{"id":279402,"date":"2023-05-22T15:10:35","date_gmt":"2023-05-22T14:10:35","guid":{"rendered":"https:\/\/zakrasnejsivimperk.cz\/?p=279402"},"modified":"2023-05-22T15:10:35","modified_gmt":"2023-05-22T14:10:35","slug":"vseobecna-zdravotni-pojistovna-lecba-mocove-inkontinence","status":"publish","type":"post","link":"https:\/\/zakrasnejsivimperk.cz\/?p=279402","title":{"rendered":"V\u0160EOBECN\u00c1 ZDRAVOTN\u00cd POJI\u0160\u0164OVNA: L\u00e9\u010dba mo\u010dov\u00e9 inkontinence"},"content":{"rendered":"

\"\"<\/p>\n

OT\u00c1ZKA T\u00ddDNE:<\/h6>\n
Jak prob\u00edh\u00e1 l\u00e9\u010dba mo\u010dov\u00e9 inkontinence?<\/h6>\n
ODPOV\u011a\u010e:<\/h6>\n
Mo\u010dov\u00e1 inkontinence je stav, kdy doch\u00e1z\u00ed k samovoln\u00e9mu neovladateln\u00e9mu \u00faniku mo\u010di z d\u016fvodu poruchy funkce mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e a\/nebo sv\u011bra\u010de mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e. Incidence v populaci nar\u016fst\u00e1 s v\u011bkem, nicm\u00e9n\u011b m\u016f\u017ee postihovat i mlad\u0161\u00ed pacienty. <\/strong><\/h6>\n

\u010cast\u011bji mo\u010dovou inkontinenc\u00ed trp\u00ed \u017eeny. I kdy\u017e inkontinence mo\u010di v r\u016fzn\u00e9 m\u00ed\u0159e ovliv\u0148uje kvalitu \u017eivota pacient\u016f a zasahuje jim do ka\u017edodenn\u00edch aktivit, mnoho lid\u00ed se ost\u00fdch\u00e1 tento probl\u00e9m \u0159e\u0161it se sv\u00fdm o\u0161et\u0159uj\u00edc\u00edm l\u00e9ka\u0159em nebo specialistou.<\/p>\n

Z\u00e1kladem spr\u00e1vn\u00e9 l\u00e9\u010dby mo\u010dov\u00e9 inkontinence je p\u0159esn\u00e9 zji\u0161t\u011bn\u00ed p\u0159\u00ed\u010diny a jak\u00fdm typem inkontinence pacient trp\u00ed<\/b>\u00a0(inkontinence stresov\u00e1, urgentn\u00ed, sm\u00ed\u0161en\u00e1, funk\u010dn\u00ed, tot\u00e1ln\u00ed, inkontinence z\u00a0p\u0159epln\u011bn\u00ed). Inkontinence m\u016f\u017ee b\u00fdt tak\u00e9 projevem jin\u00e9ho onemocn\u011bn\u00ed \u2013 nap\u0159. Alzheimerovy \u010di\u00a0Parkinsonovy choroby, demence, roztrou\u0161en\u00e9 skler\u00f3zy. Souviset tak\u00e9 m\u016f\u017ee s\u00a0diabetem, obezitou, porodem, menopauzou, u\u00a0mu\u017e\u016f se zv\u011bt\u0161enou prostatou.<\/p>\n

V mnoha p\u0159\u00edpadech se d\u00e1 inkontinence l\u00e9\u010dit nebo zm\u00edrnit r\u016fzn\u00fdmi l\u00e9\u010debn\u00fdmi metodami, jako jsou cviky sval\u016f p\u00e1nevn\u00edho dna, medikament\u00f3zn\u00ed terapie nebo p\u0159\u00edpadn\u011b opera\u010dn\u00ed \u0159e\u0161en\u00ed. Ke stanoven\u00ed vhodn\u00e9 metody l\u00e9\u010dby je nutn\u00e9 specializovan\u00e9 vy\u0161et\u0159en\u00ed urologem.<\/p>\n

