KADIN ÜRİNER İNKONTİNANSI VE FİZYOTERAPİ YAKLAŞIMLARI

Üriner inkontinans, tüm yaş grubu kadınlarda yaygın olarak görülen ve sosyal, psikolojik, fiziksel, cinsel aktivielerini ve yaşam kalitesini etkileyen bir sağlık problemidir. Bu problem sadece Amerikada 13 milyon kişide görülmekte ve bunların %85’ini kadın oluşturmaktadır. Ülkemizde ise üriner inkontinans prevelansı hakkında kesin bir bilgi yoktur. Fizyoterapi, davranış tedavisi, ilaç ve cerrahi tedavi gibi birçok yöntem üriner inkontinans tedavisinde kullanılmaktadır. Fizyoterapide özellikle, pelvik taban kas egzersizi, biofeedback ve elektriksel stimulasyon üriner inkontinansın önlenmesinde ve tedavisinde temel olan konservatif yöntemlerdir.

Anahtar Kelimeler:

Kadın Üriner İnkontinansı, Fizyoterapi

URINARY INCONTINENCE IN WOMEN AND PHYSICAL THERAPHY

Urinay incontinence is one of the most common health problems seen in women of nearlyall ages and affects a wide aspect of daily life, including the social, psychological, occupational, domestic, physical, and sexual lives of women. The problem is widespread and afflicts an estimated 13 million adults in the United States alone. Approximately 85 percent of those afflicted are women There is no data about overall prevalence of female UI from Turkey.There are many ways to treatment of incontinence eg. Physical therapy, behaviroul modifications, pharmaceutical intervention and surgical treatment. As physical therapies, particularly pelvic floor muscle exercises with or without biofeedback and electrical stimulation are the maintay of conservative management for the treatment and prevention of urinary incontinence.

Keywords:

