急迫性尿失禁之物理治療

Physiotherapy for Patients with Urge Incontinence

陳怡靜(Yi-Ching Chen) ； 陳進典(Gin-Den Chen)

《臺灣泌尿科醫學會雜誌》 13卷3期 (2002/09) Pp. 97-102

摘要

在無神經控制機轉障礙下，因多種因素促使膀胱迫尿肌不自主的收縮，患者於是感覺有強烈的尿意感或尿急，而病情嚴重時，甚至無法抑制尿液外流則為急迫性尿失禁（urge urinary incontinence, UUI）。急迫性尿失禁為婦女尿失禁種類中第二常見的情況，約占婦女尿失禁的22%。治療急迫性尿失禁，以保守療法為主。常使用膀胱迫尿肌穩定或能抑制膀胱迫尿肌不自主收縮的藥物。其他的保守療法，如物理治療（physiotherapy），也是一種有效的治療方式。治療急迫性尿失禁的物理治療方式，包含有：膀胱再訓練（bladder re-training）、骨盆底肌肉收縮運動（pelvic floor muscle exercise）、生理回饋（biofeedback）、電刺激（electrical stimulation）等。膀胱再訓練是基於修正行為習慣（behavior modification）的原則，來指導病患延長解尿間隔和控制尿急，經由訓練漸漸的使解尿間隔可延長到3至4小時的”正常”解尿習慣。證據也顯示骨盆底肌肉運動對尿急、頻尿、急迫性尿失禁也有很好的治療效果，藉由收縮骨盆底肌肉可達到抑制和停止膀胱迫尿肌收縮，而避免尿失禁的發生。以電極刺激陰部傳出神經（pudendal efferent）枝，會產生骨盆底肌肉的收縮;以電極刺激陰圓的傳入性神經纖維（pudendal afferent）會興奮神經的傳導路徑，因而抑制膀胱的收縮。藉由強化尿道閉鎖的機制（urethral closure mechanism）與抑制膀胱的躁動，電刺激可被使用在許多地方以改善尿失禁的症狀。建議以10Hz或更低的刺激頻率（5-10Hz）來治療，可以抑制膀胱收縮; 以10-50Hz的刺激頻率，則反而可促進肌肉收縮。這些治療方式，雖然者需要病患較多的主動參與，但卻很少有副作用，基於由危險性最小為優先選擇的原則，這些保守療法是值得推薦的。

關鍵字

物理治療(physiotherapy) ； 急迫性尿失禁(urge urinary incontinence) ； 膀胱再訓練(bladder re-training) ； 骨盆底肌肉收縮運動(pelvic floor muscle exercise) ； 電刺激(electrical stimulation)

並列摘要

Urge urinary incontinence (UUI), the second most common type of symptoms related to urinary incontinence (UI), accounted for 22% of UI in women and is symptomatically described as the involuntary loss of urine associated with a strong desire to void. In the past, clinicians have relied heavily on pharmacological or surgical interventions for urinary incontinence. Physiotherapy induces limited side effects and does not exclude future options. These techniques can improve and eventually restore pelvic floor function and bladder function control. Modalities for the treatment of patients with urge incontinence consist of bladder re-training, pelvic floor muscles (PFM) exercise with or without treatment adjuncts such as biofeedback or electrical stimulation (ES), and ES alone bladder re-training generally consists of a “behavioural” intervention, a program of patient education addressing lower urinary tract function and a schedule of voluntary voiding. Bladder re-retraining enables women to accommodate increasingly greater volumes of urine in the bladder and gradually to prolong the interval between voiding. Pelvic floor muscle exercises are generally reserved for the treatment of stress incontinence (SUI). Evidence also shows that PFM exercise may be effective in the treatment of symptoms of UUI. Learned pelvic floor muscle contractions can prevent urine loss by inhibiting and aborting detrusor contraction. Electrical stimulation, a neuromodulating therapy that affects the neural signaling that controls continence, is an effective and well-tolerated treatment for overactive bladder. To obtain a therapeutic effect of pelvic floor stimulation in women with detrusor overactivity, peripheral innervation of the PFMs must at least be partly intact. Electrical stimulation therapy alone is suggested to permit an effective reduction or inhibition of detrusor activity by stimulating afferents of the pudendal nerve. Physical therapy is s safe and effective conservative intervention that should be made more readily available to patients as a first-line for urge incontinence.

並列關鍵字

Physiotherapy ； urge urinary incontinence ； bladder re-training ； pelvic floor muscle exercise ； electrical stimulation