جستجوی مقالات مرتبط با کلیدواژه "بی اختیاری استرسی ادراری" در نشریات گروه "پزشکی"

Urinary incontinence is defined as a complaint of any involuntary leakage of urine. This new definition includes a significant range of women who have rarely experienced accidental leakage events. As a result, some studies have estimated the prevalence of urinary incontinence at 60%. Stress urinary incontinence is the most common type of urinary incontinence and is a term used to describe involuntary urination during physical activity such as coughing, sneezing, laughing, or lifting heavy objects, etc., when the pressure inside the bladder exceeds the pressure. The urethral closure arrives, it is used. Numerous factors, such as sphincter dysfunction, pelvic floor muscles, connective tissues, or nerve structures, may cause or develop urinary stress incontinence. Approximately 4% to 35% of adult women worldwide suffer from stress urinary incontinence. Limited studies have been conducted on the prevalence of urinary incontinence in Iran. In the study of Rashidi., The overall prevalence of urinary incontinence in Iranian women was 46%. In the study of Bakui., Which studied the prevalence of postpartum urinary incontinence in women referring to health centers in Babul, the frequency of postpartum urinary incontinence was reported to be 19.4%. Urinary incontinence is a distressing condition emotionally, physically, socially, and economically. It has been shown to be associated with embarrassment, anxiety and depression and has a significant negative impact on quality of life. Despite the widespread impact of urinary incontinence on quality of life, only a small number of women seek treatment and most of them live in silence, so the disease is never diagnosed or treated. Because most women do not seek treatment in the early stages of urinary incontinence (for example, mild to moderate urinary incontinence), they eventually present with advanced symptoms (severe urinary incontinence), at which time there is an opportunity to prevent or help regress the disease. It is demolished. Given this situation, the need for appropriate prevention and treatment to reduce the negative impact of stress urinary incontinence on women's lives is clear, and most research on current therapies for the management of stress urinary incontinence seeks to improve patients' quality of life. Non-surgical interventions are recommended by the International Association of Incontinence as the first line of treatment for uncomplicated urinary incontinence in women. Pelvic floor muscle training is the basis of non-surgical treatment of urinary stress incontinence. This treatment is based on the hypothesis that training to identify and strengthen the pelvic floor muscles by increasing the support of the urethra and bladder and improving the function of the urethral sphincter muscle neutralizes the weakness of the pelvic floor muscles. The easiest way for women to train their pelvic floor muscles is to insert cone-shaped weights into the vagina and then contract the pelvic floor muscles to prevent the weight from falling out. On the other hand, the timing of pelvic floor muscle contraction, which is transmitted from the brain to the muscle by the nervous system, is an important factor in controlling urination. In other words, when there is a sudden increase in intra-abdominal pressure during sneezing, coughing, etc., the pelvic floor muscles must unconsciously and reflexively activate their rapid contraction fibers to prevent involuntary leakage of urine by neutralizing the increase in pressure, but In people with stress urinary incontinence, the coordination and timing of pelvic floor muscle function is impaired during increased intra-abdominal pressure, and the reflex and subconscious function of the pelvic floor muscles is impaired in response to a sudden increase in intra-abdominal pressure, which means that Although having strong muscles in the pelvis is necessary for proper contraction, a timely contraction is also necessary to prevent involuntary leakage of urine. In other words, a strong muscle that is not activated in time during an increase in intra-abdominal pressure cannot prevent urinary incontinence. Since the negative effect of urinary incontinence on daily activities and quality of life of women is very significant and women with more severe urinary incontinence and weaker pelvic floor muscles have lower quality of life, it is necessary to take measures to increase the contractile strength of pelvic floor muscles and promote health. Think of the urinary tract. Also, according to research, the result of cone therapy is recognizing and strengthening the pelvic floor muscles and does not play a role in the simultaneous action of rapid fibers of contraction of the pelvic floor muscles when increasing intra-abdominal pressure, if, as mentioned, the timing of urethral closure Timely contraction of the pelvic floor muscles is an important factor in controlling urination and should be considered. Therefore, it seems that in addition to strengthening the pelvic floor muscles with the vaginal cone, there is a need to train movement control strategies (control motor) to change the timing of pelvic floor muscle contraction and start their activity while increasing intra-abdominal pressure to the Knack maneuver (speed and coordination). It is said to be necessary to prevent involuntary leakage of urine. Miller et al. In their study justified the effect of the Knack maneuver as an immediate method and early response to pelvic floor exercise regimens that are widely used in women with stress urinary incontinence. Therefore, this study was performed to evaluate the effectiveness of vaginal cone with the Knack maneuver on the severity of incontinence and quality of life in women with stress urinary incontinence compared to the vaginal cone.