Urinary incontinence, physical theraphy,

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[1] Yalçın Ö., Ürojinekoloji, Ed: Kişnişçi H, Temel Kadın Hastalıkları ve Doğum Bilgisi, s. 730-747, Güneş Kitabevi, Ankara, 1996
[2] Yalçın Ö., Pelvik Taban Bozukluklarının Fizyopatolojisi. Güner H., Ürojinekoloji, s.11-18, Atlas Kitapçılık, Ankara, 2000
[3] Yalçın Ö., Üriner İnkontinansa Genel Bakış. Ed. Güner H.,Ürojinekoloji, Atlas Kitapçılık, Ankara 2000: s. 19-27
[4] Ergen A., Arıkan N., Arslan M., Jinekolojik Üroloji, Ed:Anafarta K., Göğüş O.,Bedük O., Arıkan N., Temel Üroloji, s. 409-446, Güneş Kitabevi, Ankara, 2000
[5] Güner H. Üriner inkontinanslara genel bakış. Ürojinekoloji-2000:19-19
[6] Kris Strohbehn Obs.& Gyn. Cln. of North Am.1998:25:4;638-705
[7] Güner H.Kadın genital sistemi ve pelvik taban anatomisi.Ürojinekoloji 2000;1-10
[8] Klutke CG, Siegel CL : Functional Female Pelvic Anatomy. Evaluation and reatment of the Incontinent Female Patient, The Urologic Clinics of North America (Klutke CG, Raz S. ed) . Philadelphia, Saunders Company. Volume 22,Number 3 , 487-498,1995
[9] Wahle GR, Young GPH, Raz S : Anatomy and Pathophysiology of Pelvic Support. Female Urology (Raz S, ed). Second edition. Philadelphia, Saunders Company. 57- 72, 1996
[10] Arısan K., Propedötk. 2. baskı, Nobel Kitabevi 1997: 27-37
[11] Çoşkun A., Alt Üriner Sistem Anatomi ve Fizyolojisi Kontinans Mekanizması. Ed: Kızılkaya B.N., Kadınlarda Üriner İnkontinans ve Hemşirelik Yaklaşımı. 1. Baskı, Emek Matbaacılık İstanbul, 2002: s. 1-17
[12] Walters,Mark D,Karram Mickey M.Neurophysiology of the lower urinary tract Clinical Urogynecol 1993;2:22-23
[13] Davilla, G.W., ‘‘ Urinary Incontinence in Women,’’ Postgradute Medicine. Vol: 96, No:2, August 1994
[14] Bump R.C., McClish D.K.,Cigarette Smoking and Urinary Incontinence in Women. American Journal Obstetrics and Gynaecology 1992; 167: 1213
[15] Wolters, M.D., ‘‘ Epidemiology And Social Impact of Urinary Incontinence.’’ Clinical Urogynecology, 1993.
[16] Burgio, K.L., Mathews, K.A., Engel, B.T., ‘‘ Prevelance, Incidence and Corelates of Urinary Incontinence in Healthy, Middle-Aged Women,’’ The Journal of Urology. 1991;33
[17] Kelleher C., Epidemiology and Classification of Urinary Incontinence. Ed: Cardoza L., Urogynecology, New York, 1997: p. 3-23
[18] Foldspang, A.,Mommsen, S.,Djurhuus,J.C., ‘‘ Prevalent Urinary Incontinence as a Correlate of Pregnancy, Vaginal Childhbirth and Obstetric Techniques,’’ American Journal of Public Health. 1999; 89
[19] Sampselle, C.M., ‘‘ Changes in Pelvic Muscle Streght and Sters Urinary Incontinence in Childbirth,’’ JOGNN. Vol:19, No:5, September / October 1990.
[20] Folspang, A.,Mommsen, S., Lam, G.W., Elvings, L., ‘‘ Parite as a Correlate of Adult Female Urinary Incontinence Prevelance,’’ Journal of Epidemiology and Community Health. 1992; 46
[21] Allen, R.E., Hosker, G.L., Smith, A.R.B., Warrell, D.W., ‘‘ Pelvic Floor Damage and Childbirth: A Neurophysiological Study.’’ British Journal of Obstetric and Gynaecology. 1990; 97
[22] Tetzchner, T., Sorensen, M.,Jonson, L., Lose, G., Christiansen,J., ‘‘ Delivery and Pudental Nerve Function,’’ Acta Obstetricia et Gynecologica Scandinavica. 1997; 97
[23] Tetzchner, T., Sorensen, M., Lose, G., Christiansen,J., ‘‘ Anal and Urinary Incontinence After Obstetrics Anal Sfingter Rupture,’’ Ueskr Laeger. 1998;60(22)
[24] Dwyer PL.Obesity and urinary incontinence in women .Br J Obstet Gynecol.1998;95(1):91-25
[25] Parys, B.T., Woolfenden, K.A., Parsons, K.F., ‘‘ Bladder Dysfunction After Simple Hysterectomy: Urodynamic and Neurological Evaluation,’’ European Urology. 1990; 17
[26] Brown S.J., Sawaya G., Thom H.D., Grady D., Hysterectomy and Urinary Incontinence: A Systematic Review, Lancet, 2000, 356 (9229): 535-539
