Urinary incontinence: Difference between revisions

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===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 a [[systematic review]].<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]] 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>


[[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 a [[systematic review]].<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>
====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===

Revision as of 08:18, 24 June 2008

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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

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

Urge incontinence

For urge incontinence (detrusor instability) anticholinergic drugs such as oxybutynin and tolterodine are effective according to a systematic review.[6]A randomized controlled trial found that trospium is effective.[7]

Stress incontinence

For stress incontinence, phenylpropanolamine 50 mg twice daily by mouth can help.[8][9][10]

Topical estrogen can help[11] and can be combined with phenylpropanolamine[10].

Surgery

Among surgical options, a randomized controlled trial found greater benefit, but more complications from Fascial sling surgery as compared to Burch colposuspension.[12]

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. ↑ 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. ↑ 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
  6. ↑ 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]
  7. ↑ 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.
  8. ↑ 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]
  9. ↑ 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]
  10. ↑ 10.0 10.1 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]
  11. ↑ 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]
  12. ↑ 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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