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nietrzymanie moczu
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Abstrakt
Nietrzymanie moczu jest częstą dolegliwością u kobiet i nie stanowi fizjologicznej konsekwencji starzenia się, ciąży ani porodu. Chociaż zwykle nie zagraża bezpośrednio życiu, może istotnie ograniczać aktywność codzienną, funkcjonowanie zawodowe i społeczne, relacje intymne oraz dobrostan psychiczny. Celem niniejszego niesystematycznego przeglądu piśmiennictwa jest krytyczna analiza i synteza aktualnych doniesień naukowych, dotyczących profilaktyki, diagnostyki i terapii nietrzymania moczu u kobiet. W pracy przedstawiono najważniejsze zagadnienia dotyczące nietrzymania moczu u kobiet, ze szczególnym uwzględnieniem uwarunkowań, obrazu klinicznego, diagnostyki, leczenia i profilaktyki. Omówiono wysiłkowe, naglące i mieszane nietrzymanie moczu, a także inne, rzadziej występujące u kobiet postacie tego zaburzenia. Przedstawiono główne czynniki ryzyka, w tym wiek, ciążę i poród, nadmierną masę ciała, menopauzę, osłabienie mięśni dna miednicy, przewlekły kaszel, zaparcia, palenie tytoniu, brak aktywności fizycznej, choroby neurologiczne oraz przebyte zabiegi w obrębie miednicy mniejszej. Wskazano znaczenie wywiadu, badania fizykalnego i ginekologicznego, dzienniczka mikcji, analizy moczu, ultrasonografii, uroflowmetrii, testów prowokacyjnych oraz w uzasadnionych przypadkach, badań urodynamicznych. Omówiono postępowanie zachowawcze obejmujące edukację, modyfikację stylu życia, trening mięśni dna miednicy i trening pęcherza, a także farmakoterapię, metody małoinwazyjne i leczenie operacyjne. Podkreślono, że wczesne rozpoznanie objawów oraz indywidualizacja postępowania mogą ograniczać nasilenie dolegliwości i poprawiać jakość życia. Działania profilaktyczne powinny koncentrować się na wzmacnianiu mięśni dna miednicy, utrzymywaniu prawidłowej masy ciała, zapobieganiu zaparciom i przewlekłemu kaszlowi oraz przełamywaniu barier utrudniających kobietom zgłaszanie dolegliwości personelowi medycznemu. Objawy mogą mieć różne nasilenie – od sporadycznego wycieku niewielkich ilości moczu po częste epizody wymagające stosowania wyrobów chłonnych, ograniczające aktywność i sprzyjające wycofaniu społecznemu. Dobór leczenia powinien uwzględniać rodzaj i nasilenie objawów, choroby współistniejące, wcześniejsze postępowanie, oczekiwania pacjentki oraz możliwości aktywnego uczestnictwa pacjentki w terapii, co ma istotne znaczenie dla ograniczenia długofalowych następstw zdrowotnych, społecznych i emocjonalnych.
