老年人尿失禁的治療

Treatment of Urinary Incontinence in Older Adults

賴秀昀(Hsiu-Yun Lai) ； 陳亮恭(Liang-Kung Chen) ； 黃信彰(Shinn-Jang Hwang)

《長期照護雜誌》 13卷1期 (2009/04) Pp. 13-27

https://doi.org/10.6317/LTC.200904_13(1).0002

摘要

尿失禁的定義為不自主的漏尿，是重要的老年症候群之一，無論在身體、心理及社會層面，都可能會對病患會造成負面的影響。以尿失禁發生時間的長短可將其分類為「急性」與「慢性」兩類，慢性尿失禁則可進一步再分為急迫型、應力型、滿溢型、功能型、與混合型尿失禁。急性尿失禁的處理重點在於找出可回復的原因。行為治療，例如骨盆底肌肉訓練與提醒解尿，對治療應力型及急迫型尿失禁是有效的。對急迫型尿失禁的病患， 抗毒蕈鹼劑是有效的藥物治療方法，至於duloxetin則可減少應力型尿失禁的失禁頻率。許多手術方法可用以治療婦女的應力型尿失禁，例如：Burch陰道懸吊術、筋膜吊帶、以及無張力陰道懸吊等。至於在治療孱弱老年人的尿失禁時，醫療人員必須特別留意治療可能造成的風險以及藥物間之交互作用。

關鍵字

尿失禁 ； 老年人 ； 治療

並列摘要

Urinary incontinence, defined as involuntary loss of urine, is one of the major geriatric syndromes. Physical health, psychological well-being, and social status can be adversely affected by incontinence. Chronologic classification divides cases between acute and chronic. Chronic urinary incontinence can further be classified clinically into urge, stress, overflow, functional, and mixed incontinence. Management of acute incontinence should focus specially on treating reversible conditions. Behavioral interventions, such as pelvic floor muscle training and prompted voiding, are effective in treating stress and urge incontinence. For patients with urge incontinence, antimuscarinics are helpful pharmacologic management. In stress incontinence, duloxetin appears to reduce the frequency of incontinence episodes. Several surgical interventions are effective in the management of stress incontinence in women, including Burch colposuspension, fascial sling and tension-free vaginal tape. In managing frail older patients, medical professionals should be cautious about the potential risk of the treatments and drug-drug interaction.

並列關鍵字

urinary incontinence ； elderly ； therapeutics