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Üriner inkontinans tedavisinde davranışsal tedavi yöntemleri

Year 2009, Volume: 16 Issue: 3, 35 - 40, 30.09.2009

Nurdan Demirci Fatma Coşar

Abstract

Üriner inkontinans (Üİ), prevalansı %8 ile %52 arasında değişen, kadınların yaşam kalitesini etkileyen bir sağlık sorunudur. Üİ'lı hastaların bakım ve tedavisindeki amaç; kişilerin tekrar kontinansını sağlamaktır. Kontinansı sağlamada ise cerrahi, ilaç ve davranışsal tedaviler kullanılmaktadır. Davranışsal tedavinin amacı; mesanenin kapasite etkinliğini artırarak mesane kontrolünün kazanılmasını sağlamaktır.
Üİ için davranışsal tedavi yöntemleri; diyet, mesane eğitimi ve pelvik taban kas eğitimidir (PTKE). Diyet, mesane günlüğüne bakılarak düzenlenir. İnkontinansta alkol, kafein, asitli içecekler, domates ve bal gibi gıdaların mesane irritasyonuna neden olduğu saptanmıştır. Mesane eğitimi ilk kez 1966 yılında Jeffcoate ve Francis tarafından geliştirilmiş ve 1972 yılında da Fremen tarafından yaygın hale getirilmiştir. PTKE, ilk kez 1948 yılında Arnold Kegel tarafından tanımlanmıştır. Amacı; intra-abdominal basınç artışında kas hacmini ve kontraksiyon gücünü arttırmaktır. Egzersiz programı düzenli olarak en az 6-8 hafta sürdürülmeli ve belli bir tonusa ulaşınca ömür boyu devam edilmelidir. En önemli endikasyonları prepartum ve postpartum dönemlerdir. PTKE'den en çok yaşlılar, uzun süre stres inkontinans hikayesi olanlar, beden kitle indeksi (BKİ) yüksek olanlar ve ciddi inkontinansı olanlar faydalanır.
Üİ tedavisinde ilaç veya cerrahi tedavilerle beraber, davranışsal tedavi uygulamaları gereklidir. Ancak davranışsal tedavi seçimi ve uygulamasında inkontinansın özellikleri, hastanın yakınmalarının şiddeti ve diğer kişisel özellikler dikkate alınmalıdır.
Anahtar Kelimeler: Üriner İnkontinans, davranışsal tedavi yöntemleri.

Abstract

Behavioural therapy techniques for urinary incontinence

Urinary Incontinance (UI) is a health issue that affects quality of woman life and its prevalence ranges from 8% to 52%. The aim of therapy and care of patients with UI is to gain continence of patients. Surgical, drug and behavioural therapy are used to gain continence. The aim of behavioural therapy is to gain control of bladder increasing its capacity and activity.
Behavioural therapy techniques for UI are diet, bladder training and pelvic floor muscle training (PFMT). Diet is scheduled according to bladder diary. Alcohol, cafein, acid drink, tomato and honey are found as having irritation effects to bladder. Bladder training was evolved by Jeffcoate and Francis in 1966 for the first time and generalized by Fremen in 1972. PFMT is described by Arnold Kegel in 1948 for the first time. It's aim is to increase muscle volume and contraction force in case of increased intra-abdominal pressure. Exercise programme should be carried on regularly for minimum 6-8 weeks and also it should be carried on through lifetime when a specified level of tonus is reached . The most important indications are in prepartum and postpartum periods. Elder people, people having stress incontinence story for a long time, people having higher Bady Mass Index and people having seriously incontinence are benefited mostly from PFMT.
Behavioural therapy is necessary together with drug or surgical therapy in UI therapy. It was noticed that incontinence features, patient's severity of complaints and another personal features should be considered in choosing and carrying out behavioural therapy.

Key words: Urinary Incontinence, Behavioural Therapy Techniques.