Bibliografia
Abebe, S. A., Gashaw, F., Tsegaye, A., Abebaw, D., Kindie, E. A., & Dejen, A. M. (2024). Prevalence and determinants of depression among women with urinary incontinence: A systematic review and meta-analysis worldwide. BMC Women’s Health, 24, Article 591. https://doi.org/10.1186/s12905-024-03432-1
Alhamoud, M. A. S., Julaih, F. A., Al-Aqil, H. D. H., Almalki, N. A. S., Alharthi, F. A. G., Alghamdi, A. A., Alshehri, S. A. K., Alqhtani, A. S., Alasiri, M. A., Alaqil, A. S., Alhumaidi, B. N., Saraiva, A., Carrascosa, C., & Raposo, A. (2024). The prevalence and risk factors of stress urinary incontinence among women in Saudi Arabia: A systematic review and meta-analysis. Healthcare, 12, Article 2440. https://doi.org/10.3390/healthcare12242440
Aoki, Y., Brown, H. W., Brubaker, L., Cornu, J. N., Daly, J. O., & Cartwright, R. (2017). Urinary incontinence in women. Nature Reviews Disease Primers, 3, Article 17042. https://doi.org/10.1038/nrdp.2017.42
Batmani, S., Jalali, R., Mohammadi, M., & Bokaee, S. (2021). Prevalence and factors related to urinary incontinence in older adults women worldwide: A comprehensive systematic review and meta-analysis of observational studies. BMC Geriatrics, 21, Article 212. https://doi.org/10.1186/s12877-021-02135-8
Burton, C. S., Korsandi, S., & Enemchukwu, E. (2022). Current state of non-surgical devices for female stress urinary incontinence. Current Urology Reports, 23, 185–194. https://doi.org/10.1007/s11934-022-01104-x
Cardozo, L., Rovner, E., Wagg, A., Wein, A., & Abrams, P. (Eds.). (2023). Incontinence (7th ed.). International Continence Society. https://www.ics.org/ici
Chen, L., Han, Y., Wang, L., Zhang, H., Zheng, Y., Zhang, R., Meng, G., Zhang, Y. P., & Ji, D. (2024). Conservative interventions for urinary incontinence on postpartum women: A systematic review and meta-analysis. Journal of Midwifery & Women’s Health, 69(5), 663–671. https://doi.org/10.1111/jmwh.13653
Corrado, B., Giardulli, B., Polito, F., Aprea, S., Lanzano, M., & Dodaro, C. (2020). The impact of urinary incontinence on quality of life: A cross-sectional study in the metropolitan city of Naples. Geriatrics, 5(4), Article 96. https://doi.org/10.3390/geriatrics5040096
Dai, S., Chen, H., & Luo, T. (2023). Prevalence and factors of urinary incontinence among postpartum: Systematic review and meta-analysis. BMC Pregnancy and Childbirth, 23, Article 761. https://doi.org/10.1186/s12884-023-06059-6
Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018(10), Article CD005654. https://doi.org/10.1002/14651858.CD005654.pub4
Dumoulin, C., Hunter, K. F., Moore, K., Bradley, C. S., Burgio, K. L., Hagen, S., Imamura, M., Thakar, R., Williams, K., & Chambers, T. (2016). Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence. Neurourology and Urodynamics, 35(1), 15–20. https://doi.org/10.1002/nau.22677
Frigerio, M., Barba, M., Cola, A., Braga, A., Celardo, A., Munno, G. M., Schettino, M. T., Vagnetti, P., De Simone, F., Di Lucia, A., Grassini, G., & Torella, M. (2022). Quality of life, psychological wellbeing, and sexuality in women with urinary incontinence—Where are we now: A narrative review. Medicina, 58(4), Article 525. https://doi.org/10.3390/medicina58040525
Fusco, F., Abdel-Fattah, M., Chapple, C. R., Creta, M., La Falce, S., Waltregny, D., & Novara, G. (2017). Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. European Urology, 72(4), 567–591. https://doi.org/10.1016/j.eururo.2017.03.025
Grigoryan, B., Shadyan, G., Kasyan, G., & Pushkar, D. (2023). Adjustable slings versus other surgical methods in female stress urinary incontinence: A systematic review and meta-analysis. International Urogynecology Journal, 34(7), 1351–1367. https://doi.org/10.1007/s00192-023-05535-z
