Urinary incontinence

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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

  1. ↑ Error on call to Template:cite web: Parameters url and title must be specified. Retrieved on 2007-10-26.
  2. ↑ 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. ↑ 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. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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. ↑ 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.
  9. ↑ 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
  10. ↑ 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
  11. ↑ 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.
  12. ↑ 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]
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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]
  16. ↑ 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. ↑ 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]
  18. ↑ 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]
  19. ↑ 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.
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