Urinary incontinence: Difference between revisions
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===Exercises=== | ===Exercises=== | ||
[[Kegel exercise]]s to strengthen or retrain [[pelvic floor muscles]] and sphincter muscles can reduce stress leakage.<ref name="pmid17625461">{{cite journal |author=Choi H, Palmer MH, Park J |title=Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women |journal=Nursing research |volume=56 |issue=4 |pages=226-34 |year=2007 |pmid=17625461 |doi=10.1097/01.NNR.0000280610.93373.e1}}</ref> Patients younger than 60 years old benefit the most.<ref name="pmid17625461"/> The patient should do at least 24 daily contractions for at least 6 weeks.<ref name="pmid17625461"/> A [[systematic review]] concluded "pelvic floor muscle training would resolve 490 cases of stress urinary incontinence."<ref name="Tatyana">Tatyana A. Shamliyan et al., “Systematic Review: Randomized, Controlled Trials of Nonsurgical Treatments for Urinary Incontinence in Women,” Ann Intern Med (February 11, 2008): http://www.annals.org/cgi/content/full/0000605-200803180-00211v1</ref> | [[Kegel exercise]]s to strengthen or retrain [[pelvic floor muscles]] and sphincter muscles can reduce stress leakage.<ref name="pmid17625461">{{cite journal |author=Choi H, Palmer MH, Park J |title=Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women |journal=Nursing research |volume=56 |issue=4 |pages=226-34 |year=2007 |pmid=17625461 |doi=10.1097/01.NNR.0000280610.93373.e1}}</ref> Patients younger than 60 years old benefit the most.<ref name="pmid17625461"/> The patient should do at least 24 daily contractions for at least 6 weeks.<ref name="pmid17625461"/> A [[systematic review]] concluded "pelvic floor muscle training would resolve 490 cases of stress urinary incontinence."<ref name="Tatyana">Tatyana A. Shamliyan et al., “Systematic Review: Randomized, Controlled Trials of Nonsurgical Treatments for Urinary Incontinence in Women,” Ann Intern Med (February 11, 2008): http://www.annals.org/cgi/content/full/0000605-200803180-00211v1</ref> | ||
===Weight loss=== | |||
Weight loss was helpful in a [[randomized controlled trial]].<ref>{{Cite journal | |||
| doi = 10.1056/NEJMoa0806375 | |||
| volume = 360 | |||
| issue = 5 | |||
| pages = 481-490 | |||
| last = Subak | |||
| first = Leslee L. | |||
| coauthors = Rena Wing, Delia Smith West, Frank Franklin, Eric Vittinghoff, Jennifer M. Creasman, Holly E. Richter, Deborah Myers, Kathryn L. Burgio, Amy A. Gorin, Judith Macer, John W. Kusek, Deborah Grady, the PRIDE Investigators | |||
| title = Weight Loss to Treat Urinary Incontinence in Overweight and Obese Women | |||
| journal = N Engl J Med | |||
| accessdate = 2009-01-29 | |||
| date = 2009-01-29 | |||
| url = http://content.nejm.org/cgi/content/abstract/360/5/481 | |||
}}</ref> | |||
Revision as of 09:18, 29 January 2009
Urinary incontinence is defined as "Involuntary loss of urine, such as leaking of urine. It is a symptom of various underlying pathological processes."[1]
Classification
Urge incontinence
Stress incontinence
Etiology/Cause
Incontinence is more common after a hysterectomy.[2]
Diagnosis
A systematic review by the Rational Clinical Examination has reviewed hot to diagnose the types of incontinence and concluded that the "most helpful component for diagnosing urge urinary incontinence is a history of urine loss associated with urgency. A bladder stress test may be helpful for diagnosing stress urinary incontinence."[3] The bladder stress test is "performed while the woman is supine or standing, involves observation for urine loss immediately on coughing or with a Valsalva maneuver".[3]
Treatment
Prompted voiding
Prompted voiding helps according to a systematic review.[4]
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stress leakage.[5] Patients younger than 60 years old benefit the most.[5] The patient should do at least 24 daily contractions for at least 6 weeks.[5] A systematic review concluded "pelvic floor muscle training would resolve 490 cases of stress urinary incontinence."[6]
Weight loss
Weight loss was helpful in a randomized controlled trial.[7]
Medications
Urge incontinence
For urge incontinence (detrusor instability) anticholinergic drugs such as oxybutynin and tolterodine are effective according to a systematic review.[8]A randomized controlled trial found that trospium is effective.[9]
Stress incontinence
For stress incontinence, phenylpropanolamine 50 mg twice daily by mouth can help.[10][11][12]
Topical estrogen can help[13] and can be combined with phenylpropanolamine[12].
