Urinary incontinence: Difference between revisions
Jump to navigation
Jump to search
imported>Robert Badgett No edit summary |
imported>Robert Badgett |
||
| (17 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
Urinary | {{subpages}} | ||
'''Urinary incontinence''' is defined as "Involuntary loss of urine, such as leaking of urine. It is a symptom of various underlying pathological processes."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&index=14006 |title= |accessdate=2007-10-26 |format= |work=}}</ref> | |||
==Classification== | ==Classification== | ||
| Line 6: | Line 7: | ||
===Stress incontinence=== | ===Stress incontinence=== | ||
== | ==Etiology/Cause== | ||
Incontinence is more common after a hysterectomy.<ref name=" | 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== | ||
[[Clinical practice guideline]]s address the treatment of males. | |||
<ref name="pmid20484350">{{cite journal| author=Jones C, Hill J, Chapple C, Guideline Development Group| title=Management of lower urinary tract symptoms in men: summary of NICE guidance. | journal=BMJ | year= 2010 | volume= 340 | issue= | pages= c2354 | pmid=20484350 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20484350 | doi=10.1136/bmj.c2354 }} </ref> | |||
The treatment of women has been reviewed.<ref>{{Cite journal | |||
| doi = 10.1001/jama.2010.749 | |||
| volume = 303 | |||
| issue = 21 | |||
| pages = 2172-2181 | |||
| last = Goode | |||
| first = Patricia S. | |||
| coauthors = Kathryn L. Burgio, Holly E. Richter, Alayne D. Markland | |||
| title = Incontinence in Older Women | |||
| journal = JAMA | |||
| accessdate = 2010-06-02 | |||
| date = 2010-06-02 | |||
| url = http://jama.ama-assn.org/cgi/content/abstract/303/21/2172 | |||
}}</ref><ref name="pmid18322284">{{cite journal| author=Rogers RG| title=Clinical practice. Urinary stress incontinence in women. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 10 | pages= 1029-36 | pmid=18322284 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=18322284 | doi=10.1056/NEJMcp0707023 }} </ref> | |||
===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. | [[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> | ||
<ref name=" | |||
===Weight loss=== | |||
Weight loss was helpful in a [[randomized controlled trial]].<ref name="pmid19179316">{{cite journal| author=Subak LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM et al.| title=Weight loss to treat urinary incontinence in overweight and obese women. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 5 | pages= 481-90 | pmid=19179316 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19179316 | doi=10.1056/NEJMoa0806375 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19648434 Review in: Evid Based Med. 2009 Aug;14(4):118] [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19779077 Review in: Evid Based Nurs. 2009 Oct;12(4):110] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
===Medications=== | ===Medications=== | ||
A [[randomized controlled trial]] found that [[trospium]] is effective.<ref name="pmid17632131">{{cite journal |author=Staskin D, Sand P, Zinner N, Dmochowski R |title=Once daily trospium chloride is effective and well tolerated for the treatment of overactive bladder: results from a multicenter phase III trial |journal=J. Urol. |volume=178 |issue=3 Pt 1 |pages=978–83; discussion 983–4 |year=2007 |pmid=17632131 |doi=10.1016/j.juro.2007.05.058}}</ref> | ====Urge incontinence==== | ||
For urge incontinence (detrusor instability) [[Acetylcholine|anticholinergic drugs]] such as [http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=oxybutynin oxybutynin] and [http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=tolterodine tolterodine] are effective according to recent [[systematic review]]s. Tolterodine has low [[drug toxicity]].<ref>{{Cite journal | |||
| doi = 10.1059/0003-4819-156-12-201206190-00436 | |||
| issn = 0003-4819, 1539-3704 | |||
| last = Shamliyan | |||
| first = Tatyana | |||
| coauthors = Jean F Wyman, Rema Ramakrishnan, François Sainfort, Robert L Kane | |||
| title = Systematic Review: Benefits and Harms of Pharmacologic Treatment for Urinary Incontinence in Women | |||
| journal = Annals of Internal Medicine | |||
| accessdate = 2012-04-10 | |||
| date = 2012-04-09 | |||
| url = http://www.annals.org/content/early/2012/04/09/0003-4819-156-12-201206190-00436 | |||
