Nordic Walking in Rehabilitation of Women with Stress Urinary Incontinence after Sling Operations

Abstract

It is known that urinary incontinence remains one of the most common diseases in women, representing a serious medical and social problem. Practice shows that sling operations without subsequent rehabilitation measures, especially in the long term, do not solve the problem. In urogynecology, the use of physical exercises and physiotherapeutic methods is aimed at restoring impaired urinary functions. A relatively new approach to the rehabilitation of women after sling operations is the inclusion of Nordic walking (NW) into the rehabilitation program. Certain experience in this field has been accumulated in Sverdlovsk Regional Clinical Hospital № 1 (Yekaterinburg). Aim. To improve the efficiency of treatment of female stress urinary incontinence using the technique of NW in rehabilitation programs after sling operations. Material and methods. In Sverdlovsk Regional Clinical Hospital № 1 in Yekaterinburg, NW is included in rehabilitation programs for women with stress urinary incontinence after sling operations. Experience in planning and conducting a four-week course of NW under the physiotherapist guidance has been accumulated. Patients after sling operations (n= 85) were randomized into two groups. Rehabilitation program of patients of the first group (n = 37) included a 4-week course of NW on the background of basic therapy (antibacterial therapy, antispasmodics, anticoagulants), while in the second group (n = 48) only basic therapy was realized. The dynamics of clinical manifestations of stress urinary incontinence was studied, uroflowmetry parameters, PAD-test data, cough test were evaluated; the answers of the patients to the questions of the international questionnaires PFDI-20, PFIQ-7 were analyzed. Results and discussion. The variability of the currently used methods of rehabilitation of patients with stress urinary incontinence requires objectification of the results. The study showed that Nordic walking (NW) is a pathogenetically justified and clinically effective method for rehabilitation of women with stress urinary incontinence after sling operations. The analysis of the rehabilitation activities data based on the dynamics of leading clinical symptoms, PAD test, cough test, uroflowmetry parameters revealed significant differences (p<0.05) between two groups at all follow-up periods: a month, three and nine months. Postoperative objective evaluation of the treatment results correlate with patients’ subjective data: women who completed a course of NW rated their quality of life significantly higher than patients of the control group under the rehabilitation program without inclusion of therapeutic physical factors. The structure of NW classes is based on the understanding that the body response to the physical factors impact is provided by various organs and systems. The inclusion of NW in rehabilitation programs requires adherence to the basic principles of achieving training status. Conclusion. The expediency of NW including in the complex treatment of patients with stress urinary incontinence is due to the regression of main clinical symptoms, reliably significant dynamics of instrumental parameters and test results in comparison with the group that received only basic therapy. The implementation of the therapeutic effect is based on the principle of unity of syndromicpathogenetic and clinical-functional approaches. Clinical-functional approaches is the basis for the implementation of the therapeutic effect.