Keywords

Üriner Ýnkontinans davranýþsal tedavi yöntemleri

References

  • Ballentyne M.: Üriner Ýnkontinans Tedavisinde Davranýþsal Tedavi Yöntemleri. Kadýnlarda Üriner Ýnkontinans Ve Hemþirelik Yaklaþýmý (Editör: Nezihe Kýzýlkaya Beji). Ýstanbul Üniversitesi Yayýn No: 4338s.:123-128 Emek Matbaacýlýk,Ýstanbul,2002.
  • Erkan A., H. Acil Ýdrar Kaçýrma Ve Sýk Ýdrara Gitme Sorunu Olan Kadýnlarda Mesane Eðitiminin Etkinliðinin Belirlenmesi. Marmara Üniversitesi Saðlýk Bilimleri Enstitüsü Yayýnlanmamýþ Yüksek Lisans Tezi, Ýstanbul, 2003.
  • Eskiyurt, N., Karan A.: Üriner Ýnkontinansta Fizik Tedavi ve Rehabilitasyon. Ürojinekoloji. (Edi: Haldun Güner). Atlas Kitapçýlýk Ltd. Þti., s.:135-151, Ankara, 2000.
  • Fantl JA, Wyman JF, McClish DK, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991;265:609–613.
  • Eric S Rovner . Treatment Options for Stress Urinary Incontinence Rev Urol. 2004; 6(Suppl 3): S29–S47. 2004.
  • Aslan E. Stres Ýnkontinansta Ped Testinin Önemi ve Bu Sorunun Yaþam Kalitesi Üzerine Etkisi, Ýstanbul Üniversitesi, Saðlýk Bilimleri Enstitüsü, Yayýnlanmamýþ Yüksek Lisans Tezi, 1999.
  • Çayýr G.: Üriner Ýnkontinans Operasyonu Geçiren Kadýnlarda Postoperatif Dönemde Ortaya Çýkan Sorunlara Yönelik Hemþirelik Giriþimlerinin Etkinliði. Ýstanbul Üniversitesi, Saðlýk Bilimleri Enstitüsü, Yayýnlanmamýþ Yüksek Lisans Tezi,1999.
  • Pierson A C. Inerventions for Clients With: Urinary Problems. Medical- Surgical Nursing a Nursing Process Approach. (Edi: Donna D. Ignatavicius, M.Linda Workman, Mary A. Mishler) p.: 2059-2061. WB Saunders,1995.
  • Roe B. , Milne J. , Ostaszkýewýcz J., Wallace S. Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings on theory and methods using metastudy techniques. Journal of Advanced Nursing 57(1), 3–14: 2007.
  • Fantl JA, Wyman JF, Harkins SW, Hadley EC. Bladder training in the management of lower urinary tract dysfunction in women. A review. J Am Geriatr Soc 1990; 38: 329-32.
  • Wyman JF. Managing urinary incontinence with bladder training: a case study. J Et Nurs 1993; 20: 121-6.
  • Flynn L, Cell P, Luisi E. Effectiveness of pelvic muscle exercises in reducing urge incontinence among community residing elders. J Gerontol Nurs 1994; 20: 23-7.
  • Lentz G, Plevnik S, Stanton SL. Vaginal cones versus bladder drill for sensory urgency treatment. Abstract 102. ICS 24th Annual Meeting, Prague, Czech Republic 31.8 - 2.9 1994.
  • SA Wallace, B Roe, K Williams, M Palmer. Bladder training for urinary incontinence in adults. Cochrane Database of Systematic Reviews 2007 Issue 1.
  • Subak et al. The Effect of Behavioral Therapy on Urinary Incontinence: A Randomized Controlled Trial. Obstet gynecol.Vol. 100, NO. 1, July 2002.
  • Burgio KL, Goode PS, Locher JL, Richter HE, Roth DL, Wright KC, Varner RE. Predictors of outcome in the behavioral treatment of urinary incontinence in women. Obstet Gynecol. 2003 Nov; 102 (5 pt 1): 940- 7.
  • Goode PS, Burgio KL, Locher JL, Umlauf MG, Lloyd LK, Roth DL. Urodynamic changes asociated with behavioral and drug treatment of urge incontinence in older women. J Am Geriatr Soc. 2002 May; 50(5):808- 16.
  • Ostaszkiewicz J., Johnson L. & Roe B. Habit Training for Urinary Incontinence in Adults (Cochrane Review). In The Cochrane Library. Issue 2. 610–617. (2004)
  • Uzun Ö.: Yetiþkinlerde üriner inkontinans ve hemþirelik yönetimi. Sendrom. 6:108-113, 2001.
  • Eustice S, Roe B, Paterson J.Prompted voiding for the management of urinary incontinence in adults. 2000;(2):CD002113.
  • Bo K, Hagen RH, Kvarstein B, Jİrgensen J, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III. Effect of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn 1990; 9: 489-502.
  • Jolleys J. Prevalence of urinary symptoms in women and their management in general practice, with particular reference to incontinence. Thesis. Leicester: University of Leicester, 1992.