Surgery
Among surgical options, a randomized controlled trial found greater benefit, but more complications from Fascial sling surgery as compared to Burch colposuspension.[14]
References
- ↑ Error on call to Template:cite web: Parameters url and title must be specified. Retrieved on 2007-10-26.
- ↑ Altman D, Granath F, Cnattingius S, Falconer C (2007). "Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study". Lancet 370 (9597): 1494–9. DOI:10.1016/S0140-6736(07)61635-3. PMID 17964350. Research Blogging.
- ↑ 3.0 3.1 Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE (2008). "What type of urinary incontinence does this woman have?". JAMA 299 (12): 1446-56. DOI:10.1001/jama.299.12.1446. PMID 18364487. Research Blogging.
- ↑ Fink HA, Taylor BC, Tacklind JW, Rutks IR, Wilt TJ (December 2008). "Treatment interventions in nursing home residents with urinary incontinence: a systematic review of randomized trials". Mayo Clin. Proc. 83 (12): 1332–43. PMID 19046552. [e]
- ↑ 5.0 5.1 5.2 Choi H, Palmer MH, Park J (2007). "Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women". Nursing research 56 (4): 226-34. DOI:10.1097/01.NNR.0000280610.93373.e1. PMID 17625461. Research Blogging.
- ↑ Tatyana A. Shamliyan et al., “Systematic Review: Randomized, Controlled Trials of Nonsurgical Treatments for Urinary Incontinence in Women,” Ann Intern Med (February 11, 2008): http://www.annals.org/cgi/content/full/0000605-200803180-00211v1
- ↑ Subak, Leslee L.; Rena Wing, Delia Smith West, Frank Franklin, Eric Vittinghoff, Jennifer M. Creasman, Holly E. Richter, Deborah Myers, Kathryn L. Burgio, Amy A. Gorin, Judith Macer, John W. Kusek, Deborah Grady, the PRIDE Investigators (2009-01-29). "Weight Loss to Treat Urinary Incontinence in Overweight and Obese Women". N Engl J Med 360 (5): 481-490. DOI:10.1056/NEJMoa0806375. Retrieved on 2009-01-29. Research Blogging.
- ↑ Shamliyan TA, Kane RL, Wyman J, Wilt TJ (March 2008). "Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women". Ann. Intern. Med. 148 (6): 459–73. PMID 18268288. [e]
- ↑ Staskin D, Sand P, Zinner N, Dmochowski R (2007). "Once daily trospium chloride is effective and well tolerated for the treatment of overactive bladder: results from a multicenter phase III trial". J. Urol. 178 (3 Pt 1): 978–83; discussion 983–4. DOI:10.1016/j.juro.2007.05.058. PMID 17632131. Research Blogging.
- ↑ Lehtonen T, Rannikko S, Lindell O, Talja M, Wuokko E, Lindskog M (1986). "The effect of phenylpropanolamine on female stress urinary incontinence". Ann Chir Gynaecol 75 (4): 236–41. PMID 3535621. [e]
- ↑ Collste L, Lindskog M (October 1987). "Phenylpropanolamine in treatment of female stress urinary incontinence. Double-blind placebo controlled study in 24 patients". Urology 30 (4): 398–403. PMID 3310369. [e]
- ↑ 12.0 12.1 Beisland HO, Fossberg E, Moer A, Sander S (1984). "Urethral sphincteric insufficiency in postmenopausal females: treatment with phenylpropanolamine and estriol separately and in combination. A urodynamic and clinical evaluation". Urol. Int. 39 (4): 211–6. PMID 6541387. [e]
- ↑ Holtedahl K, Verelst M, Schiefloe A (July 1998). "A population based, randomized, controlled trial of conservative treatment for urinary incontinence in women". Acta Obstet Gynecol Scand 77 (6): 671–7. PMID 9688247. [e]
- ↑ Albo ME, Richter HE, Brubaker L, et al (2007). "Burch colposuspension versus fascial sling to reduce urinary stress incontinence". N. Engl. J. Med. 356 (21): 2143–55. DOI:10.1056/NEJMoa070416. PMID 17517855. Research Blogging.