Hay-Smith, E. J. C., Starzec-Proserpio, M., Moller, B., Aldabe, D., Cacciari, L., Pitangui, A. C. R., Vesentini, G., Woodley, S. J., Dumoulin, C., Frawley, H. C., Jorge, C. H., Morin, M., Wallace, S. A., & Weatherall, M. (2024). Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2024(12), Article CD009508. https://doi.org/10.1002/14651858.CD009508.pub2
Hu, J. S., & Pierre, E. F. (2019). Urinary incontinence in women: Evaluation and management. American Family Physician, 100(6), 339–348. https://www.aafp.org/afp/2019/0915/p339
Huang, Z., Wu, S., Yu, T., & Hu, A. (2020). Efficacy of telemedicine for urinary incontinence in women: A systematic review and meta-analysis of randomized controlled trials. International Urogynecology Journal, 31, 1507–1513. https://doi.org/10.1007/s00192-020-04205-5
Imamura, M., Hudson, J., Wallace, S. A., MacLennan, G., Shimonovich, M., Omar, M. I., Javanbakht, M., Moloney, E., Becker, F., Ternent, L., Montgomery, I., Mackie, P., Saraswat, L., Monga, A., Vale, L., Craig, D., & Brazzelli, M. (2019). Surgical interventions for women with stress urinary incontinence: Systematic review and network meta-analysis of randomised controlled trials. BMJ, 365, Article l1842. https://doi.org/10.1136/bmj.l1842
Janse van Vuuren, A. C., van Rensburg, J. A., Jacobs, L., & Hanekom, S. (2021). Exploring literature on knowledge, attitudes, beliefs and practices towards urinary incontinence management: A scoping review. International Urogynecology Journal, 32(3), 485–499. https://doi.org/10.1007/s00192-020-04628-3
Javanbakht, M., Moloney, E., Brazzelli, M., Wallace, S., Omar, M. I., Monga, A., Saraswat, L., Mackie, P., Imamura, M., Hudson, J., Shimonovich, M., MacLennan, G., Vale, L., & Craig, D. (2020). Surgical treatments for women with stress urinary incontinence: A systematic review of economic evidence. Systematic Reviews, 9, Article 85. https://doi.org/10.1186/s13643-020-01352-3
Kharaji, G., ShahAli, S., Ebrahimi-Takamjani, I., Sarrafzadeh, J., Sanaei, F., & Shanbehzadeh, S. (2023). Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence: A systematic review and meta-analysis. International Urogynecology Journal, 34(7), 1339–1349. https://doi.org/10.1007/s00192-023-05489-2
Kobashi, K. C., Vasavada, S., Bloschichak, A., Hermanson, L., Kaczmarek, J., Kim, S. K., Kirkby, E., & Malik, R. (2023). Updates to surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU guideline (2023). Journal of Urology, 209(6), 1091–1098. https://doi.org/10.1097/JU.0000000000003435
Koomson, G., Mgolozeli, S. E., & Mshunqane, N. (2025). Prevalence of urinary incontinence in postpartum women and physiotherapy interventions applied: An integrative review. International Journal of Gynecology & Obstetrics, 168(3), 965–977. https://doi.org/10.1002/ijgo.15950
Lawson, S., & Sacks, A. (2018). Pelvic floor physical therapy and women’s health promotion. Journal of Midwifery & Women’s Health, 63(4), 410–417. https://doi.org/10.1111/jmwh.12736
Lee, H., Rhee, Y., & Choi, K. S. (2021). Urinary incontinence and the association with depression, stress, and self-esteem in older Korean women. Scientific Reports, 11, Article 9054. https://doi.org/10.1038/s41598-021-98007-2
Liu, W., Sun, X., Gao, Y., Sun, H., Feng, H., Tan, H., Chen, Q., Peng, L., & Wu, I. X. Y. (2024). Comparative effectiveness of nonsurgical interventions for urinary incontinence in older women: A systematic review and network meta-analysis. Archives of Gerontology and Geriatrics, 116, Article 105214. https://doi.org/10.1016/j.archger.2023.105214
Mantilla Toloza, S. C., Villareal Cogollo, A. F., & Peña García, K. M. (2024). Pelvic floor training to prevent stress urinary incontinence: A systematic review. Actas Urológicas Españolas, 48(4), 319–327. https://doi.org/10.1016/j.acuroe.2024.01.007
Monteiro, S., Riccetto, C., Araújo, A., Galo, L., Brito, N., & Botelho, S. (2018). Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: A systematic review. International Urogynecology Journal, 29(11), 1565–1573. https://doi.org/10.1007/s00192-018-3602-x