  • Burgio KL. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am J Obstet Gynecol 1986; 154: 58-64.
  • Lagro-Janssen TLM, Debruyne FM, Smits AJ, van Weel C. Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice. Br J Gen Pract 1991; 41: 445-9.
  • Wells TJ, Brink CA, Diokno AC, Wolfe R, Gillis GL. Pelvic muscle exercise for stress urinary incontinence in elderly women. J Am Geriatr Soc 1991; 39: 785- 91.
  • Borello-France DF, Zyczynski HM, Downey PA, Rause CR, Wister JA. Effect of pelvic-floor muscle exercise position on continence and quality-of-life outcome in women with stres urinary incontinence. Phys Ther. 2006 Jul; 86(7): 974-86.
  • Bo K, Pelvic floor muscle exercise and urinary incontinence—train yourself continent. Tidsskr Nor Laegeforen. 2000 Nov 30; 120 (29):3583-9.
  • Balmforth JR, Mantle J, Bidmead J, Cardozo L. A prospective observational trial of pelvic flor muscle training for female stres urinary incontinence. BJU Int. 2006 Oct; 98(4):811-7.
  • Nygaard IE, Kreder KJ, Lepic MM, Fountain KA, Rhomberg AT. Efficacy of pelvic floor muscle execises in women with stres, urge, and mixed urinary incontinence. Am J Obstet Gynecol. 1996 Jan; 174 (1 pt 1):120-5.
  • Finckenhagen HB, Bo K. The effect of pelvic floor exercise on stres urinary incontinence. Tidsskr Nor Laegeforen. 1998 May 20; 118(13):2015-7.
  • Bo K, Larsen S. Pelvic floor muscle exercises for the treatment of female stress urinary incontinence: classification and characterization of responders. Neurourol Urodyn 1992; 11: 497-507.
  • Sherman RA, Davis GD, Wong MF. Behavioral treatment of exercise-induced urinary incontinance among female soldiers. Mill Med. 1997 Oct; 162 (10):690-4.
  • Bishop KR, Dougherty M, Mooney R, Gimotty P, Williams B. Effects of age, parity, and adherence on pelvic muscle response to exercise. J Obstet Gynecol Neonatal Nurs 1992; 21: 401-6.
  • Bo K, Talseth T, Vinsnes A. Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in geniune stress incontinent women. Acta Obstet Gynecol Scand. 2000 Jul; 79(7): 598-603.
  • Morkved S, Bo K, the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1997; 8(4):217-22.
  • 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 Stres Incontinence in Postpartum Women- A Cohort Study Physical Therapy. Dec;75(12):1075-81. 1995.
  • Eric S Rovner, Alan J Wein. Treatment Options for Stress Urinary Incontinence. Rev Urol. 2004; 6(Suppl 3): S29–S47.
  • Haken J, Benness C, Cardozo L, Cutner A. A randomised trial of vaginal cones and pelvic floor exercises in the management of genuine stress incontinence. Neurourol Urodyn 1991; 10: 393-4.
  • Norton P, Baker J. Randomized prospective trial of vaginal cones vs. Kegel exercises in postpartum primiparous women. Neurourol Urodyn 1990; 9: 434- 5.
  • Holly E Richteraat al. Non-surgical management of stress urinary incontinence: ambulatory treatments for leakage associated with stress (ATLAS) trial. Clinical Trials 2007; 4: 92–101.
  • Maria V. Capelini. Pelvic Floor Exercises with Biofeedback for Stress Urinary Incontinence International Braz J Urol 2006: Vol. 32 (4): 462-469.
  • Wyman JF, Fantl JA, McClish DK, Bump RC. Comparative efficacy of behavioral interventions in the management of female ürinary incontinence. Continence program for woman research group. 1998 Oct;179(4):999-1007.
  • Perrin L, Dauphinee SW, Corcos J, Hanley JA, Kuchel GA. Pelvic floor muscle training with biofeedback and bladder training in elderley women: A feasibility study. J Wound Ostomy Continence Nurs. 2005 May/June; 32(3):186-199.
  • Parkkinen A, Karjalainen E, Vartiainen M, Penttinen J. Physiotherapy for female stres urinary incontinence: individual therapy at the outpatient clinic versus home- based pelvic floor training : a 5 year follow-up study. Neurourol Urodyn. 2004; 23(7):643-8.
  • Burgio KL, Locher JL, Goode PS. Combined behavioral and drug therapy for urge incontinence in older women. J Am Geriatr Soc. 2000 Ar; 48(4): 370-4.

