Mixed 尿失禁 in Women

Signs & 症状

混合性尿失禁的妇女经历急迫性尿失禁和压力性尿失禁的症状. Usually, one type is more bothersome than the other. 例如, 大多数女性可能患有压力性尿失禁，只有少数情况下无法及时到达厕所.

急迫性尿失禁的症状包括:

• Loss of urine associated with sudden, strong urge to urinate

压力性尿失禁的症状包括:

• 咳嗽、打喷嚏、大笑或运动时漏尿

诊断

如果你有尿失禁，保持 尿的日记 -每天的排尿记录, 尿意外和液体摄入-可以帮助我们做出正确的诊断和决定适当的治疗.

你第一次来加州大学旧金山分校的时候, your provider will ask questions about your general health, 你的尿失禁史, 过去的手术, 你正在服用的疾病和药物. The provider will also perform a physical examination, including a pelvic exam. 此外，还将检测尿样. If your problem is complex, additional tests may be done at a later visit.

身体检查及评估

Depending on the particular details of your medical history, your doctor may proceed to any or all of the following physical evaluations.

• Neurologic examination to evaluate strength, sensation and reflexes in your legs.
• Pelvic exam to assess whether you have any pelvic relaxation or prolapse.
• 盆底评估, in which your provider will evaluate the strength of your pelvic floor muscles, particularly your ability to contract and relax the appropriate muscle group.
• 排尿后残留尿评估，测量在排尿后15分钟内膀胱内残留的尿量. This test offers an estimation of your 膀胱's ability to efficiently "empty the tank." The same urine sample may be analyzed for other factors, 比如血, sugar, 结晶或感染迹象. 这样的评估可以通过办公室尿液试纸或十大赌博平台排行榜实验室的显微镜尿液分析来完成.
• Urine culture if a urine dipstick or urinalysis suggests signs of acute infection. The culture is sent to the microbiology lab and, 大约24到48小时内, bacterial growth can be detected and the specific strain identified.
• 咳嗽压力试验, in which your 膀胱 is filled with water, and you are asked to cough or strain in the same manner that would cause you to leak urine. 该测试可以在办公室进行，也可以合并到更复杂的尿动力学测试中.
• A 尿的日记 provides details about your fluid intake and urine output, which can be crucial to making the right diagnosis. Because this is not typically the sort of information we take notice of in our daily lives, your provider will give you a 尿的日记 and a measuring receptacle. 你可能会被要求仔细记录你在一个完整的24小时内喝的液体和排尿的时间和数量. You may be asked to repeat this 24-hour diary for three to five days. This allows us to notice patterns that might be important to planning your treatment.

其他诊断测试

In some cases, the doctor may decide to pursue further diagnostic testing. Below is a list of some scenarios that are more complex and merit further testing:

• 膀胱疾病诊断不明确
• Inability to develop successful treatment plan
• 症状未改善或治疗失败
• 病人正在考虑手术
• 手术失败
• 存在其他情况，如血尿(尿中带血)，无感染，复发 尿路感染, elevated postvoid residual urine volume, neurologic condition

尿动态研究

这些研究的目的是评估膀胱和尿道的解剖和功能, 重现你的症状.

• Cystometrogram 在这 test, catheters are placed in your 膀胱 and vagina or rectum, and your 膀胱 is filled with fluid via the catheter. The test is used to determine your perception of water filling the 膀胱, 尿急, 膀胱不可控收缩, the volume at which your 膀胱 cannot comfortably hold any more, and the pressures within your 膀胱 during the fluid storage process.
• 压力测试 You may be asked to perform a number of maneuvers such as coughing, 改变位置, 或者带着导尿管在脚跟上跳来跳去试图重现任何失禁的症状.
• 尿道压力分布图 A catheter in your urethra is manipulated to measure urethral function.
• Uroflometry 排尿时，a 特别设计的插座 will measure the varying rate of urine flow, as well as duration of urination.
• 压力空化研究 This test identifies abnormal voiding patterns or urine obstruction.

膀胱镜检查

In 膀胱镜检查, a slender camera is inserted via the urethra into the 膀胱, enabling the doctor to view the interior anatomy of your 膀胱 and urethra in great detail. It is typically an outpatient procedure performed for the following 症状 or situations:

• Blood or pus in urine with no bacteria present
• Bladder infections that are unusually difficult to treat
• 新发作的排尿刺激
• 新发膀胱痛
• 膀胱内有疑似异物
• Urodynamics tests fail to duplicate incontinence 症状

放射测试

• 静脉肾盂造影(IVP) This test 包括静脉注射(IV)染料到你的血液中，并在肾脏处理注射的染料时对整个尿路进行x光检查. 如果您对静脉造影剂过敏或肾功能异常，则不能进行此测试.
• CT scan A CT scan of the abdomen and pelvis may be performed, in which an X-ray machine takes a rapid sequence of two-dimensional, thin cross-sections of the body in the area of interest. This exam can be performed with or without contrast dye; mostly, this depends on what your doctor is looking for. The X-rays pictures provide great anatomic detail of most of the internal organs.
• 超声波 与前两次测试不同的是 超声波 不涉及x射线. It utilizes a skin probe that directs sound waves to bounce off the body's internal organs, 生成解剖图像. It can be a very useful screening tool for a number of the above indications.

