Gå direkt till huvudinnehållet

Ansträngningsinkontinens hos kvinnor

Senast uppdaterad: Senast reviderad:
Sakkunnig:

Definition:
Urinläckage i samband med hosta, nysning eller annan aktivitet som ökar det intraabdominala trycket. Multifaktorella orsaker.
Förekomst:
Prevalensen bland kvinnor är cirka 5 % till 15 %. Hälften av kvinnor med urininkontinens har renodlad ansträngingsinkontinens.
Symtom:
Mindre mängder urinläckage vid aktiviteter som ökar buktrycket.
Kliniska fynd:
Gynekologisk undersökning är i regel utan avvikande fynd.
Diagnostik:
Tilläggsundersökningar som urinanalyser och eventuellt stresstest.
Behandling:
Ansträngningsinkontinens hos kvinnor behandlas i första hand med bäckenbottenträning, elektrostimulering eller med kirurgi.
  1. Norton P, Brubaker L. Urinary incontinence in women. Lancet 2006; 367: 57-67. PubMed  
  2. Abrams P, Blaivas JG, Stanton SL, et al. Standarisation of terminology of lower urinary tract function. Scand J Urol Nephrol 1988; 114 (suppl): 5-19.
  3. SBU. Behandling av urininkontinens. En systematisk litteraturöversikt. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2000. SBU-rapport nr 143. ISBN 91-87890-56-9
  4. Qassem A, Dallas P, Forciea MA, et al. Nonsurgical management of urinary incontinence in women: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2014; 161: 429-40. doi:10.7326/M13-2410 DOI  
  5. Glazener CMA, Herbison GP, Wilson PD, MacArthur C, Lang GD, Gee H, Grant AM. Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial . BMJ 2001; 323: 1-5. PubMed  
  6. Weiss BD. Selecting medications for the treatment of urinary incontinence. Am Fam Physician 2005; 71: 315-22. PubMed  
  7. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003; 348: 900-7. New England Journal of Medicine  
  8. Brown JS, Sawaya G, Thorn DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. Lancet 2000; 356: 535-9. PubMed  
  9. Handa VL, Harris TA, Ostergard DR. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynecol 1996; 88: 470-8. PubMed  
  10. Hannestad YS, Lie RT, Rørtveit G, Hunskaar S. Familial risk of urinary incontinence in women: population based cross sectional study. BMJ 2004; 329: 889-91. PubMed  
  11. Berghmans LC, Hendriks HJ, De Bie RA, van Waalwijk van Doorn ES, Bo K and van Kerrebroeck PE. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int 2000; 85: 254-63. PubMed  
  12. Holroyd-Leduc JM, Straus SE. Management of urinary incontinence in women: scientific review. JAMA 2004; 291: 986-95. Journal of the American Medical Association  
  13. Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: Randomized controlled trials of nonsurgical treatments of urinary incontinence in women. Ann Intern Med 2008; 148: 459-573. Annals of Internal Medicine  
  14. Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2018. doi:10.1002/14651858.CD005654 DOI  
  15. Subak LL, Whitcomb E, Shen H et al. Weight loss: a novel and effective treatment for urinary incontinence. J Urol 2005; 174: 190-5. PubMed  
  16. Wilson PD, Berghmans B, Hagen S et al. Adult conservative management. I: Abrams P, Cardozo L, Khoury S et al, red. Incontinence. Bd. 2. Plymouth: Health Publications, 2005: 855-964.
  17. Ayeleke RO, Hay-Smith EJ, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. Cochrane Database Syst Rev. 2013 Nov 20;11:CD010551. doi: 10.1002/14651858.CD010551.pub2. DOI  
  18. Bø K. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 1999; 318 (7182): 487-93.
  19. Choi H, Palmer MH, Park J. Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women. Nurs Res 2007; 56: 226-34. PubMed  
  20. Dumoulin C, Lemieux MC, Broubonnais D, Gravel D, Bravo G, Morin M. Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 2004; 104: 504-10. PubMed  
  21. Miller JM, Ashton-Miller JA and DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc 1998; 46: 870-4. PubMed  
