Üriner inkontinans tedavisinde davranışsal tedavi yöntemleri

Yıl 2009, Cilt: 16 Sayı: 3, 35 - 40, 30.09.2009

Nurdan Demirci , Fatma Coşar

Öz

Üriner inkontinans (Üİ), prevalansı %8 ile %52 arasında değişen, kadınların yaşam kalitesini etkileyen bir sağlık sorunudur. Üİ'lı hastaların bakım ve tedavisindeki amaç; kişilerin tekrar kontinansını sağlamaktır. Kontinansı sağlamada ise cerrahi, ilaç ve davranışsal tedaviler kullanılmaktadır. Davranışsal tedavinin amacı; mesanenin kapasite etkinliğini artırarak mesane kontrolünün kazanılmasını sağlamaktır.
Üİ için davranışsal tedavi yöntemleri; diyet, mesane eğitimi ve pelvik taban kas eğitimidir (PTKE). Diyet, mesane günlüğüne bakılarak düzenlenir. İnkontinansta alkol, kafein, asitli içecekler, domates ve bal gibi gıdaların mesane irritasyonuna neden olduğu saptanmıştır. Mesane eğitimi ilk kez 1966 yılında Jeffcoate ve Francis tarafından geliştirilmiş ve 1972 yılında da Fremen tarafından yaygın hale getirilmiştir. PTKE, ilk kez 1948 yılında Arnold Kegel tarafından tanımlanmıştır. Amacı; intra-abdominal basınç artışında kas hacmini ve kontraksiyon gücünü arttırmaktır. Egzersiz programı düzenli olarak en az 6-8 hafta sürdürülmeli ve belli bir tonusa ulaşınca ömür boyu devam edilmelidir. En önemli endikasyonları prepartum ve postpartum dönemlerdir. PTKE'den en çok yaşlılar, uzun süre stres inkontinans hikayesi olanlar, beden kitle indeksi (BKİ) yüksek olanlar ve ciddi inkontinansı olanlar faydalanır.
Üİ tedavisinde ilaç veya cerrahi tedavilerle beraber, davranışsal tedavi uygulamaları gereklidir. Ancak davranışsal tedavi seçimi ve uygulamasında inkontinansın özellikleri, hastanın yakınmalarının şiddeti ve diğer kişisel özellikler dikkate alınmalıdır.
Anahtar Kelimeler: Üriner İnkontinans, davranışsal tedavi yöntemleri.

Abstract

Behavioural therapy techniques for urinary incontinence

Urinary Incontinance (UI) is a health issue that affects quality of woman life and its prevalence ranges from 8% to 52%. The aim of therapy and care of patients with UI is to gain continence of patients. Surgical, drug and behavioural therapy are used to gain continence. The aim of behavioural therapy is to gain control of bladder increasing its capacity and activity.
Behavioural therapy techniques for UI are diet, bladder training and pelvic floor muscle training (PFMT). Diet is scheduled according to bladder diary. Alcohol, cafein, acid drink, tomato and honey are found as having irritation effects to bladder. Bladder training was evolved by Jeffcoate and Francis in 1966 for the first time and generalized by Fremen in 1972. PFMT is described by Arnold Kegel in 1948 for the first time. It's aim is to increase muscle volume and contraction force in case of increased intra-abdominal pressure. Exercise programme should be carried on regularly for minimum 6-8 weeks and also it should be carried on through lifetime when a specified level of tonus is reached . The most important indications are in prepartum and postpartum periods. Elder people, people having stress incontinence story for a long time, people having higher Bady Mass Index and people having seriously incontinence are benefited mostly from PFMT.
Behavioural therapy is necessary together with drug or surgical therapy in UI therapy. It was noticed that incontinence features, patient's severity of complaints and another personal features should be considered in choosing and carrying out behavioural therapy.

Key words: Urinary Incontinence, Behavioural Therapy Techniques.

Anahtar Kelimeler

Üriner Ýnkontinans, davranýþsal tedavi yöntemleri

Kaynakça

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