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Stressinkontinens

Sist oppdatert: Sist revidert:
Sist revidert av:
Definisjon:
Urinlekkasje i forbindelse med hoste, nysing eller andre aktiviteter som øker det intraabdominale trykket. Multifaktoriell årsak
Forekomst:
Prevalens blant kvinner er 5% til 15%
Symptomer:
Urinlekkasje av mindre urinmengder ved aktiviteter som øker buktrykket
Funn:
Gynekologisk undersøkelse er som regel normal
Diagnostikk:
Tilleggsundersøkelser er urinundersøkelse og eventuelt stresstest
Behandling:
Stressinkontinens hos kvinner behandles i første rekke med bekkenbunnstrening, elektrostimulering eller ved kirurgi
  • Nasjonal kompetansetjeneste for inkontinens og bekkenbunnsykdom - nettside 
  1. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA 2017; 318:1592. Journal of the American Medical Association  
  2. Svenningsen R, Hannestad YS, Kulseng-Hansen S, Verelst M. Urininkontinens. Veileder i generell gynekologi 2015. www.legeforeningen.no  
  3. Hannestad Y, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence. The Norwegian EPINCONT study. J Clin Epidemiol 2000;53:1150-7. PubMed  
  4. Simeonova Z, Milsom I, Kullendorff A-E, et al. The prevalence of urinary incontinence and its influence on the quality of life in women from an urban Swedish population. Acta Obstet Gynecol Scand 1999; 78: 546-51. PubMed  
  5. Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. I: Abrams P, Khoury S, Wein A, red. Incontinence: Plymouth: Health Publications, 1999: 199 - 226.
  6. Roberts RO, Jacobsen SA, Reilly WT, et al. Prevalence of combined fecal and urinary incontinence: A community-based study. J Am Geriatr Soc 1999; 47: 837-41. PubMed  
  7. O'Halloran T, Bell RJ, Robinson PJ, Davis SR. Urinary incontinence in young nulligravid women: A cross-sectional analysis.. Ann Intern Med 2012; 157: 87-93. Annals of Internal Medicine  
  8. 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  
  9. Weiss BD. Selecting medications for the treatment of urinary incontinence. Am Fam Physician 2005; 71: 315-22. PubMed  
  10. 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  
  11. Schiøtz HA. Stressinkontinens hos kvinner - aktuell behandling. Tidsskr Nor Lægeforen 2007; 127: 1773-6. PubMed  
  12. Bjerklund Johansen TE. Medikamenter mot urininkontinens. Tidsskr Nor Lægeforen 2003; 123: 178-9. Tidsskrift for Den norske legeforening  
  13. Brown JS, Sawaya G, Thorn DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. Lancet 2000; 356: 535-9. PubMed  
  14. 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  
  15. 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  
  16. Holroyd-Leduc JM, Straus SE. Management of urinary incontinence in women: scientific review. JAMA 2004; 291: 986-95. Journal of the American Medical Association  
  17. 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  
  18. Todhunter-Brown A, Hazelton C, Campbell P, et al. Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2022 Sep 2;9:CD012337. doi: 10.1002/14651858.CD012337.pub2. The Cochrane Library  
  19. Cacciari LP, Kouakou CR, Poder TG, et al. Group-based pelvic floor muscle training is a more cost-effective approach to treat urinary incontinence in older women: economic analysis of a randomised trial. J Physiother. 2022 Jul;68(3):191-196. PMID: 35753969 PubMed  
  20. Lukacz ES. Treatment of urinary incontinence in women. UpToDate - last update Jun 04, 2020. www.uptodate.com  
  21. 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  
  22. Indrekvam S, Sandvik H, Hunskår S. A Norwegian national cohort of 3198 women treated with home-managed electrical stimulation for urinary incontinence: effectiveness and treatment results. Scand J Urol Nephrol 2001; 35: 32-9. PubMed  
  23. 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, Issue 10. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub4. DOI  
  24. 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  
  25. Bø K. Bekkenbunnstrening og urininkontinens - tren deg tett! Tidsskr Nor Lægeforen 2000; 120: 3583-9. Tidsskrift for Den norske legeforening  
  26. Hagen S, Elders A, Stratton S, et al. Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial. BMJ 2020. doi:10.1136/bmj.m3719 DOI  
  27. 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 ;11:CD010551. doi: 10.1002/14651858.CD010551.pub2 DOI  
  28. Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and fecal incintinence in antenatal and postnatal women. Cochrane database of Systematic Reviews 2012; 10: CD007471. Cochrane (DOI)  
  29. 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  
  30. 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  
  31. 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  
  32. 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  
  33. 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. doi:10.1001/jama.2017.7220 DOI  
  34. Cody JD, Jacobs ML, Richardson K, et al. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2012 Oct 17; 10: CD001405. Cochrane (DOI)  
  35. 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  
  36. 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  
  37. 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.
  38. Labrie J, Berghmans BL, Fischer K, et al. Surgery versus physiotherapy for stress urinary incontinence. N Engl J Med 2013 Sep 19;369(12):1124-33. doi: 10.1056/NEJMoa1210627. DOI  
  39. Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid‐urethral sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD006375. DOI: 10.1002/14651858.CD006375.pub4. DOI  
  40. 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  
  41. 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  
  42. 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  
  43. Heinonen P, Ala-Nissila S, Raty R, et al. Objective cure rates and patient satisfaction after the transobturator tape procedure during 6.5-year follow-up. J Minim Invasive Gynecol 2013; 20(1):73-78. PubMed  
  44. Song P, Wen Y, Huang C, et al. The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta-analysis. Neurourol Urodyn. 2018;37(4):1199-1211. doi:10.1002/nau.23468 DOI  
  45. Schierlitz L, Dwyer PL, Rosamilia A, et al. Effectiveness of tension-free vaginal tape compared with transobturator tapein women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet Gynecol 2008; 112(6):1253-1261. PubMed  
  46. 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  
  47. 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  
  48. Lapitan MC, Cody JD. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev 2016. pmid:26878400 PubMed  
  49. 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  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Guri Rørtveit, spesialist i allmennmedisin, stipendiat ved Institutt for samfunnsmedisinske fag, Universitetet i Bergen
  • Per Bergsjø, professor emeritus, dr. med., Universitetet i Bergen. Spesialist i kvinnesykdommer og fødselshjelp, forsker ved Nasjonalt folkehelseinstitutt, Oslo
  • Arnfinn Seim, førsteamanuensis i allmennmedisin, Institutt for samfunnsmedisinske fag, Norges teknisk-naturvitenskapelige universitet, Trondheim