Miller J M, Ashton-Miller J A, DeLancey J O
Institute of Gerontology, University of Michigan, Ann Arbor 48109-2125, USA.
J Am Geriatr Soc. 1998 Jul;46(7):870-4. doi: 10.1111/j.1532-5415.1998.tb02721.x.
To test the hypothesis that selected older women with mild-to-moderate stress urinary incontinence (SUI) can learn to demonstrate significantly reduced urine loss in 1 week by intentionally contracting the pelvic floor muscles before and during a cough (a skill we have termed "The Knack").
A prospective, randomized, single-blind interventional study.
The Older American Independence Center, a federally sponsored research program affiliated with the University of Michigan in Ann Arbor, Michigan.
Twenty-seven women with a mean (SD) age of 68.0 (5.5) years, self-reported SUI, and demonstrable urine loss during a deep cough.
Women were randomized to an immediate intervention group (Group I: n=13) who were taught the Knack after their first clinic visit, or a wait-listed control group (Group II: n=14) who were taught the Knack after 1 month.
At 1 week after instruction, we tested the efficacy of the Knack in a standing stress test by (1) comparing the volumes of cough-related urine loss leaked by all subjects, with and without use of the Knack, and (2) comparing the volumes of cough-related urine loss leaked by Group I, using the Knack, with Group II, which had not yet been taught the Knack.
Intra-individual results showed that at 1-week follow-up, the Knack was used to reduce urine loss resulting from a medium cough by an average of 98.2%, compared with that of a similar cough performed 1 minute before without the Knack (P=.009); likewise urine loss was reduced by an average of 73.3% (P=.003) in a deep cough. Reduction in urine loss was not significantly correlated with a digital measure of pelvic floor muscle strength.
Within 1 week, selected older women with mild-to-moderate SUI can acquire the skill of using a properly-timed pelvic floor muscle contraction to significantly reduce urine leakage during a cough.
检验以下假设：部分患有轻至中度压力性尿失禁（SUI）的老年女性能够通过在咳嗽前及咳嗽过程中有意收缩盆底肌肉（我们称之为“诀窍”的一项技能），在1周内显著减少尿液流失。
一项前瞻性、随机、单盲干预研究。
美国老年独立中心，这是一个由联邦政府资助、与密歇根大学安娜堡分校相关的研究项目。
27名平均（标准差）年龄为68.0（5.5）岁的女性，她们自我报告患有SUI，且在深咳时有明显尿液流失。
女性被随机分为立即干预组（第一组：n = 13），在首次门诊就诊后即教授她们“诀窍”，以及等待名单对照组（第二组：n = 14），在1个月后教授她们“诀窍”。
在指导后的1周，我们通过以下方式在站立压力测试中检验“诀窍”的效果：（1）比较所有受试者在使用和不使用“诀窍”时咳嗽相关漏尿量；（2）比较使用“诀窍”的第一组与尚未教授“诀窍”的第二组咳嗽相关漏尿量。
个体内结果显示，在1周随访时，与1分钟前未使用“诀窍”时的类似咳嗽相比，“诀窍”使中度咳嗽导致的尿液流失平均减少了98.2%（P = 0.009）；同样，在深咳时尿液流失平均减少了73.3%（P = 0.003）。尿液流失的减少与盆底肌肉力量的数字测量结果无显著相关性。
在1周内，部分患有轻至中度SUI的老年女性能够掌握适时收缩盆底肌肉的技能，从而在咳嗽时显著减少尿液泄漏。
