Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, and Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
JAMA. 2010 Jun 2;303(21):2172-81. doi: 10.1001/jama.2010.749.
Urinary incontinence is a common geriatric syndrome that affects at least 1 in 3 older women and can greatly diminish quality of life. Incontinence has been associated with increased social isolation, falls, fractures, and admission to long-term care facilities. Often unreported and thus untreated, it is important to include incontinence as part of the review of systems for all older women. Using the case of Mrs F, we highlight the chronicity of incontinence and discuss the evidence base for evaluation of incontinence in older women, with proper initial diagnosis of the type of incontinence-stress, urgency, or mixed-in order to prescribe optimal treatment. We present an evidence-based discussion of available incontinence treatments including pelvic floor muscle exercises, stress strategies, urge-suppression strategies, fluid management, medications, intravaginal pessaries, intravesical injection of botulinum toxin, percutaneous tibial nerve stimulation, sacral neuromodulation, and surgical procedures for stress incontinence. Special considerations in evaluation and treatment of patients with dementia are presented. Urinary incontinence treatments yield high levels of patient satisfaction and improvements in quality of life.
尿失禁是一种常见的老年综合征，至少影响 1/3 的老年女性，极大地降低了生活质量。尿失禁与社会隔离增加、跌倒、骨折和入住长期护理机构有关。由于常常未被报告和治疗，因此，将尿失禁作为所有老年女性系统回顾的一部分非常重要。我们通过 F 女士的病例，强调了尿失禁的慢性特征，并讨论了评估老年女性尿失禁的证据基础，以便正确诊断尿失禁的类型（压力性、急迫性或混合性），从而开出最佳治疗方案。我们提供了一个基于证据的讨论，讨论了现有的尿失禁治疗方法，包括盆底肌肉锻炼、压力策略、抑制急迫性策略、液体管理、药物治疗、阴道子宫托、膀胱内注射肉毒杆菌毒素、经皮胫神经刺激、骶神经调节和治疗压力性尿失禁的手术。还介绍了在评估和治疗痴呆症患者时的特殊注意事项。尿失禁治疗可带来较高的患者满意度和生活质量改善。
