Mold J W
University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Am Fam Physician. 1996 Aug;54(2):673-80, 683-5.
Aging is associated with many changes that may predispose an individual to urinary incontinence. An appropriate pharmacologic treatment plan depends on identification of the type of incontinence and minimization of aggravating factors. Stress incontinence is caused by incompetence of the internal urethral sphincter and is most common in postmenopausal women. This type of incontinence may respond to estrogen therapy and/or alpha-adrenergic agonists. Urge incontinence may occur in both men and women as a result of inappropriate detrusor muscle contraction. This condition may be treated with estrogens, anticholinergics or smooth muscle relaxants. Hypertonicity of the detrusor muscle, usually secondary to a neurologic problem, leads to overflow incontinence. Although overflow incontinence is difficult to control, cholinergic agonists and beta-adrenergic blockers may be helpful. Finally, any obstruction of bladder outflow may cause overflow incontinence and is best treated by amelioration of the cause. However, alpha-adrenergic blockers and 5-alpha reductase inhibitors may be useful in selected cases.
衰老与许多可能使个体易患尿失禁的变化相关。合适的药物治疗方案取决于尿失禁类型的识别以及加重因素的最小化。压力性尿失禁是由尿道内括约肌功能不全引起的，在绝经后女性中最为常见。这种类型的尿失禁可能对雌激素治疗和/或α-肾上腺素能激动剂有反应。急迫性尿失禁可能由于逼尿肌不适当收缩而在男性和女性中均会发生。这种情况可用雌激素、抗胆碱能药物或平滑肌松弛剂治疗。逼尿肌张力亢进通常继发于神经问题，会导致充溢性尿失禁。尽管充溢性尿失禁难以控制，但胆碱能激动剂和β-肾上腺素能阻滞剂可能会有帮助。最后，膀胱流出道的任何梗阻都可能导致充溢性尿失禁，最好通过病因改善来治疗。然而，α-肾上腺素能阻滞剂和5-α还原酶抑制剂在某些特定情况下可能有用。
