Princess Anne Hospital, Southampton, UK.
Post Reprod Health. 2020 Jun;26(2):63-70. doi: 10.1177/2053369120927112.
Urinary incontinence is a common problem affecting 25-45% women. Effective management can have a huge impact on a patient's quality of life and many treatments are available. Management should be dictated by the degree of bother the symptoms are having, and vary depending on the type on incontinence. Conservative measures should always be initiated, including optimisation of body mass index and smoking cessation. Overactive bladder and urge urinary incontinence can be improved with bladder retraining and avoidance of bladder stimulants. Medical treatment then includes anticholinergic medications or Mirabegron. More invasive options include Botulinum Toxin A (Botox®) injections, sacral nerve stimulation or urological surgery. Stress urinary incontinence should be managed initially with pelvic floor exercises, and input from a specialist nurse or physiotherapist is beneficial. The surgical options for managing stress incontinence have changed considerably over the years, but include bladder neck injections, mid-urethral slings, colposuspension or autologous fascial slings. Mixed urinary incontinence is more challenging to manage, but all conservative measures should be started. Further treatment is directed towards the predominant symptom, but overactivity should be controlled before surgical measures for stress urinary incontinence are performed.
尿失禁是一种常见的问题，影响 25-45%的女性。有效的管理可以对患者的生活质量产生巨大影响，并且有许多治疗方法可供选择。管理应该根据症状的严重程度来决定，并且因失禁类型而异。应始终开始保守治疗，包括优化体重指数和戒烟。膀胱过度活动症和急迫性尿失禁可以通过膀胱训练和避免膀胱刺激物来改善。然后可以使用抗胆碱能药物或米拉贝隆进行药物治疗。更具侵入性的选择包括肉毒杆菌毒素 A（肉毒杆菌毒素）注射、骶神经刺激或泌尿科手术。压力性尿失禁应首先通过骨盆底运动进行管理，并且来自专科护士或物理治疗师的指导是有益的。用于治疗压力性尿失禁的手术选择多年来发生了很大变化，但包括膀胱颈注射、中段尿道吊带、耻骨后悬吊术或自体筋膜吊带。混合性尿失禁更具挑战性，但应开始所有保守治疗措施。进一步的治疗针对主要症状，但在进行治疗压力性尿失禁的手术措施之前，应控制过度活动。
