骨盆底肌訓練外加髖部肌力訓練對應力性尿失禁病人之成效

骨盆底肌失能會造成應力性尿失禁。骨盆底肌治療性運動訓練，是針對應力性尿失禁病人第一線的治療方式。在解剖構造上骨盆底肌與髖部肌肉互相連接，且在功能上有協同動作。針對尿失禁治療方式，探討骨盆底肌訓練外再加髖部肌肉訓練的臨床成果的相關文獻較少。本病例報告描述一名產後4級會陰撕裂傷，並接受修補手術後，3年陸續接受骨盆底肌訓練，仍有應力性尿失禁的病人，再加上髖部肌力訓練後的治療成果。病人為一名35歲女性，2020年5月9日自然產後出現4級會陰撕裂，經2次修補手術後，仍有應力性尿失禁症狀，本次介入前已接受常規之骨盆底肌物理治療與居家運動超過2年以上的時間。此篇報告觀察在常規骨盆底肌訓練外，再加入髖關節外展及外轉肌力訓練的治療成效。經過4週訓練與2個月後的電話追蹤，病人尿失禁頻率、程度與對生活造成的影響均有進步。臨床意義：本報告發現例行性骨盆底肌訓練，再加上髖部肌肉肌力訓練，對功能恢復遇到瓶頸的應力性尿失禁病人，能進一步症狀改善。本報告病人數量僅1名，期望未來能發展臨床研究，以進一步了解運用治療性髖部肌肉運動訓練，在應力性尿失禁病人身上的應用及長期效果。

Pelvic floor muscle dysfunction can lead to stress urinary incontinence. Pelvic floor muscle training is the first-line recommended treatment for patients with stress urinary incontinence. The pelvic floor muscles and hip muscles are connected in anatomy and function with coordinated movements. There is a limitation to the literature review in finding out the treatment outcome of integrating pelvic floor muscle with hip muscle training for patients with urinary incontinence. This case report described the outcomes of adding hip muscle strength training to the pelvic floor muscle training for patients suffering from stress urinary incontinence after delivery for 3 years. This 35-year-old woman was complicated with a fourth-degree perineal tear following a vaginal birth on May 9, 2020. She received two repair surgeries for perineal tear due to re-rupture. After routine physical therapy and home exercise for pelvic floor muscle for more than 2 years, she still suffered from stress urinary incontinence. This report presents the treatment effect after incorporating hip abduction and external rotation strength training into routine pelvic floor muscle training. After four weeks of training and a follow-up phone call two months later, the frequency and severity of urinary incontinence, as well as its impact on her daily life, had improved. Clinical Significance: This report revealed that adding hip muscle strength training to routine pelvic floor muscle training may improve symptoms for patients with stress urinary incontinence who already reached a plateau with standard pelvic floor exercises. Future clinical research is needed to determine the application and long-term clinical outcome, including hip muscle integration with pelvic muscle training for patients with stress urinary incontinence.