually with biphasic current, and low frequency and optimal intensity allowing painless contraction, are used.Conclusion: The urinary incontinence (UI) is highly prevalent and causes significant levels of morbidity, especially in women. The treatment for urinary incontinence is strictly individual and depends on the type of incontinence, the severity and the reasons for its occurrence. A stepwise approach treatment is recommended. The disease often does not progress over time, the conservative therapy is well tolerated, effective and safe.