In this randomized controlled clinical trial that was performed in the pelvic floor dysfunction clinic of the Faculty of Rehabilitation Sciences, University of Iran, during the years 2021-2022, 76 patients with stress urinary incontinence were present who were randomly assigned to two groups of vaginal cones and were randomly divided into two groups: vaginal cone with the Knack maneuver and vaginal cone. Participants in both groups were finally accepted after an initial evaluation session. The initial evaluation included educating patients in plain language about the anatomy of the pelvic floor muscles, their proper contraction, and the benefits of therapeutic cones for the women participating in the study. Complete urine test (analysis and culture) to rule out participants' urinary tract infections, specific examinations of women in standard lithotomy with an empty bladder, and no vaginal bleeding. Pelvic visceral prolapse was also considered and the degree of each type was determined based on the POP-Q system, which is a standard approved by the International Continent Control Society and recorded in a special sheet. Grade 3 and 4 prolapses removed the sample from the study. Therapeutic interventions were performed for 12 weeks for both groups. The cone treatment protocol was common for both groups, and the intervention group received Knack exercises in addition to the cone treatment protocol. All patients before and after the intervention were evaluated for the severity of urinary stress incontinence due to increased intra-abdominal pressure and the number of involuntary leakage of urine with Urinary Diary, pelvic floor muscle contraction with Dynamometer and quality of life with Incontinence quality of life questionnaire. Paired and Wilcoxon t-tests were used for intragroup analysis and Independent Sample t-test and Mann-Whitney tests were used to compare the differences between the two groups.

There was a significant difference between all values ​​before and after the intervention in each group (P<0.05). Also, comparison between treatment groups showed significant differences in quality of life (P=0.02), pelvic floor muscle contraction strength (P=0.00), urine leakage due to increased intra-abdominal pressure (P=0.01) and the number of leaks (P=0.01).

According to the findings of this study, the treatment of cone protocol with the Knack maneuver can be suggested as a treatment strategy for patients with stress urinary incontinence.

Urinary incontinence is one of the prevalent hygienic problems of women that is negatively affecting physically, psycho- socially on quality of women’s life. The aim of this study was to evaluate the effectiveness and safety of stress urinary incontinence surgery by the trans-obturator tape method (minimally invasive).

In this cross-sectional study, 30 women with stress urinary incontinence who underwent the TOT procedure in the in the Gynecology Department of Motaharri hospital, Urmia, Iran between August 2016- December 2017 were included. All patients underwent pre-operative clinical examination, cough-stress test in lithotomy position with full bladder, bladder sonography and post-voiding residual volume assessment.

The Mean ± SD age of patients was 43.7±7.62 years, ranging from 30 to 58 years. Patient were followed at the months of 1and 6 after surgery. The average duration of the surgery was about 20 minutes. 100% of patients were completely cured and none of patients have failure of treatment or surgery complications.

In this study, trans-obturator tape placement was found to be a safe, effective and low-complication method. All patients were satisfied with the surgical results. Considering the relatively small number of people studied, it is recommended to conduct more studies, especially focusing on evaluating the quality of life with standard questionnaires in the field of women's urinary problems. Also, clinical trial studies should be designed and implemented in the field of comparison of TOT with existing standard surgical methods in the treatment of female incontinence.

Background and Aims :

Urinary incontinence (UI) has been known as one of the clinical manifestations of pelvic floor muscle (PFM) instability; however, limited research has been published on PFM function in patients with different types of UI. This study aimed to compare the PFM function of the continent women and women with Stress urinary incontinence (SUI) and overactive bladder (OAB).

Methods :

This cross-sectional comparative study was performed on 30 women, 10 continents, 10 SUI, and 10 OAB, with a mean age of 42.67±4.77 years. PFM function was assessed using manual muscle testing, a perimeter, and surface electromyography. Data analysis was performed using SPSS software and the level of significance was considered as P≥0. 05.

Results :

There was no significant difference in the PFM function, strength, and electromyographic activity between SUI and OAB patients.  However, it decreased in both groups compared to the healthy group (P=0.001). Also, a strong correlation was found between clinical examination, a perimeter, and electromyography (r=0.82, P=0.0001).

Conclusion:

 This study revealed that the PFM function was impaired in both groups of women with SUI and OAB. Also, both manual examination and the perimeter can be used as clinical methods in evaluating PFM function.

Urinary incontinence is one of the clinical symptoms of pelvic floor muscle instability whose potential role in the body balance has been suggested. The present study aimed to compare static and dynamic balance indices in women with and without Stress Urinary Incontinence (SUI).

In the present cross-sectional analytic study, 15 women with and 15 women without SUI were enrolled. After collecting demographic data, the static balance indices, time to stability, rate of loading during landing, and ground reaction force during walking were measured using the force plate device. Independent t tests were used for data analysis and the significance level was set at p≤0. 05.

The length of the route of the center of pressure in the anterior-posterior (p=0.004) and lateral (p=0.002) directions, the velocity of the center of pressure in the anterior-posterior (p=0.004) and lateral (p=0.002) directions, and length of total path traveled with open eyes in women with and without SUI had significant difference. All of the static balance indices were significantly different between the two groups (p< 0.05). Time for stability in the vertical (p=0.001), anterior-posterior (p=0.008), and lateral (p=0.044) directions in the group without SUI was significantly less than that of the group with SUI.

Based on our results, almost all static and dynamic balance indices were weaker in women with SUI than in women without SUI. Therefore, it can be concluded that pelvic floor muscles, as a part of core muscles, play an important role in postural control.

The aim of this study was to assess the efficacy and safety of a new minimally-invasive surgical procedure using trans-obturator tape (TOT) to treat female stress urinary incontinence. This clinical trial study was performed from 2003 to 2004 in the Gynecology Department of Imam Hospital, Vali-e-Asr, Tehran, Iran. A total of 35 women with stress urinary incontinence underwent the TOT procedure. All patients underwent pre-operative clinical examination, cough-stress test (full bladder), uroflowmetry and post-voiding residual volume assessment. The mean age of patients was 50 years, ranging from 26 to 74 years, with an average urinary stress incontinence duration of six years.