Ouslander J G, Schnelle J F
University of California, Borun Center for Gerontological Research, Los Angeles.
Ann Intern Med. 1995 Mar 15;122(6):438-49. doi: 10.7326/0003-4819-122-6-199503150-00007.
Urinary and fecal incontinence are prevalent, disruptive, and expensive health problems in the nursing home population. Nursing home residents who are incontinent of urine should have a basic diagnostic assessment, including a focused history and bladder record, a targeted physical examination, a urinalysis, and a determination of postvoid residual urine volume done by catheterization or ultrasonography. Potentially reversible conditions, such as fecal impaction and drug side effects, should be identified and treated. Selected residents should have further urodynamic evaluation or other diagnostic tests. Prompted voiding, a simple, noninvasive behavioral intervention, is effective in managing daytime urinary incontinence in one quarter to one third of incontinent nursing home residents. If it is to be effective over a long period of time, this intervention must be targeted to those residents most likely to respond. Selected nursing home residents will benefit from other behavioral interventions, drug therapy, or surgery. Because of the morbidity associated with it, long-term catheterization should only be used for specific indications. Like urinary incontinence, fecal incontinence may be caused by potentially reversible conditions. After such conditions have been excluded, fecal incontinence can generally be managed effectively by avoiding fecal impaction and by using a systematic bowel-training protocol.
尿失禁和大便失禁在疗养院人群中是普遍存在、具有破坏性且成本高昂的健康问题。尿失禁的疗养院居民应进行基本的诊断评估，包括重点病史和膀胱记录、针对性的体格检查、尿液分析，以及通过导尿或超声检查测定排尿后残余尿量。应识别并治疗潜在的可逆性病症，如粪便嵌塞和药物副作用。部分居民应进行进一步的尿动力学评估或其他诊断测试。定时排尿是一种简单的非侵入性行为干预措施，对四分之一至三分之一的失禁疗养院居民的日间尿失禁管理有效。若要长期有效，这种干预措施必须针对最有可能有反应的居民。部分疗养院居民将从其他行为干预、药物治疗或手术中受益。由于长期导尿会带来相关发病率，所以仅应在特定指征下使用。与尿失禁一样，大便失禁可能由潜在的可逆性病症引起。排除这些病症后，大便失禁通常可通过避免粪便嵌塞和采用系统的肠道训练方案得到有效管理。
