icon fsr

文献詳細

雑誌文献

理学療法ジャーナル48巻5号

2014年05月発行

文献概要

特集 老年症候群と理学療法 老年症候群と理学療法

4.理学療法で頻尿・失禁や便秘は改善するか?

著者: 橋立博幸1

所属機関: 1杏林大学保健学部理学療法学科

ページ範囲:P.423 - P.432

文献購入ページに移動
はじめに

 尿失禁,頻尿,便秘は加齢とともに増加する1)老年症候群の症状であり,疾患の罹患によって助長される排泄障害である.これらの排泄障害は,日常生活活動制限,社会参加制約を引き起こし,生活の質の低下や閉じこもりを招くとともに家族介護者の介護負担増加の要因となる2).そのため,排泄障害の効果的・効率的な改善は超高齢社会において継続的に求められる課題である.排泄障害を有する高齢者を対象とした理学療法では,排泄動作にかかわる動作障害への介入3)とともに,尿失禁や便秘の症状そのものの改善に資する介入を積極的に推進していくことが望ましい4)

 本稿では,老年症候群を有する高齢者の尿失禁と便秘に対して理学療法士がどのような手段で改善を図ることができる可能性があるか,病態を整理しつつ近年の研究報告を交えて述べることとする.

参考文献

1)厚生労働省大臣官房統計情報部社会統計課国民生活基礎調査室:平成22年度国民生活基礎調査の概況.厚生の指標58:37-52,2011
2)中田晴美:尿失禁予防プログラム.鈴木隆雄,他(監):続 介護予防完全マニュアル,財団法人東京都福祉保健財団,65-89,2005
3)末廣健児,他:トイレ動作について考える.関西理学療法8:7-11,2008
4)平川倫恵:腹圧性尿失禁に対する運動療法.理学療法学37:292-293,2010
5)泌尿器科領域の治療標準化に関する研究班:EBMに基づく尿失禁診療ガイドライン,じほう,2004
6)Diokno AC, et al:Prevention of urinary incontinence by behavioral modification program:a randomized controlled trial among older women in the community. J Urol 171:1165-1171, 2004
7)Creason NS, et al:Prompted voiding therapy for urinary incontinence in aged female nursing home residents. J Adv Nurs 14:120-126, 1989
8)Hu TW, et al:A clinical trial of a behavioral therapy to reduce urinary incontinence in nursing homes. Outcome and implications. JAMA 261:2656-2662, 1989
9)Schnelle JF:Treatment of urinary incontinence in nursing home patients by prompted voiding. J Am Geriatr Soc 38:356-360, 1990
10)Colling J, et al:The effects of patterned urge-response toileting(PURT)on urinary incontinence among nursing home residents. J Am Geriatr Soc 40:135-141, 1992
11)Jarvis GJ, et al:The treatment of incontinence due to detrusor instability by bladder drill. Prog Clin Biol Res 78:341-343, 1981
12)Jarvis GJ:A controlled trial of bladder drill and drug therapy in the management of detrusor instability. Br J Urol 53:565-566, 1981
13)Fantl JA, et al:Efficacy of bladder training in older women with urinary incontinence. JAMA 265:609-613, 1991
14)National Institute for Health and Care Excellence. Urinary incontinence in women:the management of urinary incontinence in women.(Clinical guideline 171.). 2013. http://guidance.nice.org.uk/CG171(2014年2月15日閲覧)
15)Smith A, et al:Management of urinary incontinence in women:summary of updated NICE guidance. BMJ 10:347:f5170, 2013
16)Burgio KL:Update on behavioral and physical therapies for incontinence and overactive bladder:the role of pelvic floor muscle training. Curr Urol Rep 14:457-464, 2013
17)Johnson TM 2nd, et al:Effects of behavioral and drug therapy on nocturia in older incontinent women. J Am Geriatr Soc 53:846-850, 2005
18)Johnson TM, et al:Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia. BJU Int 112:100-108, 2013
19)Klarskov P, et al:Pelvic floor exercise versus surgery for female urinary stress incontinence. Urol Int 41:129-132, 1986
20)Bø K, et al:Pelvic floor muscle exercise for the treatment of female stress urinary incontinence:Ⅲ. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn 9:489-502, 1990