[27] Thom, D.H., Brown, J.S., ‘‘ Reproductive and Hormonal Risk Factors for Urinary Incontinence in Later Life: A Review of the Clinical and Epidemiologic Literature,’’ Journal of American Geriatrics Society. 1998; 46
[28] Vale J.A., Trott K.R., Withfield H.H., Post-radiotherapy Bladder Dysfunction – adenervation Disorder? Neurology and Uradynam 1991; 10 (4): 349-350
[29] Kişnişçi H. A. ve diğerleri., Temel Kadın Hastalıkları ve Doğum Bilgisi. Ankara, Güneş Kitabevi, 1996
[30] Abrams P., Cardoza L., Fall M., GriffithsD., Rosier P., The Standardisation of Terminology of Lower Urinary Tract Function. Neurology and Urodynamics, 2002, 21: p.167-178
[31] Walters Mark D,Karram Mickey M. Evaluation of Incontinence .Clinical Urogynecol 1993;5:49-59
[32] Susset J.,Galea G.,Read L., Biofeedback Therapy for Female Incontinence Due to Low Urethral Resistance. Journal of Urology 1990; 143(6): 1205-08
[33] Adams C., Frahm J., Genitourinary system. In ‘‘ Saunders Manuel of Physical Therapy Practice’’. W.B. Sounders Company, Philadelphia, 1995: 459-504.
[34] Davilla, G.W., ‘‘ Urinary Incontinence in Women,’’ Postgradute Medicine. Vol: 96, No:2, August 1994
[35] Wise B., Physiotherapy. Ed: Cardoza L., Urogynecology, New York, 1997: p. 583-594
[36] Hay-Smith EJ, Bo Berghmans LC, Hendriks HJ, de Bie RA, Van Waalwijk van Doorn ES. Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2001;(1):CD001407. Review
[37] Bo K., Talseth T., Holme I., Singe Blind, Randomised Controlled Trial of Pelvic Floor Exercises, Electrical Stimulation, Vaginal Cones and no Treatment in Management of Genuine Stress Incontinence in Women, British Journal of Medicine, 1999, 318 (20): 487-93
[38] Bo K, Kvarstein B, Nygaard I. Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Obstet Gynecol. 2005 May;105(5 Pt 1):999-1005.
[39] Wilson D., Herbison P., Borland M., Grant A., A Randomised Trial of Physiotherapy Treatment of Postnatal Urinary Incontinence. British Journal of Obstetrics and Gynaecology 1992: 162
[40] Parkkinen A, Karjalainen E, Vartiainen M, Penttinen J. Physiotherapy for female stress urinary incontinence: individual therapy at the outpatient clinic versus homebased pelvic floor training: a 5-year follow-up study. Neurourol Urodyn. 2004;23(7):643-8
[41] Berghmans LC, Frederiks CM, de Bie RA, Weil EH, Smeets LW, van Waalwijk van Doorn ES, Janknegt RA Efficacy of biofeedback, when included with pelvic loor muscle exercise treatment, for genuine stress incontinence. Neurourol Urodyn. 1996;15(1):37-52.
[42] Aukee P, Immonen P, Laaksonen DE, Laippala P, Penttinen J, Airaksinen O. The effect of home biofeedback training on stress incontinence. Acta Obstet Gynecol Scand. 2004 Oct;83(10):973-7.
[43] Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, Varner RE, Lloyd LK. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002 Nov 13;288(18):2293-9.
[44] Berek, J.S., Novak Jinekoloji. Çev: Ahmet Erk, 12. bs., İstanbul, Nobel Kitabevleri, 1998.
[45] Fall M.,Erlandson B.E., Carlsson C.A., The Effect of Intravaginal Electrical Stimulation on the Urethra and Bladder. Journal of Urology, 1977; 44:9-30
[46] Lindstrom S., Fall M., Carlsson C.A., The Neurophysiological Basis of Bladder Inhibition in Response to Intravaginal Electrical Stimulation. Journal of Urology, 1983;129:405-410
[47] Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ. Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study. Phys Ther. 1995 Dec;75(12):1075-81.
[48] Berghmans LC, Hendriks HJ, De Bie RA, van Waalwijk van Doorn ES, Bo K, van Kerrebroeck PE. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int. 2000 Feb;85(3):254-63. Review
[49] Sung MS, Hong JY, Choi YH, Baik SH, Yoon H. FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence. J Korean Med Sci. 2000 Jun;15(3):303-8.
[50] Hasan ST, Robson WA, Pridie AK, Neal DE. Transcutaneous electrical nerve stimulation and temporary S3 neuromodulation in idiopathic detrusor instability. J Urol 1996; 155: 2005±11