哈佛医学院附属医院尿失禁的指南.pdf

E MARY HORRIGAN CONNORS R CENTER FOR WOMEN’S HEALTH A C H T URINARY INCONTINENCE: L Guide to Diagnosis and Management© A E H S ’ N E M O W Urinary Incontinence Guideline Authors Joan Bengtson, MD Division of General Gynecology Department of Obstetrics and Gynecology Mary D. Chapin, RN Director,Women’s Health Guidelines Neeraj Kohli, MD, MBA Director, Division of Urogynecology Department of Obstetrics and Gynecology Kevin R. Loughlin, MD, MBA Division of Urology Department of Surgery Jane Seligson, MD Director BWH-DGM Primary Care Residency Program Department of Medicine Soheyla Gharib, MD Associate Director for Academic Affairs Division of Women’s Health Department of Medicine 2 Brigham and Women’s Hospital Urinary Incontinence: Guide to Diagnosis and Management© Medical Impact Urinary incontinence is a common health problem among women and is associated with impaired quality of life, social isolation, and poor self-rated health. Often, urinary incontinence places burdens on the caregivers and influences decisions to institutionalize elderly women. The medical consequences of incontinence include perineal candidal infections, cellulitis, and pressure ulcers. About 10-30 percent of women under age 65, 15-30 percent of women over age 65, and 50 percent of women living in nursing homes have urinary incontinence. Physicians must initiate a discussion about incontinence, since only half of incontinent women mention the problem at office visits, and often, when they do, their providers fail to prescribe treatment. The primary care clinician can play an important role in the management of urinary incontinence by • diagnosing the disorder • identifying its cause • instituting appropriate therapy • referring to subsp