Year 2009, Volume: 16 Issue: 3, 35 - 40, 30.09.2009

Nurdan Demirci Fatma Coşar

Abstract

References

  • Ballentyne M.: Üriner Ýnkontinans Tedavisinde Davranýþsal Tedavi Yöntemleri. Kadýnlarda Üriner Ýnkontinans Ve Hemþirelik Yaklaþýmý (Editör: Nezihe Kýzýlkaya Beji). Ýstanbul Üniversitesi Yayýn No: 4338s.:123-128 Emek Matbaacýlýk,Ýstanbul,2002.
  • Erkan A., H. Acil Ýdrar Kaçýrma Ve Sýk Ýdrara Gitme Sorunu Olan Kadýnlarda Mesane Eðitiminin Etkinliðinin Belirlenmesi. Marmara Üniversitesi Saðlýk Bilimleri Enstitüsü Yayýnlanmamýþ Yüksek Lisans Tezi, Ýstanbul, 2003.
  • Eskiyurt, N., Karan A.: Üriner Ýnkontinansta Fizik Tedavi ve Rehabilitasyon. Ürojinekoloji. (Edi: Haldun Güner). Atlas Kitapçýlýk Ltd. Þti., s.:135-151, Ankara, 2000.
  • Fantl JA, Wyman JF, McClish DK, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991;265:609–613.
  • Eric S Rovner . Treatment Options for Stress Urinary Incontinence Rev Urol. 2004; 6(Suppl 3): S29–S47. 2004.
  • Aslan E. Stres Ýnkontinansta Ped Testinin Önemi ve Bu Sorunun Yaþam Kalitesi Üzerine Etkisi, Ýstanbul Üniversitesi, Saðlýk Bilimleri Enstitüsü, Yayýnlanmamýþ Yüksek Lisans Tezi, 1999.
  • Çayýr G.: Üriner Ýnkontinans Operasyonu Geçiren Kadýnlarda Postoperatif Dönemde Ortaya Çýkan Sorunlara Yönelik Hemþirelik Giriþimlerinin Etkinliði. Ýstanbul Üniversitesi, Saðlýk Bilimleri Enstitüsü, Yayýnlanmamýþ Yüksek Lisans Tezi,1999.
  • Pierson A C. Inerventions for Clients With: Urinary Problems. Medical- Surgical Nursing a Nursing Process Approach. (Edi: Donna D. Ignatavicius, M.Linda Workman, Mary A. Mishler) p.: 2059-2061. WB Saunders,1995.
  • Roe B. , Milne J. , Ostaszkýewýcz J., Wallace S. Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings on theory and methods using metastudy techniques. Journal of Advanced Nursing 57(1), 3–14: 2007.
  • Fantl JA, Wyman JF, Harkins SW, Hadley EC. Bladder training in the management of lower urinary tract dysfunction in women. A review. J Am Geriatr Soc 1990; 38: 329-32.
  • Wyman JF. Managing urinary incontinence with bladder training: a case study. J Et Nurs 1993; 20: 121-6.
  • Flynn L, Cell P, Luisi E. Effectiveness of pelvic muscle exercises in reducing urge incontinence among community residing elders. J Gerontol Nurs 1994; 20: 23-7.
  • Lentz G, Plevnik S, Stanton SL. Vaginal cones versus bladder drill for sensory urgency treatment. Abstract 102. ICS 24th Annual Meeting, Prague, Czech Republic 31.8 - 2.9 1994.
  • SA Wallace, B Roe, K Williams, M Palmer. Bladder training for urinary incontinence in adults. Cochrane Database of Systematic Reviews 2007 Issue 1.
  • Subak et al. The Effect of Behavioral Therapy on Urinary Incontinence: A Randomized Controlled Trial. Obstet gynecol.Vol. 100, NO. 1, July 2002.
