压力性尿失禁：咳嗽或大笑时漏尿

最后更新： 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.

• 曼谷医院泌尿外科中心 泰国 在线预订 02-310-3009 bhquro@bdms.co.th
• 春武里府斯里拉查（Samitivej Sriracha）医院 088-022-1445

两大原因 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:

• 肥胖 — the pelvic floor carries the weight of everything above it, and excess abdominal weight increases that load year after year.
• 绝经 — estrogen maintains the blood supply and lining of the urethra; when it falls, the urethra seals less effectively.
• 怀孕 — 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.
• 慢性咳嗽与便秘 — 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 尿失禁 are treated completely differently — and many women have both at once.

Where the picture is mixed or the symptoms do not fit neatly, a 尿动力学检查 measures how the bladder and urethra behave during filling and during a rise in pressure, which settles it. Soarawee 医生在曼谷医院总部进行尿动力学检查。.

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. 药物治疗——二线

• 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

• 尿道填充剂注射液 — 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.

如果您正经历压力性尿失禁并希望获得专家评估，Soarawee Weerasopone 医生将在曼谷医院总部提供专家咨询。. 预约咨询. 如需预约三美泰是拉差医院，请致电泌尿科： 088-022-1445.

压力性尿失禁常见问题解答

尿失禁的诱因是什么？

尿失禁是由盆底肌肉和尿道括约肌的无力或损伤引起的，它们通常在腹腔内压力增加时保持尿道关闭。主要有两个原因：（1）盆底肌肉功能障碍——由肥胖、更年期、怀孕、阴道分娩损伤或慢性咳嗽/便秘引起；（2）先前盆腔手术引起的神经肌肉损伤——特别是男性前列腺根治术或女性大型妇科手术。任何削弱控制机制的因素，都会在腹腔内压力升高时导致尿液漏出。.

凯格尔运动真的有助于缓解压力性尿失禁吗？

是的——凯格尔运动是尿失禁最重要的一线治疗方法。当正确且持续地进行（每天三次，每次三组，每组重复10次，每次收缩保持10秒）时，它们可以加强支撑尿道的盆底肌肉。许多轻中度尿失禁患者仅通过专门的凯格尔训练就能获得显著改善或完全控制，而无需药物或手术。通常在持续练习6-12周后就能看到效果。物理治疗师或盆底专家可以确认正确的技巧。.

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.

当出现以下情况时，应考虑对压力性尿失禁进行手术治疗： * **保守治疗无效。** 试过盆底肌肉锻炼（凯格尔运动）、生活方式改变（如减肥、戒烟）、使用阴道支撑器等保守方法，但症状没有改善或仍然对生活质量造成严重影响。 * **症状严重影响生活质量。** 即使保守治疗取得一定效果，但尿失禁的程度仍然很严重，导致患者回避社交活动、运动，并且感到尴尬和沮丧。 * **有潜在的解剖结构异常。** 例如，盆腔器官脱垂（子宫、膀胱或直肠下垂）可能需要手术纠正，尿失禁有时是伴随的症状。 * **患者有能力且愿意接受手术。** 手术需要一定的恢复时间，患者需要了解手术的风险、益处和术后护理。 通常，手术是作为尿失禁的最后治疗选择。医生会根据患者的具体情况、症状的严重程度、合并症以及患者的意愿来决定是否以及何时推荐手术。

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.

免责声明 本文由曼谷医院总院的董事会认证泌尿科医师索拉维·维拉索蓬（Soarawee Weerasopone）博士撰写并审核。本内容仅供教育目的，不构成医疗建议。通过私人消息渠道不提供任何医疗建议、诊断或处方。在开始任何医疗治疗之前，请务必咨询合格的医疗保健专业人员。.