  22. Visco AG, Weidener AC, Cundiff GW et al. Observed patient compliance with a structured outpatient bladder retraining program. Am J Obstet Gynecol 1999; 181: 1392-4. PubMed  
  23. Bø K, Kvarstein B, Nygaard I. Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Obstet Gynecol 2005; 105: 999-1005. PubMed  
  24. Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2013 Dec;7: CD002114. DOI: 10.1002/14651858.CD002114.pub2. DOI  
  25. Aksac B, Aki S, Karan A, Yalcin O, Isikoglu M and Eskiyurt N. Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Gynecol Obstet Invest 2003; 56: 23-7. PubMed  
  26. Nygaard I. Prevention of exercise incontinence with mechanical devices. J Reprod Med 1995; 40: 89-94. PubMed  
  27. Lipp A, Shaw C, Glavind K. Mechanical devices for urinary incontinence in women. Cochrane Database of Syst Rev 2014; 12: CD001756. doi:10.1002/14651858.CD001756.pub6. DOI  
  28. Liu Z, Liu Y, Xu H, et al. Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence A Randomized Clinical Trial. JAMA 2017; 317: 2493-501. PMID:28655016. PubMed  
  29. Cody JD, Richardson K, Moehrer B, et al. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2009; 4: CD001405. Cochrane (DOI)  
  30. Waetjen LE, Dwyer PL. Estrogen therapy and urinary incontinence: what is the evidence and what should we tell our patients. Int Urogynecol J 2006; 17: 541-5. PubMed  
  31. Schuessler B, Baessler K. Pharmacologic treatment of stress urinary incontinence: expectations for outcome. Urology 2003; 62(4 Suppl 1): 31-8.
  32. Norton PA, Zinner NR, Yalcin I, Bump RC; Duloxetine Urinary Incontinence Study Group. Duloxetine versus placebo in the treatment of stress urinary incontinence. Am J Obstet Gynecol 2002; 187: 40-8. PubMed  
  33. Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC. Duloxetine versus placebo for the treatment of North American women with stress urinary incontinence published correction appears in J Urol 2004;171:360. J Urol 2003; 170: 1259-63. PubMed  
  34. Li J, Yang L, Pu C, et al. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol. 2013 Jun;45(3):679-86. PMID: 23504618. PubMed  
  35. Mariappan P, Alhasso AA, Grant A, N'Dow JMO. Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004742. DOI: 10.1002/14651858.CD004742.pub2. The Cochrane Library  
  36. Kulseng-Hanssen S, Husby H, Schiøtz HA. The tension free vaginal tape operation for women with mixed incontinence. Do preoperative variables predict the outcome? Neurourol Urodyn 2007; 26: 115-22. PubMed  
  37. Ford AA, Rogerson L, Cody JD, et al.. Mid-urethral sling operations for stress urinary incontinence in women.. Cochrane Database Syst Rev. 2015. pmid:26130017 PubMed  
  38. Smith ARB, Daneshgari F, Dmochowski G et al. Surgical treatment of incontinence in women. I: Abrams P, Cardozo L, Khoury S et al, red. Incontinence. Bd. 2. Plymouth: Health Publications, 2005: 823-63.
  39. Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007; 356: 2143-55. PubMed  
  40. Ward KL, Hilton P. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence. Am J Obstet Gynecol 2004; 190: 324-31. PubMed  
  41. Kulseng-Hanssen S. The development of a national database of the results of surgery for urinary incontinence in women. BJOG 2003; 110: 1-8. PubMed  
  42. Nilsson CG, Falconer C, Rezapour M. Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol 2004; 104: 1259-62. PubMed  
  43. Dean N, Ellis G, Herbison GP, Wilson D. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD002239. DOI: 10.1002/14651858.CD002239.pub2. DOI  
  44. Lapitan MCM, Cody JD, Mashayekhi A. . Open retropubic colposuspension for urinary incontinence in women.. Cochrane Database of Systematic Reviews 2017. doi:10.1002/14651858.CD002912.pub7. DOI  
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet

Tidigare sakkunniga

  • Pia Teleman, docent och överläkare, VO kvinnosjukvård, Skånes universitetssjukhus