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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳欣宏 | 骨盆底運動之外的行為治療對於尿失禁及相關排尿症狀的重要性 | 2010/10/28 下午 02:03:33 | 0 |
| 原 文 | 題 目 | ehavioral Interventions for Incontinence and Other Urinary Symptoms: More Than Pelvic Muscle Exercises |
| 作 者 | Gianna Pace | |
| 出 處 | The Journal of Urology | |
| 出版日期 | Volume 184, Issue 3, Sept. 2010, p 827-828 | |
| 評 論 |
尿失禁、頻尿、急尿等是婦女常罹患的排尿症狀，而且盛行率有不斷增加的趨勢。本文作者再次重申對於這類患者我們必須在給予藥物或手術治療前，清楚教育病患行為治療及骨盆底肌肉(PFM)運動的重要性及其療效。排尿日誌可以教導病患如何調整排尿時間以減少尿失禁次數；戒除飲食中對膀胱易產生刺激的物質(如碳酸飲料、代糖及咖啡因)，控制體重、戒菸及改善規律的排大便習慣。適當的水分攝取(每天1500 ml)是重要的，過多會加重尿失禁，而限水則會導致尿液過濃，反而容易刺激膀胱黏膜而加劇頻尿、急尿及尿路感染。至於有夜尿的患者，則應避免下午6點以後或睡前3-4小時當中飲用太多水分。 練習緩慢及深呼吸的運動以及從事需要心智專注的工作或興趣，可以將排尿間隔延長(最好可以間隔至3-4小時)。當然骨盆底肌肉運動是重要的方法，藉由每天不斷的練習，可以熟習技巧及增加強度，由每天45次(分成早、中、晚各15次)練習，慢慢量力而為增加次數，且延長每次收縮的時間至10秒後再以相等時間放鬆，這樣便可以得到最佳的治療效果；這些都是病患及醫療提供者不可不知的資訊。 |
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| abstract |
URINARY incontinence (UI) is far more common in women than in men and its prevalence increases with age. UI, urgency, overactive bladder symptoms, cystitis and urinary tract infections are frequently diagnosed in the female population, and have been estimated as occurring in 5% to 69% of women. The prevalence of male UI ranges between 1% and 39% with urge urinary incontinence the predominant subtype, although the relative proportion shifts toward stress urinary incontinence with increasing age. UI impacts the lives of men and women with detrimental effects on social, professional and recreational activities as well as on sexual health. As described in this issue of The Journal in articles by Soda et al (page 1000) and Wing et al (page 1005), it may also encourage adaptive changes in the behavior of those affected such as prophylactic urination, urination on first desire and fluid restriction. The first management strategy for adult UI, as advocated by the U.S. Department of Health and Human Services Clinical Guidelines Panel, should be the least invasive and most reversible intervention (lifestyle and behavioral) before drug therapy and surgery.4 Recommendations of behavioral interventions in the treatment of UI published by the International Consultation on Incontinence include healthy bladder habits and lifestyle modification as well as training techniques for skills to control the symptoms of bladder dysfunction. Healthy bladder habits enhance patient understanding of normal and abnormal bladder function. Considering that behavioral intervention and bladder training are safe and noninvasive, patients with the cognitive and functional capability may be advised that they can rely on a nonpharmacological first line treatment to successfully manage their urinary symptoms. |
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