  • Burgio KL, Goode PS, Locher JL, Richter HE, Roth DL, Wright KC, Varner RE. Predictors of outcome in the behavioral treatment of urinary incontinence in women. Obstet Gynecol. 2003 Nov; 102 (5 pt 1): 940- 7.
  • Goode PS, Burgio KL, Locher JL, Umlauf MG, Lloyd LK, Roth DL. Urodynamic changes asociated with behavioral and drug treatment of urge incontinence in older women. J Am Geriatr Soc. 2002 May; 50(5):808- 16.
  • Ostaszkiewicz J., Johnson L. & Roe B. Habit Training for Urinary Incontinence in Adults (Cochrane Review). In The Cochrane Library. Issue 2. 610–617. (2004)
  • Uzun Ö.: Yetiþkinlerde üriner inkontinans ve hemþirelik yönetimi. Sendrom. 6:108-113, 2001.
  • Eustice S, Roe B, Paterson J.Prompted voiding for the management of urinary incontinence in adults. 2000;(2):CD002113.
  • Bo K, Hagen RH, Kvarstein B, Jİrgensen J, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III. Effect of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn 1990; 9: 489-502.
  • Jolleys J. Prevalence of urinary symptoms in women and their management in general practice, with particular reference to incontinence. Thesis. Leicester: University of Leicester, 1992.
  • Burgio KL. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am J Obstet Gynecol 1986; 154: 58-64.
  • Lagro-Janssen TLM, Debruyne FM, Smits AJ, van Weel C. Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice. Br J Gen Pract 1991; 41: 445-9.
  • Wells TJ, Brink CA, Diokno AC, Wolfe R, Gillis GL. Pelvic muscle exercise for stress urinary incontinence in elderly women. J Am Geriatr Soc 1991; 39: 785- 91.
  • Borello-France DF, Zyczynski HM, Downey PA, Rause CR, Wister JA. Effect of pelvic-floor muscle exercise position on continence and quality-of-life outcome in women with stres urinary incontinence. Phys Ther. 2006 Jul; 86(7): 974-86.
  • Bo K, Pelvic floor muscle exercise and urinary incontinence—train yourself continent. Tidsskr Nor Laegeforen. 2000 Nov 30; 120 (29):3583-9.
  • Balmforth JR, Mantle J, Bidmead J, Cardozo L. A prospective observational trial of pelvic flor muscle training for female stres urinary incontinence. BJU Int. 2006 Oct; 98(4):811-7.
  • Nygaard IE, Kreder KJ, Lepic MM, Fountain KA, Rhomberg AT. Efficacy of pelvic floor muscle execises in women with stres, urge, and mixed urinary incontinence. Am J Obstet Gynecol. 1996 Jan; 174 (1 pt 1):120-5.
  • Finckenhagen HB, Bo K. The effect of pelvic floor exercise on stres urinary incontinence. Tidsskr Nor Laegeforen. 1998 May 20; 118(13):2015-7.
  • Bo K, Larsen S. Pelvic floor muscle exercises for the treatment of female stress urinary incontinence: classification and characterization of responders. Neurourol Urodyn 1992; 11: 497-507.
  • Sherman RA, Davis GD, Wong MF. Behavioral treatment of exercise-induced urinary incontinance among female soldiers. Mill Med. 1997 Oct; 162 (10):690-4.
