物理治療於婦女尿失禁之應用

Physical Therapy for Women with Urinary Incontinence

應力性尿失禁與膀胱過動症皆為困擾婦女的常見症狀，除了手術或藥物治療外，物理治療介入亦能提供良好的療效。針對應力性尿失禁，可教導婦女學習用力前自主收縮技巧，藉由密集的骨盆底肌訓練改善骨盆底肌功能，並對橫膈膜、深層腹肌和骨盆底肌進行協調性訓練，以達到應力性尿禁制的成效。針對膀胱過動症婦女，除了可提供骨盆底肌訓練外，亦可利用電刺激或磁刺激提供神經性的調節，並加入生活形態與行為改善或膀胱訓練，以減少急尿、頻尿、夜尿、或急迫性尿失禁的症狀。本文針對應力性尿失禁與膀胱過動症之流行病學、治療方法及療效的實證研究進行探討，提供臨床工作者對應力性尿失禁及膀胱過動症之進一步認識，且可運用於此類婦女的治療。

Stress urinary incontinence and overactive bladder are common in women. Previous studies have shown treatment effects of physical therapy for women with stress urinary incontinence and overactive bladder. For women with stress urinary incontinence, physical therapy should aim to restore the functions of pelvic floor muscles. Women can learn the Knack strategy, receive intensive pelvic floor muscle training, train the coordination function of diaphragm, pelvic floor muscles, and transverse abdominis. For women with overactive bladder, physical therapy could also provide intensive pelvic floor muscle training and neuromodulation by electrical or magnetic stimulation to decrease the symptoms of urgency, frequency, nocturia, and urgency urinary incontinence. Besides, the lifestyle behavioral modification and bladder training should also be added. This article features on evidence-based review of the epidemiology, treatment strategies and treatment effects regarding overactive bladder and stress urinary incontinence as well as providing clinical advices to those health professionals.