Urinary incontinence: Difference between revisions
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===Stress incontinence=== | ===Stress incontinence=== | ||
== | ==Etiology/Cause== | ||
Incontinence is more common after a hysterectomy.<ref name="pmid17964350">{{cite journal |author=Altman D, Granath F, Cnattingius S, Falconer C |title=Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study |journal=Lancet |volume=370 |issue=9597 |pages=1494–9 |year=2007 |pmid=17964350 |doi=10.1016/S0140-6736(07)61635-3 |issn=}}</ref> | Incontinence is more common after a hysterectomy.<ref name="pmid17964350">{{cite journal |author=Altman D, Granath F, Cnattingius S, Falconer C |title=Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study |journal=Lancet |volume=370 |issue=9597 |pages=1494–9 |year=2007 |pmid=17964350 |doi=10.1016/S0140-6736(07)61635-3 |issn=}}</ref> | ||
==Diagnosis== | |||
A [[systematic review]] by the [http://www.sgim.org/clinexam-rce.cfm 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."<ref name="pmid18364487">{{cite journal |author=Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE |title=What type of urinary incontinence does this woman have? |journal=JAMA |volume=299 |issue=12 |pages=1446-56 |year=2008 |pmid=18364487 |doi=10.1001/jama.299.12.1446 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18364487}}</ref> 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".<ref name="pmid18364487"/> | |||
==Treatment== | ==Treatment== | ||
Revision as of 10:37, 31 March 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
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stress leakage.[4] Patients younger than 60 years old benefit the most.[4] The patient should do at least 24 daily contractions for at least 6 weeks.[4] A systematic review concluded "pelvic floor muscle training would resolve 490 cases of stress urinary incontinence."[5]
Medications
A randomized controlled trial found that trospium is effective.[6]
Anticholinergic drugs such as oxybutynin and tolterodine are effective according to a systematic review.[5]
Surgery
Among surgical options, a randomized controlled trial found greater benefit, but more complications from Fascial sling surgery as compared to Burch colposuspension.[7]
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.
- ↑ 4.0 4.1 4.2 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.
- ↑ 5.0 5.1 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
- ↑ 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.
- ↑ 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.