漏尿之不能說的秘密（上）
許多產後媽媽、孕婦或更年期後的女性們都有過漏尿的經驗。常難以啟齒也造成生活中的困擾。這篇文章詳說關於尿失禁問題的相關細節。
Pregnant women, postpartum moms and postmenopausal women may experience at least one urinary leakage in their life. In severe cases, urinary incontinence (UI) may lead to life inconvenience and affect their social life. This article tells you details of incontinence and the ways to improve it.
尿失禁的兩大分類 Types of urinary incontinence
應力性尿失禁 Stress urinary incontinence：
常常因為外力（譬如：打噴嚏、咳嗽）使得腹部內部壓力突來的增加，骨盆底肌無法應付此壓力的狀況下，產生的尿失禁。當骨盆底肌群無力時，容易使膀胱與尿道下滑，改變了原本施力的方式。
大部分是由於骨盆底肌鬆弛以及支配骨盆底肌的神經損傷導致。
Urine leaks out with sudden forceful activities, like sneezing, laughing or coughing. This is due to sudden pressure on the bladder and urethra, causing the weakened pelvic floor muscles to open briefly.
Stress UI is a result of dysfunctional pelvic floor muscles and impaired pudendal nerve.
急迫性尿失禁 Urge incontinence：
常有頻尿狀況。時常覺得膀胱鼓漲，類似尿道感染的脹痛感，一直想跑廁所，每次上出來的尿量卻只有一點點。
大部分是由於膀胱過於敏感與自主神經控制異常所導致。
You may feel distention pain in your bladder and have a sudden urge to urinate. In urge incontinence, the urinary bladder contracts when it shouldn’t, causing urine leakage.
Urge incontinence is due to overactive bladder and dysautonomia.
解決尿失禁之前要先知道自己屬於哪一類型！
You should know what type of incontinence you are before treatment!
本篇文章是針對應力性尿失禁進行介紹喔！
This article focus on stress urinary incontinence!
應力性尿失禁的比例 The rate of stress UI
根據過去的統計，產後4年內的應力性尿失禁的比例高達29%，將近1/3的年輕媽媽們都有這問題。隨著生產次數的增加以及年紀的增長，應力性尿失禁的比例也會有所提升。
According to statistics, 1/3 postpartum moms have stress UI. The rate of stress UI increases through the numbers of labor. In addition, elderly women is prone to have weakened pelvic floor muscles, which increases the prevalence of stress UI.
在這麼高比例發生率的狀況下，除非很嚴重，真正就醫的人數不多。在亞洲社會，對於這種比較私密的問題比較不會輕易向外求助。有些年長女性會認為『這是正常老化現象』或『本來就會發生的事情』，而因此延後就醫的時間。但其實應力性尿失禁的問題，是可以靠肌力的強化得到改善的。
Although the high prevalence rate of stress UI, there are few who seek for medical help. Some might believe that stress UI is a sign of aging and is irreversible. In fact, enhancing functions of your pelvic floor muscles is beneficial to improve urinary leakage.
骨盆底肌失能是尿失禁最大的因素 Pelvic floor muscle dysfunction is the major reason to stress UI
骨盆底肌失能會發生在各個年齡層，但怎麼樣會使之失能？
There are several factors causing pelvic floor muscles weakness.
- 懷孕賀爾蒙 Pregnancy hormones
懷孕期間分泌的激素會使得孕婦全身肌肉與韌帶鬆弛，讓產道可以更有彈性伸縮以便順產。這項優點卻會使得骨盆底肌群變得無力且較無法應付突來的腹壓。
Relaxin is mainly for releasing your muscles (including pelvic floor muscles), tendons and ligaments, during pregnancy to increase space for the fetus. The loosened pelvic floor muscles would decrease in ability to resist abdominal pressure during daily activities.
- 胎兒體重 Fetus weight
懷孕進入最後一個孕期時，寶寶體重增加的速度會大幅上升，因此壓迫在骨盆腔的力道也會提升。骨盆腔的肌群長時間受壓後，會失去彈性，好比使用年久的彈簧床形變後難以復位。
The weight of your baby gains rapidly in the third pregnancy trimester, putting more stress into your pelvic girdle. The lengthened pelvic floor muscles would then decrease support of the bladder and urethra, causing urinary leakage.
- 自然產 Vaginal birth
在分娩時，胎兒的頭經過母親產道，骨盆底肌、會陰神經與周遭韌帶被破壞的機率大幅增加。為了加快生產速度與胎兒考量，『剪會陰』、『產鉗』『真空吸引』的舉動也會帶來更多骨盆底肌的破壞。
Women who give birth vaginally are slightly more likely to develop urinary incontinence afterward compared to women who have c-sections. During vaginal childbirth, the baby’s head distends and stretches the pelvic floor muscles, connective tissue, and nerves. In addition, the use of forceps and vacuum were found to be the risk factors associated with vaginal delivery.
- 生產次數
根據過去統計，生產次數與應力性尿失禁有很高的關係性。生過多胎的媽媽相較只生一胎的媽媽有應力性尿失禁的比例高2.5倍。原因來自於反復破壞骨盆底肌導致。
According to studies, the prevalence of stress UI in multiparous (>3 births) is 2.5 times higher than primiparous (single birth). This may be due to repeatedly stretching and damaging the pelvic floor muscles.