}}</ref><ref name="pmid18268288">{{cite journal |author=Shamliyan TA, Kane RL, Wyman J, Wilt TJ |title=Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women |journal=Ann. Intern. Med. |volume=148 |issue=6 |pages=459–73 |year=2008 |month=March |pmid=18268288 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=18268288 |issn=}}</ref> | |||
A [[randomized controlled trial]] of both men and women found that the [[anticholinergic]] medication [[trospium]] is effective.<ref name="pmid17632131">{{cite journal |author=Staskin D, Sand P, Zinner N, Dmochowski R |title=Once daily trospium chloride is effective and well tolerated for the treatment of overactive bladder: results from a multicenter phase III trial |journal=J. Urol. |volume=178 |issue=3 Pt 1 |pages=978–83; discussion 983–4 |year=2007 |pmid=17632131 |doi=10.1016/j.juro.2007.05.058}}</ref> | |||
A [[randomized controlled trial]] in men of behavioral therapy versus the [[anticholinergic]] medication [[oxybutynin]] (no control group) found similar effectiveness.<ref name="pmid22092152">{{cite journal| author=Burgio KL, Goode PS, Johnson TM, Hammontree L, Ouslander JG, Markland AD et al.| title=Behavioral Versus Drug Treatment for Overactive Bladder in Men: The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial. | journal=J Am Geriatr Soc | year= 2011 | volume= 59 | issue= 12 | pages= 2209-16 | pmid=22092152 | doi=10.1111/j.1532-5415.2011.03724.x | pmc= | url= }} </ref> The behavioral treatment included: | |||
* Pelvic floor muscle training | |||
** "contract and relax pelvic floor muscles while keeping abdominal muscles relaxed" | |||
** "contract their muscles for 2- to 10-second periods separated by 2 to 10 seconds of relaxation. | |||
*** "Initial contraction duration was based on the ability demonstrated by each participant in the training session.” | |||
** "Daily practice included 45 exercises” | |||
*** "divided into manageable sessions” | |||
*** "usually three sessions of 15 exercises each” | |||
** "Duration was increased gradually to a maximum of 10 seconds" | |||
* Urge suppression techniques when awakened at night with the urge to void | |||
** "Remain still in bed and attempt to diminish the urgency with repeated pelvic floor muscle contractions. | |||
** "If successful, they could go back to sleep; if not, they could void and return to bed." | |||
* Fluid restriction (after 6:00 p.m.) | |||
====Stress incontinence==== | |||
For stress incontinence, [[phenylpropanolamine]] 50 mg twice daily by mouth can help.<ref name="pmid3535621">{{cite journal |author=Lehtonen T, Rannikko S, Lindell O, Talja M, Wuokko E, Lindskog M |title=The effect of phenylpropanolamine on female stress urinary incontinence |journal=Ann Chir Gynaecol |volume=75 |issue=4 |pages=236–41 |year=1986 |pmid=3535621 |doi= |url= |issn=}}</ref><ref name="pmid3310369">{{cite journal |author=Collste L, Lindskog M |title=Phenylpropanolamine in treatment of female stress urinary incontinence. Double-blind placebo controlled study in 24 patients |journal=Urology |volume=30 |issue=4 |pages=398–403 |year=1987 |month=October |pmid=3310369 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0090-4295(87)90314-1 |issn=}}</ref><ref name="pmid6541387">{{cite journal |author=Beisland HO, Fossberg E, Moer A, Sander S |title=Urethral sphincteric insufficiency in postmenopausal females: treatment with phenylpropanolamine and estriol separately and in combination. A urodynamic and clinical evaluation |journal=Urol. Int. |volume=39 |issue=4 |pages=211–6 |year=1984 |pmid=6541387 |doi= |url= |issn=}}</ref> | |||
Topical estrogen can help<ref name="pmid9688247">{{cite journal |author=Holtedahl K, Verelst M, Schiefloe A |title=A population based, randomized, controlled trial of conservative treatment for urinary incontinence in women |journal=Acta Obstet Gynecol Scand |volume=77 |issue=6 |pages=671–7 |year=1998 |month=July |pmid=9688247 |doi= |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0001-6349&date=1998&volume=77&issue=6&spage=671 |issn=}}</ref> and can be combined with [[phenylpropanolamine]]<ref name="pmid6541387">{{cite journal |author=Beisland HO, Fossberg E, Moer A, Sander S |title=Urethral sphincteric insufficiency in postmenopausal females: treatment with phenylpropanolamine and estriol separately and in combination. A urodynamic and clinical evaluation |journal=Urol. Int. |volume=39 |issue=4 |pages=211–6 |year=1984 |pmid=6541387 |doi= |url= |issn=}}</ref>. | |||
