Treating Women's Incontinence: A Review of the Literature and Recommendations for Practice

摘要

Urinary incontinence is common and nurse practitioners are often the first professionals to evaluate and treat this condition. A growing body of literature exists that supports non-surgical treatment approaches for women with stress, urge, and mixed incontinence. This article reviews the existing literature regarding non-surgical treatment of incontinence in women, including behavioral therapies, pharmacologic interventions, self-care strategies, and prevention. Recommendations for practice are also included. Address correspondence to:Christine Bradway, MSN, RN, CSRalston House, Room 3213615 Chestnut StreetPhiladelphia, PA 19104phone: 215-898-3899fax: 215-573-7917email: cwb@pobox.upenn.edu Introduction Urinary incontinence (UI) is involuntary loss of urine sufficient to be a problem [1]. At any age, women are twice as likely as men to suffer from UI [2,3]. Although it is generally accepted that the prevalence of incontinence increases with age [4,5], advanced practice nurses (APNs) are likely to encounter women of all ages with UI [6,7,8,9,10] and are in an ideal position to effectively manage incontinence with non-surgical interventions [11]. The purpose of this article is to review the existing literature regarding non-surgical treatment strategies and to make recommendations for primary care of women who suffer from UI. Review of the Literature The literature regarding non-surgical treatment options for UI in women generally falls into three categories: behavioral techniques, pharmacologic measures, and self-care strategies. Moreover, most literature is concerned with three of the established subtypes of UI; stress, urge, or mixed UI. Subjectively, stress UI is usually described as urine loss during activities that increase intra-abdominal pressure. The most common cause of stress UI in women is urethral hypermobility, however in some cases, an intrinsic urethral sphincter deficiency (ISD) is responsible for the symptoms [12]. Individuals usually describe urge UI as urine loss accompanied by a strong desire to void. This subtype of incontinence is most often associated with involuntary contractions of the detrusor muscle (located on the inside of the bladder), and is sometimes referred to as detrusor instability (DI). When individuals present with symptoms of both stress and urge UI, the incontinence is called mixed.Some articles separate women by menstrual status, however the majority address a wide range of ages and a variety of interventions. In addition, the literature includes important information regarding health promotion and prevention of UI. Although it is outside the scope of this article, it is assumed that the APN performs a basic assessment (e.g., a focused history and physical examination, urinalysis [and if infection is suspected, a urine culture], and post void residual urine) prior to initiating treatment or referral [12,13]. Behavioral Techniques In general, behavioral techniques including pelvic muscle re-education (Kegel exercises; pelvic muscle exercises) and bladder retraining effectively reduce UI without adding significant side effects [12]. Thus, these techniques are often recommended as a first choice for therapy in women with stress, urge, and mixed UI.Pelvic muscle exercises (PMEs) are performed to strengthen the voluntary periurethral and perivaginal muscles (e.g., the pubococcygeus muscle) [14,15], and are often recommended for stress UI associated with urethral hypermobility [16,17,18]. Benvenuti, et al [16] studied 26 community-dwelling women (ages 36-65; mean age, 50.8 years) during three months of PME therapy. Although this was an uncontrolled study, all of the women were “improved” and seven reported being “cured” of their UI. Bo, et al [17] randomized 52 women (mean age, 45.9) with stress UI into two groups. Group I received PME instructions and exercised on their own at home; Group II received the same instructions, but in addition, met with a trainer for 45 minutes once a week for six