Moroni, R. M., Magnani, P. S., Haddad, J. M., Castro, R. A., & Brito, L. G. O. (2016). Conservative treatment of stress urinary incontinence: A systematic review with meta-analysis of randomized controlled trials. Revista Brasileira de Ginecologia e Obstetrícia, 38(2), 97–111. https://doi.org/10.1055/s-0035-1571252
Mostafaei, H., Sadeghi-Bazargani, H., Hajebrahimi, S., Salehi-Pourmehr, H., Ghojazadeh, M., Onur, R., Al Mousa, R. T., & Oelke, M. (2020). Prevalence of female urinary incontinence in the developing world: A systematic review and meta-analysis—A report from the Developing World Committee of the International Continence Society and Iranian Research Center for Evidence Based Medicine. Neurourology and Urodynamics, 39(4), 1063–1086. https://doi.org/10.1002/nau.24342
Nygaard, I. E., & Shaw, J. M. (2016). Physical activity and the pelvic floor. American Journal of Obstetrics and Gynecology, 214(2), 164–171. https://doi.org/10.1016/j.ajog.2015.08.067
Paiva, L. L., Ferla, L., Darski, C., Catarino, B. M., & Ramos, J. G. L. (2017). Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: Systematic review and meta-analysis. International Urogynecology Journal, 28(3), 351–359. https://doi.org/10.1007/s00192-016-3133-2
Petca, A., Fotă, A., Petca, R.-C., & Rotar, I. C. (2025). Modern conservative management strategies for female stress urinary incontinence: A systematic review. Journal of Clinical Medicine, 14(10), Article 3268. https://doi.org/10.3390/jcm14103268
Pierce, H., Perry, L., Chiarelli, P., & Gallagher, R. (2016). A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. Journal of Advanced Nursing, 72(8), 1718–1734. https://doi.org/10.1111/jan.12909
Pizzol, D., Demurtas, J., Celotto, S., Maggi, S., Smith, L., Angiolelli, G., Trott, M., Yang, L., & Veronese, N. (2021). Urinary incontinence and quality of life: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 33(1), 25–35. https://doi.org/10.1007/s40520-020-01712-y
Połocka-Molińska, M., Jakóbczak, B., & Plagens-Rotman, K. (2017). Wpływ nietrzymania moczu na jakość życia kobiet [The impact of urinary incontinence on women’s quality of life]. Polski Przegląd Nauk o Zdrowiu, 2(51), 161–167.
Rada, M. P., Jones, S., Betschart, C., Falconi, G., Haddad, J. M., Doumouchtsis, S. K., & CHORUS: An International Collaboration for Harmonising Outcomes, Research, and Standards in Urogynaecology and Women’s Health. (2022). A meta-synthesis of qualitative studies on stress urinary incontinence in women for the development of a Core Outcome Set: A systematic review. International Journal of Gynecology & Obstetrics, 158(1), 3–12. https://doi.org/10.1002/ijgo.13934
Radzimińska, A., Strączyńska, A., Weber-Rajek, M., Styczyńska, H., Strojek, K., & Piekorz, Z. (2018). The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: A systematic literature review. Clinical Interventions in Aging, 13, 957–965. https://doi.org/10.2147/CIA.S160057
Rocha, F., Carvalho, J., Natal, R. J., & Viana, R. (2018). Evaluation of the pelvic floor muscles training in older women with urinary incontinence: A systematic review. Porto Biomedical Journal, 3(2), Article e9. https://doi.org/10.1016/j.pbj.0000000000000009
Rostami, P., Mostafaei, H., Salehi-Pourmehr, H., & Hajebrahimi, S. (2025). An updated systematic review and meta-analysis on the prevalence of female urinary incontinence in developing countries—A collaborative report by the International Continence Society (Developing World Committee) and the Iranian Research Center for Evidence-Based Medicine. Neurourology and Urodynamics, 44(8), 1639–1668. https://doi.org/10.1002/nau.70127
Sheng, Y., Carpenter, J. S., Ashton-Miller, J. A., & Miller, J. M. (2022). Mechanisms of pelvic floor muscle training for managing urinary incontinence in women: A scoping review. BMC Women’s Health, 22, Article 161. https://doi.org/10.1186/s12905-022-01742-w