Z\u00e1kladn\u00ed vy\u0161et\u0159en\u00ed a stanoven\u00ed p\u0159\u00ed\u010diny<\/b><\/h6>\n

Prvotn\u00ed vy\u0161et\u0159en\u00ed mo\u010dov\u00e9 inkontinence provede v\u0161eobecn\u00fd praktick\u00fd l\u00e9ka\u0159<\/b>.\u00a0Nejprve s\u00a0pacientem projde jeho osobn\u00ed anamn\u00e9zu<\/b>\u00a0(informace t\u00fdkaj\u00edc\u00ed se \u00faniku mo\u010di, p\u0159idru\u017een\u00e1 onemocn\u011bn\u00ed, absolvovan\u00e9 operace, \u00farazy \u010di porody, u\u017e\u00edvan\u00e9 l\u00e9ky atd.)\u00a0s\u00a0c\u00edlem zjistit p\u0159\u00ed\u010dinu inkontinence, ur\u010dit typ inkontinence, stanovit stupe\u0148 jej\u00ed z\u00e1va\u017enosti a p\u0159ipravit pl\u00e1n v\u0161ech n\u00e1sledn\u00fdch vy\u0161et\u0159en\u00ed<\/b>. Role praktick\u00e9ho l\u00e9ka\u0159e je d\u016fle\u017eit\u00e1 \u2013 posoud\u00ed m\u00edru zdravotn\u00edch obt\u00ed\u017e\u00ed pacienta a rozhodne, zda ho bude l\u00e9\u010dit s\u00e1m nebo zda jsou nutn\u00e1 dal\u0161\u00ed vy\u0161et\u0159en\u00ed u specialisty.<\/p>\n

Urologick\u00e9 vy\u0161et\u0159en\u00ed<\/b><\/h6>\n

V\u00a0p\u0159\u00edpad\u011b, \u017ee\u00a0praktick\u00fd l\u00e9ka\u0159 doporu\u010d\u00ed pacienta do p\u00e9\u010de specialisty\u00a0<\/b>\u2013\u00a0<\/b>ode\u0161le ho\u00a0k\u00a0urologovi, gynekologovi nebo urogynekologovi.<\/b>\u00a0Urologick\u00e9 vy\u0161et\u0159en\u00ed zah\u00e1j\u00ed l\u00e9ka\u0159 specialista vstupn\u00edm pohovorem \u2013 tzn.\u00a0b\u011bhem podrobn\u00e9ho anamnestick\u00e9ho rozhovoru zji\u0161\u0165uje<\/b>\u00a0(stejn\u011b tak jako praktick\u00fd l\u00e9ka\u0159)\u00a0ve\u0161ker\u00e9 pot\u0159ebn\u00e9 informace o pacientov\u011b zdravotn\u00edm stavu a jeho zdravotn\u00edch obt\u00ed\u017e\u00edch<\/b>\u00a0(viz\u00a0v\u00fd\u0161e).<\/p>\n

L\u00e9ka\u0159 m\u016f\u017ee po\u017e\u00e1dat pacienta tak\u00e9 o vypln\u011bn\u00ed speci\u00e1ln\u00edho dotazn\u00edku a veden\u00ed tzv. Mik\u010dn\u00edho den\u00edku \u2013 jedn\u00e1 se o n\u011bkolikadenn\u00ed z\u00e1znam p\u0159\u00edjmu a v\u00fddeje tekutin (pitn\u00e9ho re\u017eimu), \u010dasu mo\u010den\u00ed, frekvenci mo\u010den\u00ed, po\u010dtu \u00fanik\u016f mo\u010di a z\u00e1va\u017enosti nucen\u00ed na mo\u010den\u00ed.\u00a0Mik\u010dn\u00ed den\u00edk napom\u00e1h\u00e1 v\u00a0hodnocen\u00ed pacientov\u00fdch obt\u00ed\u017e\u00ed.<\/b><\/p>\n

