[Urinary incontinence--conservative therapy].
About 5% of our population suffers from urinary incontinence. Basically urinary incontinence is caused by two mechanisms: (1) loss of voluntary control of the urinary bladder due to detrusor hyperactivity or detrusorhyperreflexia, resulting in urge or reflex incontinence and (2) sphincter weakness or sphincter paralysis resulting in urinary stress incontinence. Less frequent are overflow incontinence and loss of urine due to ectopic ureter or a fistula. Therapy of urge incontinence is basically conservative: Causes for secondary detrusor hyperactivity must be eliminated. With idiopathic hyperactivity "bladder drill" with or without support of parasympathicolytic agents is the method of choice. Also in patients with less severe degrees of genuine urinary stress incontinence conservative therapy is helpful: pelvic floor exercises, performed in an accurate ("feel and move"), regular and persistent way, reduction of body weight in obese persons, regular bladder emptying and the elimination of "stress situations", e.g. chronic bronchitis due to nicotine abuses may improve the situation considerably. The treatment of neurogenic incontinence is rather complex and must be based on the underlying pathophysiology of detrusor and sphincter dysfunction, but also in these patients therapy is mainly conservative. Elderly people have double the incidence of urinary incontinence found in younger age groups. About 20% of those in old persons homes have been found to be incontinent. 80% of these elderly people suffer from urge incontinence as a result of bladder hyperactivity, in about 30% bladder hyperactivity is combined with residual urine and consequent urinary tract infection which makes bladder instability worse. Moreover physical immobility increases the problem of urgency.(ABSTRACT TRUNCATED AT 250 WORDS)
Urologischen Universitätsklinik, Innsbruck.
H
H
Madersbacher
D003131:Combined Modality Therapy; D005081:Exercise Therapy; D006801:Humans; D001750:Urinary Bladder, Neurogenic / Q000628:therapy; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000628:therapy*; D014550:Urinary Incontinence, Stress / Q000628:therapy
Harninkontinenz. Konservative Therapie.