腹圧性尿失禁：咳や笑った時の尿もれ

最終更新日： 2026年8月15日

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Stress urinary incontinence (SUI) is leakage that happens when pressure inside the abdomen rises — coughing, laughing, sneezing, exercising, lifting something heavy. It affects around 15% of adult women, and the statistic that matters more is the second one: only about 60% of them ever seek treatment.

That gap is the reason for this article. Women stop running, avoid trampolines with their children, plan outings around toilets and carry spare underwear — all for a condition that is common, well understood and treatable. There is nothing shameful in it, and nothing inevitable about it either.

• 泌尿器センター バンコク病院 タイ オンライン予約 02-310-3009 bhquro@bdms.co.th
• サミティジ・シラチャ病院 チョンブリ 088-022-1445

二大原因 stress urinary incontinence

1. Pelvic floor dysfunction

The pelvic floor muscles are the hammock that keeps the urethra closed when pressure rises. Anything that weakens or damages them can cause SUI:

• 肥満 — the pelvic floor carries the weight of everything above it, and excess abdominal weight increases that load year after year.
• 更年期 — estrogen maintains the blood supply and lining of the urethra; when it falls, the urethra seals less effectively.
• 妊娠 — each pregnancy loads the pelvic floor, and the risk rises with the number of them.
• Vaginal delivery — some pelvic floor trauma is unavoidable as the baby passes through, particularly where there is a perineal tear.
• 慢性咳嗽と便秘 — repeated pressure spikes, day after day, wear the pelvic floor down. Both are treatable, which makes them the most modifiable items on this list.

2. Nerve or muscle damage from previous pelvic surgery

Major pelvic surgery can disrupt the continence mechanism directly. In men, radical prostatectomy for prostate cancer is the usual context — worth saying plainly, because SUI is often thought of as a women’s condition and men who develop it afterwards are frequently unprepared for it.

Getting the diagnosis right first

Assessment covers a full history, physical examination and appropriate tests. The important thing it establishes is which kind of incontinence you actually have, because stress incontinence and 失禁を促す are treated completely differently — and many women have both at once.

Where the picture is mixed or the symptoms do not fit neatly, a 尿流動態検査 measures how the bladder and urethra behave during filling and during a rise in pressure, which settles it. Dr. Soarawee performs urodynamic studies at Bangkok Hospital Headquarters.

Treatment, in order

1. Behavioural measures — first line

• Kegel (pelvic floor) exercises — 3 sets of 10 contractions, each held for 10 seconds, three times a day. Two things are worth knowing before you start: improvement takes 6–12 weeks, so early disappointment is normal rather than failure; and a great many women contract the wrong muscles, so having the technique checked by a pelvic floor physiotherapist is time well spent.
• Timed voiding — emptying on a schedule so the bladder is never full when the pressure rises.
• Weight loss and treating a chronic cough or constipation — unglamorous, and they remove the force that is causing the leakage in the first place.
• Pessary — useful where examination shows anatomical prolapse contributing to the problem.

2. Medication — second line

• Duloxetine — increases the closing pressure of the urethral sphincter. Note that it is licensed for stress incontinence in some countries and not others, so availability varies.
• Topical vaginal estrogen — restores the urethral lining after the menopause; the same treatment also reduces recurrent urinary infections in this group.
• Anticholinergics — these do not treat stress incontinence itself. They are used where there is a coexisting overactive bladder component, which is why establishing the type first matters.

3. Surgery — definitive

• 尿道増量剤注射 — less invasive, suitable for selected patients, with a shorter recovery.
• Mid-urethral sling (MUS) — the gold standard for female SUI, with high long-term success rates.

Surgery is considered once behavioural measures and medication have been given a fair trial, or where the leakage is severe enough that starting there makes more sense. Neither the mid-urethral sling nor urethral bulking agent injection is performed at Bangkok Hospital Headquarters — if your case reaches that point, a referral to a centre that provides them can be arranged. Everything up to that decision, including the assessment, the urodynamic study and the medical treatment, can be done here.

ストレス性尿失禁に悩んでおり、専門医による評価をご希望の場合は、ソアラウィー・ウィーラソポーン医師がバンコク病院本院で専門的診察を行っております。. 診療をご予約. サミティウェート・シーラチャ病院のご予約は、泌尿器科（電話番号：）までお問い合わせください。 088-022-1445.

ストレス性尿失禁に関するよくある質問

腹圧性尿失禁の原因は何ですか？

SUIは、通常、腹圧上昇時に尿道を閉じたままにする骨盤底筋と尿道括約筋の弱化または損傷によって引き起こされます。主な原因は2つあります。(1) 骨盤底筋機能不全 — 肥満、更年期、妊娠、膣分娩時の外傷、または慢性的な咳/便秘によるもの。(2) 過去の骨盤手術による神経筋損傷 — 特に男性の前立腺全摘除術や女性の主要な婦人科手術。尿失禁メカニズムを弱める要因は、腹圧が上昇したときに尿が漏れることを許します。.

ケーゲル運動は、腹圧性尿失禁に本当に効果がありますか？

はい、ケーゲル体操はSUI（腹圧性尿失禁）の最も重要な第一線治療法です。正しく継続して（10秒間保持する収縮を3セット、1日3回）行うことで、尿道を支える骨盤底筋を強化します。軽度から中等度のSUIの患者さんの多くは、投薬や手術を必要とせずに、ケーゲル体操トレーニングのみで著しい改善や完全な尿失禁の解決を達成しています。通常、6〜12週間の継続的な練習で効果が実感できるようになります。理学療法士や骨盤底専門医が正しいテクニックを確認できます。.

How is stress incontinence told apart from urge incontinence?

Stress incontinence leaks on physical effort — coughing, laughing, lifting — with no warning urge. Urge incontinence leaks after a sudden compelling need to pass urine. The distinction matters because the treatments differ completely, and many women have both, which is called mixed incontinence. Where the history is unclear or symptoms are mixed, a urodynamic study measures bladder and urethral behaviour during filling and straining, and establishes which mechanism is dominant.

ストレス性尿失禁に対して手術を検討すべき時期はいつですか？

Surgery is recommended when behavioral therapy and medications have not provided adequate symptom control, or when the SUI is severe enough to significantly affect daily life. The mid-urethral sling (MUS) procedure is the gold standard surgical treatment for female SUI, and urethral bulking agent injection is a less invasive intermediate option. Neither procedure is performed at Bangkok Hospital Headquarters; assessment, urodynamic study and medical treatment are provided here, and a referral to a centre offering surgery can be arranged when it is needed.

免責事項 この記事は、バンコク病院本部のボード認定泌尿器科医であるソアラウィー・ウィーラソポン医師（Dr. Soarawee Weerasopone）によって執筆および監修されています。教育目的のみを意図しており、医学的なアドバイスを構成するものではありません。個人的なメッセージチャンネルを通じて、医学的なアドバイス、診断、処方箋が提供されることはありません。医療処置を開始する前に、必ず資格を持った医療従事者にご相談ください。.