  • Bishop KR, Dougherty M, Mooney R, Gimotty P, Williams B. Effects of age, parity, and adherence on pelvic muscle response to exercise. J Obstet Gynecol Neonatal Nurs 1992; 21: 401-6.
  • Bo K, Talseth T, Vinsnes A. Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in geniune stress incontinent women. Acta Obstet Gynecol Scand. 2000 Jul; 79(7): 598-603.
  • Morkved S, Bo K, the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1997; 8(4):217-22.
  • 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 Stres Incontinence in Postpartum Women- A Cohort Study Physical Therapy. Dec;75(12):1075-81. 1995.
  • Eric S Rovner, Alan J Wein. Treatment Options for Stress Urinary Incontinence. Rev Urol. 2004; 6(Suppl 3): S29–S47.
  • Haken J, Benness C, Cardozo L, Cutner A. A randomised trial of vaginal cones and pelvic floor exercises in the management of genuine stress incontinence. Neurourol Urodyn 1991; 10: 393-4.
  • Norton P, Baker J. Randomized prospective trial of vaginal cones vs. Kegel exercises in postpartum primiparous women. Neurourol Urodyn 1990; 9: 434- 5.
  • Holly E Richteraat al. Non-surgical management of stress urinary incontinence: ambulatory treatments for leakage associated with stress (ATLAS) trial. Clinical Trials 2007; 4: 92–101.
  • Maria V. Capelini. Pelvic Floor Exercises with Biofeedback for Stress Urinary Incontinence International Braz J Urol 2006: Vol. 32 (4): 462-469.
  • Wyman JF, Fantl JA, McClish DK, Bump RC. Comparative efficacy of behavioral interventions in the management of female ürinary incontinence. Continence program for woman research group. 1998 Oct;179(4):999-1007.
  • Perrin L, Dauphinee SW, Corcos J, Hanley JA, Kuchel GA. Pelvic floor muscle training with biofeedback and bladder training in elderley women: A feasibility study. J Wound Ostomy Continence Nurs. 2005 May/June; 32(3):186-199.
  • Parkkinen A, Karjalainen E, Vartiainen M, Penttinen J. Physiotherapy for female stres urinary incontinence: individual therapy at the outpatient clinic versus home- based pelvic floor training : a 5 year follow-up study. Neurourol Urodyn. 2004; 23(7):643-8.
  • Burgio KL, Locher JL, Goode PS. Combined behavioral and drug therapy for urge incontinence in older women. J Am Geriatr Soc. 2000 Ar; 48(4): 370-4.
There are 45 citations in total.

Details

Primary Language Turkish
Journal Section Derlemeler
Authors

Nurdan Demirci

Fatma Coşar This is me

Publication Date September 30, 2009
Submission Date November 6, 2009
Published in Issue Year 2009 Volume: 16 Issue: 3

Cite

Vancouver Demirci N, Coşar F. Üriner inkontinans tedavisinde davranışsal tedavi yöntemleri. Med J SDU. 2009;16(3):35-40.
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