治疗

混合性尿失禁的治疗包括压力或冲动相关性尿失禁的联合治疗. 这些治疗方法如下所述.

行为治疗

行为治疗很简单, 自主, have no side effects and are often used in conjunction with other treatment options. They have proven effective for many women and work well for certain types of incontinence. 它们包括:

• 膀胱训练 膀胱训练的目标是增加排空膀胱和膀胱能容纳的液体量之间的间隔. This training can help diminish the sense of urgency and leakage. Bladder training requires adhering to a fixed voiding schedule, 你是否有想小便的冲动. If you feel the urge to urinate before the assigned interval, 你应该使用抑制冲动的技巧, 比如放松和凯格尔运动. 取得成功后, 间隔时间以15到30分钟为单位增加，直到你能舒服地保持三到四个小时. This goal can be adjusted to suit each woman's needs and desires.
• 盆腔肌锻炼 盆腔肌锻炼, 也被称为凯格尔, are an essential part of improving incontinence and preventing it from worsening. They can also help you suppress the urge to urinate. The 锻炼s strengthen and tone the muscles that support the pelvic organs. 这些肌肉在你的命令下收缩和放松来控制膀胱的打开和关闭. Achieving results requires commitment and regular 锻炼. 正确的技术也很重要.
• 生物反馈 生物反馈已被证明是有效的在许多研究中治疗尿失禁. It can help you learn to control and strengthen your pelvic floor muscles, which play an important role in 膀胱 control. Because you cannot see the pelvic floor muscles, 你可能会发现很难找到它们，也很难确定你是否在正确地做盆腔肌肉锻炼. 生物反馈疗法使用计算机图形和声音来显示你正在锻炼的肌肉. 它还允许治疗师测量你的肌肉力量和个性化的锻炼计划.
• 冲动抑制 Urge suppression is a way to help control the sudden urge to urinate, so that going to the bathroom is not an emergency. Running to the bathroom is the worst thing you can do, 因为它会增加膀胱的易怒感，干扰你集中精力控制膀胱的能力.

电刺激

盆底电刺激使用低强度的电流刺激虚弱或不活动的盆腔肌肉收缩. 将一个类似卫生棉条的传感器插入阴道，该传感器连接到手持可调节设备. The patient then increases the current to the level of a comfortable tingle. 定期的电刺激可以补充或增强你的骨盆肌肉锻炼制度. Units are available for home use and may be covered by medicare or insurers.

Percutaneous Tibial Nerve Stimulation (PTNS)

Normal voiding depends not only on the normal function of organs and muscles, but also on nerves that deliver appropriate signals regarding urination. 在冲动中失禁, the nerves regulating the 膀胱 can become hyper-reactive, sending strong signals to empty before the 膀胱 is full. Nerve stimulation therapies "jam" the pathways that transmit these abnormal messages.

In PTNS, a small acupuncture needle is placed in the ankle along the tibial nerve. A handheld device connects to the needle to deliver mild electrical impulses to the nerve. These travel up the tibial nerve to the sacral nerve plexus, which regulates the 膀胱. PTNS sessions are painless, last 30 minutes and are repeated weekly for 12 weeks. All sessions take place in a medical office.

Sacral Neuromodulation Therapy (Interstim)

骶神经调节疗法也使用直接作用于骶神经的电脉冲. Wires are threaded through openings in the pelvic bones along the sacral nerves. This is done in an operating room using local anesthesia. The wires are attached to a small external generator. If a two week test using the external device shows improvement in 症状, 永久装置, 叫Interstim, 植入皮下. This procedure requires general anesthesia.

肉毒杆菌膀胱注射

肉毒杆菌毒素A, 更广为人知的名字是肉毒杆菌, 是用来治疗急迫性尿失禁的患者，没有改善药物或其他保守疗法. It works by paralyzing 膀胱 muscle, which helps decrease unwanted 膀胱 contractions. 通常在注射后7天出现最大缓解，通常持续6至12个月. 经常需要重复注射.

阴道插入

阴道插入物 子宫托 are frequently used to treat 膀胱 and pelvic support problems. These devices are placed into the vagina to provide support for the uterus, 膀胱, 尿道和直肠. A number of types are available, and the inserts are fit to meet your needs and anatomy.

Surgery

Surgery is performed to restore the normal position of the 膀胱 neck and urethra. 有两种主要类型的手术失禁:膀胱颈部悬吊手术和吊带手术. 在医学界, the comparative effectiveness of these procedures is still being debated, and it is important that your decision is based on your individual circumstances.

药物

目前市场上还没有专门用于治疗压力性尿失禁的药物. However, there are several experimental medications in development. 药物 for this condition should be available in the near future.

在冲动中失禁 or overactive 膀胱, medications can help relax the 膀胱. These medications do not cure incontinence, but they can be very useful in reducing or eliminating problems of 膀胱 control. They can be used alone or in combination with behavioral treatments.

服用避孕药或皮肤贴片形式的雌激素替代疗法尚未被证明是女性尿失禁的有效治疗方法. Vaginal estrogen (creams, vaginal rings or vaginal pellets) have helped reduce recurrent 尿路感染 in postmenopausal women, but their effectiveness for incontinence is unknown.