骨盆底肌訓練對婦女應力性尿失禁預防與改善之成效

Effectiveness of the Pelvic Floor Muscle Training for Women with Stress Urinary Incontinence Prevention and Improvement

王秉和(Ping-He Wang)；林晉利(Jin-Li Lin)

尿失禁 ； 應力性尿失禁 ； 骨盆底肌運動 ； Urinary incontinence ； Stress urinary incontinence ； Pelvic floor muscle exercise

醫學與健康期刊

5卷2期（2016 / 09 / 01）

21 - 30

繁體中文

應力性尿失禁為婦女最常見的尿失禁種類。台灣20至65歲的婦女患有尿失禁佔18.7%，其原因為打噴嚏、咳嗽、身體活動或用力時造成尿液的流失，在懷孕最後三個月的患病率高達67%，約有54.3％的孕婦生活品質受到影響，在尋求治療部分只有1/4的婦女，原因為尷尬、不想開刀或誤以為是老化造成。應力性尿失禁是子宮頸和尿道中段的閉合能力下降，與尿道、骨盆底肌改變有關，雖然尿失禁不會造成生命危險，但卻是造成婦女晚年傷殘或依賴的重要原因。整理文獻結論，骨盆底肌可協助尿道、肛門直腸的控制，骨盆底肌訓練對應力性尿失禁是一種有效、安全、無併發症、費用低、不用儀器、執行簡單，且可以有效的預防懷孕期間及產後應力性尿失禁，並可改善婦女應力性尿失禁症狀及生活品質。

The most common type of women urinary incontinence is stress urinary incontinence. 18.7% of Taiwanese women aged 20-65 have urinary incontinence. Stress urinary incontinence often occurs when sneezing, coughing, physical activity or exertion produces leakage of urine. About 54.3% of pregnant women experience compromised quality of life, mostly (67%) the final three months. However, only a quarter of women will look for treatment because they feel embarrassed, because they do not want operations or because they consider it a natural part of aging, at which time the ability of the cervix and middle urethra to close is reduces and the urethra and pelvic floor muscles are changing. Although urinary incontinence is not life threatening, it is a very important reason that the elderly become labelled disable or dependent. Study results show that pelvic floor muscle can assist urethral and anorectal control. Pelvic floor muscle training is a safe, effective, uncomplicated, inexpensive, easily carried out and does not require special instruments. Pelvic floor muscle training intervention can effectively prevent stress incontinence during pregnancy and postpartum. It improves symptoms and quality of life these women.

1. Abrams, P,Cardozo, L,Fall, M(2002).The standardization of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.Neurourol Urodyn,21,167-78.
2. Bø, K(2004).Urinary Incontinence, Pelvic Floor Dysfunction, Exercise and Sport.Sports Med,34,451-64.
3. Bø, K,Stein, R(1994).Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, valsalva, abdominal, hip adductor and gluteal muscle contractions in nulliparous healthy females.Neurourol Urodyn,13,35-41.
4. Borello-France, DF,Downey, PA,Zyczynski, HM,Rause, CR(2008).Continence and quality-of-life outcomes 6 months following an intensive pelvic-floor muscle exercise program for female stress urinary incontinence: a randomized trial comparing low-and highfrequency maintenance exercise.Phys Ther,88,1545-53.
5. Borello-France, DF,Zyczynski, HM,Downey, PA,Rause, CR,Wister, JA(2006).Effect of pelvic-floor muscle exercise position on continence and quality-of-life outcomes in women with stress urinary incontinence.Phys Ther,86,974-98.
6. Burns, PA,Pranikoff, K,Nochajski, TH,Hadley, EC,Levy, KJ,Ory, MG(1993).A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women.J Gerontol,48,M167-74.
7. Child, S,Bateman, A,Shuttleworth, J,Gericke, C,Freeman, R(2013).Can primary care nurse administered pelvic floor muscle training(PFMT) be implemented for the prevention and treatment of urinary incontinence? A study protocol.F1000Res,2,47.
8. Davis, K,Kumar, D(2003).Pelvic floor dysfunction: a conceptual framework for collaborative patient-centred care.J Adv Nurs,43,555-68.
9. FitzGerald, MP,Graziano, S(2007).Anatomic and functional changes of the lower urinary tract during pregnancy.Urol Clin N Am,34,7-12.
10. Gouldthorpe, H(2011).Pelvic floor management.O&G Magazine,13,54-5.
11. Haylen, BT,de, Ridder, D,Freeman, RM(2010).An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.Neurourol Urodyn,29,4-20.
12. Holley, RL,Varner, RE,Kerns, DJ,Mestecky, PJ(1995).Longterm failure of pelvic floor musculature exercises in treatment of genuine stress incontinence.South Med J,88,547-9.
13. Joanna Briggs Institute(2011).The Joanna Briggs Institute best practice information sheet: the effectiveness of pelvic floor muscle exercises on urinary incontinence in women following childbirth.Nurs Health Sci,13,378-81.
14. Kim, EY,Kim, SY,Oh, DW(2012).Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training.Clin Rehabil,26,132-41.
15. Ko, PC,Liang, CC,Chang, SD,Lee, JT,Chao, AS,Cheng, PJ(2011).A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence.Int Urogynecol J,22,17-22.
16. McKinnie, V,Swift, SE,Wang, W(2005).The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence.Am J Obstet Gynecol,193,512-8.
17. Mørkved, S,Bø, K,Schei, B,Salvesen, KA(2003).Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single Ulblind randomized controlled trial.Obstet Gynecol,101,313-9.
18. Sangsawang, B,Sangsawang, N(2013).Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment.Int Urogynecol J,24,901-12.
19. Sangsawang, B,Serisathien, Y(2012).Effect of pelvic floor muscle exercise programme on stress urinary incontinence among pregnant women.J Adv Nurs,68,1997-2007.
20. Stafne, SN,Salvesen, KÅ,Romundstad, PR,Torjusen, IH,Mørkved, S(2012).Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial.BJOG,119,1270-80.
21. Susan, L,Jackson, PT(2010).Urinary incontinence: offering solutions that make a difference.Journal on Active Aging,44-54.
22. Thom, DH,Rortveit, G(2010).Prevalence of postpartum urinary incontinence: a systematic review.Acta Obstet Gynecol Scand,89,1511-22.
23. 呂小娟、謝卿宏、張少同(2003)。台灣地區65歲以下成年婦女尿失禁盛行率調查。華岡理科學報，20，183-208。
24. 陳進典、陳淑月、陳怡靜、郭漢崇、蔡娟秀(2000)。骨盆底功能障礙與治療。台灣尿失禁防治協會=Taiwanese Continence Society。