21)Wells TJ, et al:Pelvic muscle exercise for stress urinary incontinence in elderly women. J Am Geriatr Soc 39:785-791, 1991
22)Gallo ML, et al:Cues to action:pelvic floor muscle exercise compliance in women with stress urinary incontinence. Neurourol Urodyn 16:167-177, 1997
23)Bø K, et al:Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 318:487-493, 1999
24)Nygaard IE, et al:Efficacy of pelvic floor muscle exercises in women with stress, urge, and mixed urinary incontinence. Am J Obstet Gynecol 174:120-125, 1996
25)Burgio KL, et al:Behavioral vs drug treatment for urge urinary incontinence in older women:a randomized controlled trial. JAMA 280:1995-2000, 1998
26)Paterson J, et al:Pelvic floor exercises as a treatment for post-micturition dribble. Br J Urol 79:892-897, 1997
27)Bump RC, et al:Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 165:322-327, 1991
28)Miller JM, et al:A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc 46:870-874, 1998
29)田舎中真由美:泌尿器系障害に対する理学療法.理学療法21:843-847,2004
30)Weiss JP, et al:The evaluation and treatment of nocturia:a consensus statement. BJU Int 108:6-21, 2011
31)Weiss JP, et al:The New England Research Institutes, Inc.(NERI)Nocturia Advisory Conference 2012:focus on outcomes of therapy. BJU Int 111:700-716, 2013
32)Koffler KH, et al:Strength training accelerates gastrointestinal transit in middle-aged and older men. Med Sci Sports Exerc 24:415-419, 1992
33)Moses FM:The effect of exercise on the gastrointestinal tract. Sports Med 9:159-172, 1990
34)Rao SS, et al:Effects of acute graded exercise on human colonic motility. Am J Physiol 276:G1221-G1226, 1999
35)De Schryver AM, et al:Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation. Scand J Gastroenterol 40:422-429, 2005
36)高野正博:直腸肛門機能障害の位置づけ―新しいROME Ⅲとの関連について.日本大腸肛門病会誌60:889-894,2007
37)味村俊樹:ナースが感じる排便ケアの疑問―便秘への骨盤底筋体操の効果について.泌尿器ケア18:40-44,2013
38)Brouns F, et al:Is the gut an athletic organ? Digestion, absorption and exercise. Sports Med 15:242-257, 1993
39)佐々木大輔:排便機構と排便障害.総合リハ33:109-113,2005
40)槌野正裕,他:排泄機能と姿勢に関する研究―理学療法士として排泄姿勢に関与して.日ストーマ・排泄会誌24:34-38,2008
41)Ayaş S, et al:The effect of abdominal massage on bowel function in patients with spinal cord injury. Am J Phys Med Rehabil 85:951-955, 2006
42)Harrington KL, et al:Managing a patient's constipation with physical therapy. Phys Ther 86:1511-1519, 2006
43)Brookes SJ, et al:Initiation of peristalsis by circumferential stretch of flat sheets of guinea pig ileum. J Physiol 516:525-538, 1999
44)Liu Z, et al:Mechanism of abdominal massage for difficult defecation in a patient with myelopathy. J Neurol 252:1280-1282, 2005
45)Lämås K, et al:Effects of abdominal massage in management of constipation-a randomized controlled trial. Int J Nurs Stud 46:759-767, 2009
46)Sinclair M:The use of abdominal massage to treat chronic constipation. J Bodyw Mov Ther 15:436-445, 2011
47)細田誠弥:生活習慣と排便異常.順天堂医学50:330-337,2004

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1359

印刷版ISSN:0915-0552

雑誌購入ページに移動
icon up
あなたは医療従事者ですか?