SPECIFIC EDUCATION, EXERCISE, AND STRESS INCONTINENCE

尿失禁影响大约27%的65岁以上的妇女 年 超过75%的失禁老年妇女有压力性尿 尿失禁（SI）单独或作为混合的重要组成部分 失禁 在这项研究中，我们寻求改善 保守治疗中度SI。 凯格尔运动（Kegel Exercise，KE） 规定加强骨盆底肌肉，特别是 肛提肌（Levator Ani，LA） 然而，有多少好处， 从这种治疗可以归因于实际加强的LA，和 有多少可以归因于教育的组成部分， 明知而不自知，也收不清。 教育 组件包括一般的膀胱训练，更具体地说， 了解LA在哪里，何时以及为什么它们可以用于预防SI 在最基本的层面上， 意志上。 在第一阶段，我们将使用一个随机的，三组 (60+60+60），对照试验，以量化，首次，效果 治疗SI的教育。 我们将招募至少180名65-84岁的老年人 中度SI（1-3湿润）的经产社区居住妇女 每日一次）。 特定教育组（艾德组，n=60） 将随访三个月，以确定结果是否 措施，包括每日湿润发作次数和泄漏点 压力，显示出显着的变化，相对于一个等待名单没有治疗 (NT对照组60例。 我们还将确定三个月的KE是否 干预（KE组，n=60），其中包括运动，以加强 洛杉矶除了艾德计划，结果在一个显着更好的 在3个月和6个月随访时的结果比单独使用艾德。 艾德和KE组LA 强度变化将使用装有仪器的窥器来量化。 所有 将按一般教育和体育活动分为三组 水平，以评估其对结果的影响。 在第二阶段，我们将 进行发展研究，以提高第一阶段干预措施的成效 通过确定加权阴道锥的使用接受度， 学习收缩LA和（B）加强LA肌肉。

Urinary incontinence affects approximately 27% of women over the age of 65 years. Over 75% of incontinent elderly women have stress urinary incontinence (SI) either alone or as a significant component of mixed incontinence. In this research we seek insights for improving the conservative treatment of moderate SI. Kegel exercises (KE) are commonly prescribed to strengthen the pelvic floor muscles, with particular emphasis on the levator ani (LA). However, how much any benefits derived from this treatment can be ascribed to actual strengthening of the LA, and how much can be ascribed to the educational component which patients, knowingly and unknowingly also receive, is unclear. The educational component includes general bladder training and, more specifically, learning where the LA are, when and why they can be of use to prevent SI and, at a very basic level, the "knack" of how to contract them volitionally. In Phase I we will use a randomized, three group (60+60+60), controlled trial to quantify, for the first time, the effect of education on treating SI. We will recruit at least 180 elderly 65-84 years) parous community-dwelling women with moderate SI (1-3 wetting episodes/day) for this study. A specific education group (ED group, n=60) will be followed over three months in order to determine whether outcome measures, including the number of daily wetting episodes and leak point pressures, show significant changes relative to a wait-listed no-treatment (NT, n=60) control group. We will also determine whether a three month KE intervention (KE group, n=60), which includes exercise to strengthen the LA in addition to the ED program, results in a significantly better outcome at three and six months follow-up than ED alone. ED & KE group LA strength changes will be quantified using an instrumented speculum. All three groups will be stratified by general education and physical activity levels in order to evaluate their effects on outcome. In Phase II we will conduct development studies to enhance Phase I intervention effectiveness by determining the use-acceptance of weighted vaginal cones for (a) learning to contract the LA and (b) strengthening the LA muscles.