-肥胖 Obesity
坦白說就是內臟脂肪擠壓到骨盆腔導致的尿失禁。
與BMI<25的人相比，
BMI 介於25~29尿失禁的機率是2倍;
BMI 介於30~34尿失禁的機率是3倍;
BMI 介於35~39尿失禁的機率是4倍;
BMI >40者尿失禁的機率是5倍
Fatty tissues increase pressure in the abdominal area, increasing risk of stress UI. Compared with women with a BMI less than 25, BMI between 25–29 women have 2 times the chance to develop stress UI; BMI between 30–34 have 3 times the chance; BMI between 35–39 have 4times the chance and BMI 40 or above have 5 times the chance of incontinence.
- 更年期 Menopause
停經婦女或老年女性有高比例尿失禁患者。主要原因有二：1. 骨盆底肌力的衰退造成括約肌無法正常運作。2. 更年期後雌激素的減少使尿液阻力減少。這些都會使尿液容易溢出。
Stress incontinence is common during menopause or elder women. When intra-urethral pressure involuntarily falls below intra-vesicular pressure, urinary leakage may happen. The main reasons are: 1. weakened pelvic floor and sphincter muscles 2. inadequate estrogen.
可以改善的方式 Ways to improve stress UI
- 手術 Sling surgery
由於骨盆底肌的失能會使得膀胱與尿道下墜，造成更容易漏尿。手術的目的是靠植入一個懸吊帶，改變尿道的角度，使得尿液阻力增加，不容易外流。
優點：可以較快感受到漏尿的改善。
缺點：1. 為侵入性治療，需要照顧傷口。2. 懸吊角度不適合可能會演變成尿不出來的問題。3. 需要確定不再生孩子才做手術。
Sling surgery helps change the angle of urethra, decreasing the flow speed of urine.
PROS: It is an effective way to stop incontinence immediately.
CONS: 1. Sling surgery is an invasive treatment and wound care is needed. 2. Some may experience urinary retention. 3. It is suggested that the treatment be done when you are not expecting another child.
- 生物回饋電刺激 Electric biofeedback stimulation
置入電擊於產道內部，藉由電流對骨盆底肌肉的刺激，配合主動憋尿動作，可幫骨盆底肌群功能的恢復，與促進修復損壞的會陰神經。進行電刺激同時，儀器以圖像的方式提示使用者是否有正確的出力。
優點：1. 可以增進骨盆底肌的自主收縮。2. 可清楚讓使用者了解骨盆底肌使力的力道大小與是否正確使力。
缺點：1. 需要在醫院進行治療，頻率頻繁，對於時間有限者較不適合。2. 剛開始需要花時間適應異物感。3. 需要時間才能改善漏尿。
Vaginal electrical stimulation is widely used in women who have incontinence. The device sends mild electric current to nerves in the lower back or the pelvic muscles that are involved in urination. The stimulator signals users to voluntary contract the sphincter along with electric current to effectively increase pelvic muscle control and strength.
PROS: 1. It can help increase voluntary muscle control of the sphincter. 2. Biofeedback system tells whether you have contract the pelvic floor muscles correctly.
CONS: 1. Treatment is usually done in the hospital/ clinic in Taiwan, which may be time-consuming. 2. It takes some time to adapt to vaginal electrical probe. 3. It needs time and patience to notice improvement.
-運動加強骨盆底肌 Pelvic floor muscle strengthening
透過學習使用骨盆底肌肌群並且強化達到改善漏尿的效果。可搭配其他運動或生活姿勢執行。大家耳熟能詳的『凱格爾運動』是一個很好的訓練方式。
優點：1. 可在居家自主運動，不受場地限制。2. 藉由運動提升自我對骨盆底肌的認識。
缺點：1. 訓練姿勢不完整會影響訓練效果。2. 需要高度的自主性。
Strengthening exercises help improve muscle strength and control of your pelvic floor. It can be done at home in various positions. “Kegel exercise” is known for improving incontinence.
PROS: 1. Exercise in not limited to specific places. 2. You can know better how your muscles function during exercise.
CONS: 1. There are certain steps to follow during exercise that may influence training effect. 2. Training plans should be followed strictly.
沒有最好的治療尿失禁方式，只有最適合的方式
There is always a suitable way to treat incontinence
決定任何治療前，請跟您的醫療人員進行完整的諮詢再進行決定喔！
Please contact your health provider for more information before deciding any way of treatment!
身為物理治療師，下篇一定會介紹關於骨盆底肌的訓練。骨盆底肌訓練只能做『凱格爾運動』嗎？
運動的細節與迷思破解敬請期待吧！！
Be sure to stay tuned for the next part, which is going to be talking about exercise training for pelvic floor muscles!
若有興趣，歡迎參考之前的文章
Other articles you might be interested in…
＊孕婦系列 For pregnant moms
懷孕期間可以運動嗎？物理治療師提供幾招小撇步讓孕媽咪動起來！
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懷孕時我的身體會如何變化，運動會不會有風險？
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懷孕期間腰痠痛！該如何是好？
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