Urinary incontinence: Difference between revisions
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==Treatment== | ==Treatment== | ||
===Prompted voiding=== | |||
Prompted voiding helps according to a [[systematic review]].<ref name="pmid19046552">{{cite journal |author=Fink HA, Taylor BC, Tacklind JW, Rutks IR, Wilt TJ |title=Treatment interventions in nursing home residents with urinary incontinence: a systematic review of randomized trials |journal=Mayo Clin. Proc. |volume=83 |issue=12 |pages=1332–43 |year=2008 |month=December |pmid=19046552 |doi= |url=http://www.mayoclinicproceedings.com/Abstract.asp?AID=4832&Abst=Abstract&UID= |issn=}}</ref> | |||
===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> | ||
Revision as of 09:37, 22 December 2008
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]
Medications
Urge incontinence
For urge incontinence (detrusor instability) anticholinergic drugs such as oxybutynin and tolterodine are effective according to a systematic review.[7]A randomized controlled trial found that trospium is effective.[8]
Stress incontinence
For stress incontinence, phenylpropanolamine 50 mg twice daily by mouth can help.[9][10][11]
Topical estrogen can help[12] and can be combined with phenylpropanolamine[11].
Surgery
Among surgical options, a randomized controlled trial found greater benefit, but more complications from Fascial sling surgery as compared to Burch colposuspension.[13]
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
- ↑ 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]
- ↑ 11.0 11.1 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.