Abstract
Background: Urinary incontinence is an underaddressed issue for deployed female soldiers. Deployed soldiers routinely carry, push, and pull heavy loads, walk and run on uneven terrain, and climb in and out of vehicles. Such activities can increase stress urinary incontinence (SUI) episodes in soldiers with a history of SUI. Deployed physical therapists can use skills to make an impact on SUI in austere environments having few common SUI treatment resources.
Study Design: This is a case study.
Case Description: This case report involved a deployed 31-year-old female soldier (para 2, gravida 2) with a 5-year history of SUI. She avoided running outdoors and agility drills and used absorbent pads to manage episodes.
Outcomes: After 30 days of treatment, she could sprint outdoors and perform plyometrics; after 44 days, she lifted 18.2 kg without reported leakage. In 12 weeks, a 50% decrease in symptoms resulted, as assessed by the International Consultation on Incontinence Questionnaire for Urinary Incontinence Short Form. She stopped using absorbent pads.
Discussion: Improving neuromotor control and coordination of pelvic floor muscle (PFM) and transversus abdominis (TA) muscle contraction during periods of increased intra-abdominal pressure produced positive results in this case. Training incorporated tactile cues to the TA and emphasized PFM precontraction to enhance reflexive contraction before the increased intra-abdominal pressure. Progressive motor learning through progression of activities allowed her to return to running, jumping, and lifting. This case suggests that improved coordination of TA and PFM contractions can reduce SUI symptoms successfully in a deployed environment.