Sousa, A. J. D. S., Rodrigues, J. C., Padilha, J. F., Godoy, A. G., Degani, A. M., Danna-Santos, A., & Driusso, P. (2024). Effects of health education on women with urinary incontinence: Systematic review and meta-analysis. International Urogynecology Journal, 35(2), 273–289. https://doi.org/10.1007/s00192-023-05693-0
Steenstrup, B., Le Rumeur, E., Moreau, S., & Cornu, J. N. (2018). Sédentarité et incontinence urinaire chez la femme: Une revue de littérature [Sedentary lifestyle and urinary incontinence in women: A literature review]. Progrès en Urologie, 28(17), 973–979. https://doi.org/10.1016/j.purol.2018.07.006
Stewart, F., Berghmans, B., Bø, K., & Glazener, C. M. A. (2017). Electrical stimulation with non-implanted devices for stress urinary incontinence in women. Cochrane Database of Systematic Reviews, 2017(12), Article CD012390. https://doi.org/10.1002/14651858.CD012390.pub2
Stroppa, V., Iovino, P., Marcomini, I., D’Errico, R., Poliani, A., Rosa, D., Manara, D. F., & Villa, G. (2025). Social isolation among individuals with incontinence: A scoping review. Nursing Reports, 15(11), Article 375. https://doi.org/10.3390/nursrep15110375
Sussman, R. D., Syan, R., & Brucker, B. M. (2020). Guideline of guidelines: Urinary incontinence in women. BJU International, 125(5), 638–655. https://doi.org/10.1111/bju.14927
Syeda, F., & Pandit, U. (2024). Urinary incontinence in female athletes: A systematic review on prevalence and physical therapy approaches. Cureus, 16(7), Article e64544. https://doi.org/10.7759/cureus.64544
Teixeira, R. V., Colla, C., Sbruzzi, G., Mallmann, A., & Paiva, L. L. (2018). Prevalence of urinary incontinence in female athletes: A systematic review with meta-analysis. International Urogynecology Journal, 29(12), 1717–1725. https://doi.org/10.1007/s00192-018-3651-1
Todhunter-Brown, A., Hazelton, C., Campbell, P., Elders, A., Hagen, S., & McClurg, D. (2022). Conservative interventions for treating urinary incontinence in women: An overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews, 2022(9), Article CD012337. https://doi.org/10.1002/14651858.CD012337.pub2
Trapani, S., Villa, G., Poliani, A., Gnecchi, S., Rosa, D., & Manara, D. F. (2024). Non-pharmacological management of urge urinary incontinence in women between 40 and 65 years old: A systematic review. Nursing Reports, 14(1), 174–196. https://doi.org/10.3390/nursrep14010015
Troko, J., Bach, F., & Toozs-Hobson, P. (2016). Predicting urinary incontinence in women in later life: A systematic review. Maturitas, 94, 110–116. https://doi.org/10.1016/j.maturitas.2016.09.006
Vasconcelos, C. T. M., Firmiano, M. L. V., Oriá, M. O. B., Vasconcelos Neto, J. A., Saboia, D. M., & Bezerra, L. R. P. S. (2019). Women’s knowledge, attitude and practice related to urinary incontinence: Systematic review. International Urogynecology Journal, 30(2), 171–180. https://doi.org/10.1007/s00192-018-3759-3
Wang, H., Liu, J., Fang, K., Liu, J., Chen, T., Yang, T., & Shi, X. (2022). Transobturator tape, tension-free vaginal tape, and transvaginal tension-free vaginal tape-obturator for the treatment of female stress urinary incontinence: A systematic review and network meta-analysis. International Journal of Gynecology & Obstetrics, 157(3), 527–535. https://doi.org/10.1002/ijgo.13790
Wang, K., Xu, X., Jia, G., & Jiang, H. (2020). Risk factors for postpartum stress urinary incontinence: A systematic review and meta-analysis. Reproductive Sciences, 27(12), 2129–2145. https://doi.org/10.1007/s43032-020-00254-y
Wieland, L. S., Shrestha, N., Lassi, Z. S., Panda, S., Chiaramonte, D., & Skoetz, N. (2019). Yoga for treating urinary incontinence in women. Cochrane Database of Systematic Reviews, 2019(2), Article CD012668. https://doi.org/10.1002/14651858.CD012668.pub2
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