Female stress urinary incontinence

  I. Non-surgical treatment In the treatment of stress urinary incontinence, non-surgical treatment is an important part. It is mainly effective for mild and moderate patients, and the treatment effect is not ideal for severe patients, but it can be used as an adjuvant treatment before and after surgical treatment. Non-surgical treatment can reduce symptoms, even if it does not achieve complete cure, it can reduce urinary incontinence and other urinary tract symptoms to varying degrees, and patient compliance is better. Non-surgical treatments for stress urinary incontinence include lifestyle interventions, bladder training, pelvic floor muscle exercises, pelvic floor electrical stimulation, wearing a uterine support and a urinary stopper.  Lifestyle interventions and bladder training Lifestyle interventions include weight reduction, smoking cessation, prohibition of caffeinated beverages, regular living, avoidance of strong physical work (including lifting and carrying heavy objects), and avoidance of physical activities that increase abdominal pressure. At the same time, diseases causing chronic increase in abdominal pressure such as constipation and cough should be treated.  Bladder training is to regulate bladder function by changing urination habits. By recording daily water intake and urination, filling out bladder function training forms, consciously extending the interval between urination and learning to delay urination by suppressing urinary urgency.  2.Pelvic floor muscle training (PFMT), also known as Kegel excercises, refers to the voluntary contraction exercise of the pelvic floor muscle groups by the patient consciously, and is the most common and effective non-surgical treatment for SUI.  The main component of PFMT is repeated anal contraction, requiring patients to perform 3 sets of 8 to 12 contractions per day, each time trying to achieve their longest contraction time, for at least 6 months of training. Even if the symptoms have improved, the exercise still needs to be maintained and the patient is asked to consciously train the situational reflex to be able to actively and forcefully contract the pelvic floor muscles before coughing, sneezing or laughing, thus preventing the occurrence of urinary incontinence. About 55% to 67% of the patients’ symptoms are improved, 30% of the patients are cured, and the patients’ quality of life is improved to varying degrees. In mothers, PFMT exercises for 8 weeks, under medical supervision, are effective in preventing and treating stress incontinence for up to 1 year after delivery. Another 10-year follow-up study showed that the positive effects of effective PFMT on pelvic floor muscle function had a 66% chance of lasting at least 10 years.  3, pelvic floor electrical stimulation For patients who are unable to perform PFMT properly and effectively, electromagnetic stimulation can be helpful. It is effective up to 50%, and all quality of life scores are significantly improved. Randomized controlled trials have shown that 50% of patients treated with electrical stimulation achieved complete urinary control or symptom improvement of 90% or more. In addition, the biofeedback + electrical stimulation treatment approach emphasized passive muscle training by patients actively performing pelvic floor muscle contraction training while receiving different frequencies of electrical current stimulation. The meta-analysis showed that the treatment effect of combined application was better than that of single method.  4. uterine support In recent years, some new uterine supports have emerged to improve the symptoms of stress urinary incontinence. For those who are not suitable for surgical treatment, the use of anti-incontinence uterine rests may be considered.