N\u00e1sleduje fyzik\u00e1ln\u00ed vy\u0161et\u0159en\u00ed<\/b>, kdy specialista vy\u0161et\u0159\u00ed pacienta pohledem, pohmatem, poklepem na\u00a0mo\u010dov\u00fd m\u011bch\u00fd\u0159 a u mu\u017e\u016f provede vy\u0161et\u0159en\u00ed prostaty per rectum.\u00a0Sou\u010d\u00e1st\u00ed je stanoven\u00ed BMI a\u00a0posouzen\u00ed mobility pacienta<\/b>. D\u00e1le k\u00a0z\u00e1kladn\u00edm vy\u0161et\u0159en\u00edm pat\u0159\u00ed\u00a0laboratorn\u00ed vy\u0161et\u0159en\u00ed krve a mo\u010di<\/b>\u00a0(bakteriologick\u00e9 vy\u0161et\u0159en\u00ed mo\u010di a mo\u010dov\u00e9ho sedimentu).<\/p>\n

K\u00a0potvrzen\u00ed \u010di up\u0159esn\u011bn\u00ed diagn\u00f3zy m\u016f\u017ee b\u00fdt vyu\u017eita tak\u00e9 sonografie<\/b>\u00a0(ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed) mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e a ledvin z d\u016fvodu zhodnocen\u00ed kapacity mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e a mno\u017estv\u00ed mo\u010di, kter\u00e1 z\u016fst\u00e1v\u00e1 v\u00a0mo\u010dov\u00e9m m\u011bch\u00fd\u0159i po vymo\u010den\u00ed, pop\u0159\u00edpad\u011b k vylou\u010den\u00ed kamen\u016f atd.\u00a0V\u00a0p\u0159\u00edpad\u011b pot\u0159eby mohou b\u00fdt provedena dal\u0161\u00ed specializovan\u00e1 vy\u0161et\u0159en\u00ed\u00a0<\/b>\u2013 nap\u0159. urodynamick\u00e9 vy\u0161et\u0159en\u00ed, stress test, kalibrace mo\u010dov\u00e9 trubice, cystoskopick\u00e9 vy\u0161et\u0159en\u00ed\u00a0\u010di uroflowmetrie (vy\u0161et\u0159en\u00ed proudu mo\u010de).<\/p>\n

Typy l\u00e9\u010dby<\/b><\/h6>\n

L\u00e9\u010dba mo\u010dov\u00e9 inkontinence je komplexn\u00ed, v\u017edy se odv\u00edj\u00ed od zdravotn\u00edho stavu pacienta a\u00a0konkr\u00e9tn\u00edho typu inkontinence.<\/b>\u00a0Po zhodnocen\u00ed p\u0159\u00ed\u010diny a\u00a0diagnostice l\u00e9ka\u0159 zvol\u00ed vhodn\u00fd l\u00e9\u010debn\u00fd p\u0159\u00edstup \u2013 konzervativn\u00ed, farmakologick\u00fd, operativn\u00ed.\u00a0Z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed jsou hrazena ve\u0161ker\u00e1 vy\u0161et\u0159en\u00ed indikovan\u00e1 o\u0161et\u0159uj\u00edc\u00edm l\u00e9ka\u0159em. Vy\u0161et\u0159en\u00ed a odb\u011bry je nutn\u00e9 prov\u00e9st ve\u00a0smluvn\u00edch zdravotnick\u00fdch za\u0159\u00edzen\u00edch\u00a0<\/b>(tzn. u poskytovatele zdravotn\u00edch slu\u017eeb, kter\u00fd m\u00e1 smlouvu se zdravotn\u00ed poji\u0161\u0165ovnou pacienta).<\/p>\n