===Surgery=== | ===Surgery=== | ||
| Line 22: | Line 85: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 07:49, 10 April 2012
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
Clinical practice guidelines address the treatment of males. [4]
The treatment of women has been reviewed.[5][6]
Prompted voiding
Prompted voiding helps according to a systematic review.[7]
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stress leakage.[8] Patients younger than 60 years old benefit the most.[8] The patient should do at least 24 daily contractions for at least 6 weeks.[8] A systematic review concluded "pelvic floor muscle training would resolve 490 cases of stress urinary incontinence."[9]
Weight loss
Weight loss was helpful in a randomized controlled trial.[10]
Medications
Urge incontinence
For urge incontinence (detrusor instability) anticholinergic drugs such as oxybutynin and tolterodine are effective according to recent systematic reviews. Tolterodine has low drug toxicity.[11][12]
A randomized controlled trial of both men and women found that the anticholinergic medication trospium is effective.[13]
A randomized controlled trial in men of behavioral therapy versus the anticholinergic medication oxybutynin (no control group) found similar effectiveness.[14] The behavioral treatment included:
- Pelvic floor muscle training
- "contract and relax pelvic floor muscles while keeping abdominal muscles relaxed"
- "contract their muscles for 2- to 10-second periods separated by 2 to 10 seconds of relaxation.
- "Initial contraction duration was based on the ability demonstrated by each participant in the training session.”
- "Daily practice included 45 exercises”
- "divided into manageable sessions”
- "usually three sessions of 15 exercises each”
- "Duration was increased gradually to a maximum of 10 seconds"
- Urge suppression techniques when awakened at night with the urge to void
- "Remain still in bed and attempt to diminish the urgency with repeated pelvic floor muscle contractions.
- "If successful, they could go back to sleep; if not, they could void and return to bed."
- Fluid restriction (after 6:00 p.m.)
Stress incontinence
For stress incontinence, phenylpropanolamine 50 mg twice daily by mouth can help.[15][16][17]
Topical estrogen can help[18] and can be combined with phenylpropanolamine[17].
Surgery
Among surgical options, a randomized controlled trial found greater benefit, but more complications from Fascial sling surgery as compared to Burch colposuspension.[19]
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.
- ↑ Jones C, Hill J, Chapple C, Guideline Development Group (2010). "Management of lower urinary tract symptoms in men: summary of NICE guidance.". BMJ 340: c2354. DOI:10.1136/bmj.c2354. PMID 20484350. Research Blogging.
- ↑ Goode, Patricia S.; Kathryn L. Burgio, Holly E. Richter, Alayne D. Markland (2010-06-02). "Incontinence in Older Women". JAMA 303 (21): 2172-2181. DOI:10.1001/jama.2010.749. Retrieved on 2010-06-02. Research Blogging.
- ↑ Rogers RG (2008). "Clinical practice. Urinary stress incontinence in women.". N Engl J Med 358 (10): 1029-36. DOI:10.1056/NEJMcp0707023. PMID 18322284. 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]
- ↑ 8.0 8.1 8.2 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 LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM et al. (2009). "Weight loss to treat urinary incontinence in overweight and obese women.". N Engl J Med 360 (5): 481-90. DOI:10.1056/NEJMoa0806375. PMID 19179316. Research Blogging. Review in: Evid Based Med. 2009 Aug;14(4):118 Review in: Evid Based Nurs. 2009 Oct;12(4):110
- ↑ Shamliyan, Tatyana; Jean F Wyman, Rema Ramakrishnan, François Sainfort, Robert L Kane (2012-04-09). "Systematic Review: Benefits and Harms of Pharmacologic Treatment for Urinary Incontinence in Women". Annals of Internal Medicine. DOI:10.1059/0003-4819-156-12-201206190-00436. ISSN 1539-3704 0003-4819, 1539-3704. Retrieved on 2012-04-10. 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.
- ↑ Burgio KL, Goode PS, Johnson TM, Hammontree L, Ouslander JG, Markland AD et al. (2011). "Behavioral Versus Drug Treatment for Overactive Bladder in Men: The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial.". J Am Geriatr Soc 59 (12): 2209-16. DOI:10.1111/j.1532-5415.2011.03724.x. PMID 22092152. 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]
- ↑ 17.0 17.1 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.