Utilization of Blood Flow Restriction Therapy for Stress Urinary Incontinence: A Case Study

Jennifer Gentile

 Co-Presenters: Andria Reber
College: The College of Health Professions and Human Services
Department: Physical Therapy
 

Abstract:

Background: Blood flow restriction (BFR) is used in rehabilitation to increase muscular hypertrophy with relatively low load resistance exercises . BFR involves arterial vascular occlusion leading to a hypoxic state distal to the occlusion cuff that increases metabolites, which are mediators of muscular hypertrophy. Additionally research has shown that muscular hypertrophy increases both distally and proximally to the occlusive cuff. Thus, BFR applied distal to the hip improves strength in the gluteus maximus. Since the gluteus maximus co-contracts with the PF and since strengthening has been correlated to improved vaginal squeeze pressure we hypothesized that BFR for hip-related exercises would assist in PF strengthening in a woman experiencing SUI.Case Description: A 56-year-old woman presented to pelvic floor physical therapy with symptoms of frequency, urgency, and leaking with activity. Initial findings included weakness with hypertonicity throughout the pelvic floor. For 18 visits, treatment consisted of downtraining, manual techniques, and hip/pelvis strengthening, resulting in improved strength, decreased tenderness to palpation with improved urinary frequency. However she continued to leak with vigorous walking and reported this functional limitation showed no improvement. We elected to perform 8 sessions of BFR with exercise directed at the hip external rotators and the gluteus maximus due to the correlation of hip muscle activity and pelvic floor activity.Results: The patient completed PFIQ-7 and PFDI-20 outcome measures before starting BFR treatment and after completing 8 sessions. Initial score for PFIQ-7 was 47.62 and PFDI-20 was 69. After treatment PFIQ-7 was scored as 33.3 and PFDI-20 was 41.67. The PFIQ-7 decreased by 30% which was greater than the 12% identified as the MCID. The PFDI-20 decreased by 39%, exceeding the 15% identified as the MCID. The patient also reported no leaking with vigorous walking.Conclusion: The patient’s PF hypertonicity and strength improved with digital assessment following traditional PF treatment, however functional improvement in vigorous walking minimally improved with traditional treatment. Additional treatment with BFR and hip strengthening resulted in resolved symptoms with activity.Clinical Relevance: BFR in conjunction with hip strengthening exercises may help improve functional strength of the pelvic floor muscles to assist in maintaining continence.