This is the orientation according to new guidelines of evidence-based clinical practice, American College of Physicians (ACP). The new recommendations, aimed at doctors who treat women with UI, were published in the September issue of the Annals of Internal Medicine.
“The urinary incontinence is a common problem for women and it is often under reported and under diagnosed,” said the president of the ACP, dr. David Fleming, in a statement to the press. “Physicians should take an active approach and ask questions specific as a start, the symptoms and frequency of urinary incontinence ; it is estimated that about halfà of the women with incontinence do not tell their doctor.”
The prevalence of urinary incontinence reported is about 25% of the women of età between 14 and 21, from 44% to 57% among women between 40 and 60 years and 75% among women 75 years and older. In 2004, the costs in the USA for the help to women with urinary incontinence were approximately 19.5 billion dollars, and this disorder is responsible for 6% of the inputs in the nursing home among elderly women, with an approximate cost of $ 3 billion.
The risk factors for urinary incontinence include pregnancy, the trauma of the pelvic floor after vaginal birth, menopause, hysterectomy, obesityà, urinary tract infections, functional impairment and/or cognitive impairment, chronic cough, and constipation.
The authors have done research on the MEDLINE, the Library of the Cochrane, Scirus, and Google Scholar from 1990 through December 2013 to identify published literature in English on the management of non-surgical urinary incontinence in women. Relevant results were continence, improvement , qualityà of life, adverse effects and discontinuation of therapy because of adverse effects.
specific Recommendations were the following:
- women with UI from stress incontinence on laughing, coughing or sneezing) should have a first-line treatment with training of the pelvic floor muscle and Kegel exercises, which involve the relaxation and the contraction of the muscles that control the flow of urine (recommendation strong, evidence high qualityà).
- women with UI, urge incontinence (incontinence for no apparent reason after feeling a sudden urgency to urinate) should undergo training of the bladder (recommendation strong, the qualityà of evidence moderate).
- women with IU mixed should undergo training of the pelvic floor muscle training with bladder, which is a behavioral therapy that involves urinating according to a predetermined plan and gradually increase the time between urination (recommendation strong, the qualityà of evidence moderate).
- women with UI, stress should not receive drug therapy, systemic (recommendation strong, the qualityà of evidence low).
- women with OI by the urgency in which the training of the bladder has been, without success, should receive drug therapy with the specific agents chosen for tollerabilità, the profile of adverse effects, easeà of use and cost (recommendation strong, evidence high qualityà).
- obese women with UI should also be treated with loss of weight and exercise (recommendation strong, the qualityà of evidence moderate).
“clinicians should use as much as is possible treatments without any drugs for the urinary incontinence,” said dr. Fleming in a press release. “Kegel exercises for the IU from the stress, the training of the bladder for the UI, urge incontinence, and Kegel exercises with training of the bladder for the IU mixed are effective, have few side-effects and are less expensive than drugs. Although various drugs can improve the urinary incontinence and to provide continence complete, the adverse effects often lead many patients to stop taking their medication.”
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