Physical Activity and Other Conservative Methods of Preventing and Treating Urinary Disorders in Women

Inkontinencija urina (IU) čest je simptom koji može biti prisutan u žena svih dobnih skupina s različitim rasponom težine simptoma zbog čega može znatno utjecati na fizičku, psihološku i socijalnu kvalitetu života svakog pojedinca. Kao što je poznato, IU dijelimo na statičku, miješanu i urgentnu inkontinenciju te prekomjerno aktivan mokraćni mjehur (PAMM) sa znatno većom incidencijom u starijoj dobi, posebice nakon 65. godine. Inkontinencija urina, praćena sramom i isključivanjem iz svakodnevnog života, znatno remeti socijalni život žene. Pri prvom posjetu liječniku svakako je nužna pravilna inicijalna procjena tipa IU-a (statički, urgentni ili miješani) koja nas usmjerava prema prikladnom liječenju predominantnog simptoma. Brojni upitnici (ICIQ, I-QOL, SUIQQ, OAB-Q) te dnevnici mokrenja mogu biti korisni u evaluaciji težine simptoma i utjecaja IU-a na kvalitetu života žene. Bazični fizikalni pregled trebao bi biti vođen dobrom anamnezom i prisutnosti simptoma prolapsa organa male zdjelice. Testiranje urin-vrpčicom preporučljivo je, svakako, kod svih pacijentica s IU-om da bi se isključila infekcija urotrakta (IUT). Savjetuje se antibiotsko liječenje svih simptomatskih infekcija donjeg urotrakta (IUT) unatoč nalazu urin-vrpčice. U obzir dolaze i ostala testiranja za IU kao što su mjerenja rezidualnog urina ili testnim ulošcima (kratkotrajni ili 24-satni), ali ona daju nedostatne podatke pa se stoga i ne preporučuju pri rutinskoj kliničkoj procjeni IU-a. Međutim, u većine bolesnica invazivna se testiranja ne provode prije započinjanja konzervativnog liječenja IU-a. Konzervativni pristup u liječenju inkontinencije urina obuhvaća način života (navike crijeva, prehrambeni proizvodi, kofein, unos tekućina, pušenje, tjelesna težina, sport), fizikalnu terapiju (vježbanje mišića dna zdjelice, biofeedback, vaginalni konusi, magnetska i električna stimulacija) i bihevioralnu terapiju (vježbanje mokraćnog mjehura) te neurostimulaciju (T-SNS, T-PTNS, P-PTNS). U alternativnu konzervativnu terapiju pripadaju svi proizvodi koji skupljaju urin (npr., ulošci, kateteri) te oni koji sprječavaju istjecanje urina (npr., instrumenti koji su potpora vratu mokraćnog mjehura, pesari, intrauretralni ili ekstrauretralni dodaci). ICS (International Continence Society) smatra da je konzervativna terapija učinkovita, jeftina i minimalno štetnog učinka, a nije u koliziji s ostalom mogućom terapijom.Urinary incontinence (UI) is a common symptom that may be present in women of all ages, with varying degrees of symptom severity, which can significantly affect the physical, psychological and social well-being of each individual. As is well known, there are several types of UI: stress (static) incontinence, mixed incontinence and urge incontinence, including an overactive bladder syndrome with a significantly higher incidence rate in older age groups, especially in people aged 65 and over. Urine incontinence considerably disrupts the life of women, affecting their social interactions and generating feelings of embarrassment. During the patient’s first visit to a physician, it is crucial to get an accurate initial UI type assessment (stress, urge or mixed incontinence) that can point to adequate treatment of the predominant symptom. Numerous questionnaires (ICIQ, I-QOL, SUIQQ, OAB-Q) and bladder diaries can help evaluate the severity of the symptoms and the impact of UI on the quality of life of women. Basic physical examination should focus on proper medical history and the presence of the symptom of pelvic organ prolapse. Tests using a urine test strip are definitely recommended in all patients suffering from UI in order to exclude a urinary tract infection (UTI). It is advised to treat all symptomatic lower urinary tract infections (UTI) with antibiotics despite the results provided by testing using urine test strips. Other testing for UI includes the postvoid residual urine measurement or pad tests (short-term or 24-hour), which provide insufficient data and are therefore not recommended in routine clinical assessment of UI. However, in most cases, invasive testing is not performed prior to the conservative treatment of UI. Conservative approach to the treatment of urinary incontinence includes the lifestyle (bowel habits, food products, caffeine, fluid intake, smoking, body weight, sports), physical therapy (pelvic floor exercises, biofeedback, vaginal cones, magnetic and electrical stimulation), behavioural therapy (bladder training) and neurostimulation (T-SNS, T-PTNS, P-PTNS). Alternative conservative therapy involves all products that collect urine (e.g. pads, catheters) and products that prevent urine leakage (e.g. bladder neck support device, pessaries, urethral inserts or extra-urethral devices). The International Continence Society (ICS) considers the conservative therapy to be effective and inexpensive and to have a minimally invasive effect, without colliding with other potential therapies