스트레스 요실질: 기침이나 웃을 때 소변이 새는 경우

마지막 업데이트: 2026년 8월 15일

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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.

• 비뇨기과 센터 태국 방콕 병원 온라인 예약 02-310-3009 bhquro@bdms.co.th
• 사미티브 스리라차 병원 촌부리 088-022-1445

주요 원인 2가지 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:

• 비만 — the pelvic floor carries the weight of everything above it, and excess abdominal weight increases that load year after year.
• 폐경 — estrogen maintains the blood supply and lining of the urethra; when it falls, the urethra seals less effectively.
• 임신 — 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.
• 만성 기침과 변비 — 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 절박성 요실금 are treated completely differently — and many women have both at once.

Where the picture is mixed or the symptoms do not fit neatly, a 요역동학 검사 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

• 요도 팽창제 주입 — 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.

스트레스성 요실금 증상이 있고 전문적인 평가를 원하시면, Soarawee Weerasopone 박사님이 방콕 병원 본원에서 전문 상담을 제공합니다. 진료 예약. 사미즈 시라차 병원 예약은 비뇨기과로 전화하여 하실 수 있습니다. 088-022-1445.

복압성 요실금에 대한 자주 묻는 질문

복압성 요실금은 왜 발생할까요?

SUI는 요도를 정상적으로 닫는 골반저 근육과 요도 괄약근의 약화 또는 손상으로 인해 발생합니다. 두 가지 주요 원인은 다음과 같습니다. (1) 골반저 근육 기능 장애 — 비만, 폐경, 임신, 질 분만 손상 또는 만성 기침/변비로 인한 경우; (2) 이전 골반 수술로 인한 신경근 손상 — 특히 남성의 근치적 전립선 절제술 또는 여성의 주요 부인과 수술. 배뇨 조절 메커니즘을 약화시키는 모든 요인은 복강 내압이 상승할 때 소변이 새어 나오게 합니다.

케겔 운동이 요실금에 정말 도움이 되나요?

네 — 케겔 운동은 복압성 요실금(SUI)의 가장 중요한 초기 치료법입니다. 올바르게 꾸준히 수행하면(하루 세 번, 10초씩 10회 수축, 3세트), 요도를 지지하는 골반저 근육을 강화합니다. 경증에서 중등도의 복압성 요실금이 있는 많은 환자들은 약물이나 수술 없이 오직 케겔 훈련만으로도 상당한 개선 또는 완전한 요실금 방지를 달성합니다. 결과는 일반적으로 꾸준한 연습 후 6~12주 후에 눈에 띄기 시작합니다. 물리치료사나 골반저 전문가는 올바른 기술을 확인할 수 있습니다.

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.

스트레스성 요실금 수술은 언제 고려해야 합니까?

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.

고지 사항: 이 콘텐츠는 방콕병원 본원의 공인 비뇨기과 전문의인 소라위 위라소폰(Soarawee Weerasopone) 박사가 작성하고 검토했습니다. 교육 목적으로만 제공되며 의학적 조언에 해당하지 않습니다. 개인 메시징 채널을 통해 의학적 조언, 진단 또는 처방은 제공되지 않습니다. 의학적 치료를 시작하기 전에 항상 자격을 갖춘 의료 전문가와 상담하십시오.