Konzervativn\u00ed l\u00e9\u010dba<\/u><\/strong><\/p>\n

Z\u00e1kladem konzervativn\u00ed l\u00e9\u010dby je zm\u011bna \u017eivotospr\u00e1vy, sn\u00ed\u017een\u00ed t\u011blesn\u00e9 hmotnosti, kontrola p\u0159\u00edjmu tekutin, stop kou\u0159en\u00ed, omezen\u00ed nadm\u011brn\u00e9 fyzick\u00e9 z\u00e1t\u011b\u017ee, vyl\u00e9\u010den\u00ed infekce doln\u00edch mo\u010dov\u00fdch cest. Konzervativn\u00ed l\u00e9\u010dba vy\u017eaduje aktivn\u00ed zapojen\u00ed pacienta do l\u00e9\u010debn\u00e9ho procesu. D\u016fle\u017eitou sou\u010d\u00e1st\u00ed konzervativn\u00ed l\u00e9\u010dby je tak\u00e9 rehabilitace p\u00e1nevn\u00edho dna, tedy fyzioterapeutick\u00e9 postupy s\u00a0c\u00edlem odstranit nebo zm\u00edrnit dysfunkci a oslaben\u00ed sval\u016f p\u00e1nevn\u00edho dna.<\/p>\n

Farmakologick\u00e1 l\u00e9\u010dba<\/u><\/strong><\/p>\n

Tak\u00e9 preskripce l\u00e9k\u016f se odv\u00edj\u00ed od konkr\u00e9tn\u00edho typu mo\u010dov\u00e9 inkontinence. L\u00e9ka\u0159 m\u016f\u017ee p\u0159edepsat nap\u0159. \u010d\u00edpky, vagin\u00e1ln\u00ed tablety nebo kr\u00e9m, \u017een\u00e1m v\u00a0menopauze hormon\u00e1ln\u00ed substitu\u010dn\u00ed l\u00e9\u010dbu.<\/p>\n

Operativn\u00ed l\u00e9\u010dba<\/u><\/strong><\/p>\n

K\u00a0operativn\u00ed l\u00e9\u010db\u011b se p\u0159istupuje v\u00a0p\u0159\u00edpadech, kdy konzervativn\u00ed l\u00e9\u010dba nebyla \u00fa\u010dinn\u00e1. Z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed je hrazena nap\u0159. operace tzv. tahuprostou p\u00e1skou (retropubick\u00e1 \u2013 TVT nebo transobtur\u00e1torov\u00e1 \u2013 TOT). Jedn\u00e1 se o miniinvazivn\u00ed chirurgick\u00fd v\u00fdkon s n\u00edzk\u00fdm rizikem komplikac\u00ed a\u00a0rychlou rekonvalescenc\u00ed pacienta. Pokud pacient trp\u00ed st\u0159edn\u011b t\u011b\u017ekou nebo t\u011b\u017ekou inkontinenc\u00ed m\u016f\u017ee mu b\u00fdt operativn\u011b implantov\u00e1n um\u011bl\u00fd sv\u011bra\u010d mo\u010dov\u00e9 trubice.<\/p>\n

Inkontinen\u010dn\u00ed pom\u016fcky<\/b><\/h6>\n

V\u00a0p\u0159\u00edpad\u011b pot\u0159eby \u010di selh\u00e1v\u00e1n\u00ed l\u00e9\u010dby m\u016f\u017ee o\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159 pacientovi p\u0159edepsat inkontinen\u010dn\u00ed pom\u016fcky (vlo\u017eky, vlo\u017en\u00e9 pleny \u010di plenkov\u00e9 kalhotky). Inkontinentn\u00ed pacient m\u00e1 n\u00e1rok na \u00fahradu absorp\u010dn\u00edch zdravotnick\u00fdch prost\u0159edk\u016f z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed (viz\u00a0podm\u00ednky preskripce a spolu\u00fa\u010dasti pacienta<\/a>).<\/strong><\/p>\n

 <\/p>\n

(tz-vzp)<\/strong><\/p>\n

\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

OT\u00c1ZKA T\u00ddDNE: <\/p>\n","protected":false},"author":2,"featured_media":279403,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"gallery","meta":{"footnotes":""},"categories":[88],"tags":[],"jetpack_featured_media_url":"https:\/\/zakrasnejsivimperk.cz\/wp-content\/uploads\/2023\/05\/22\/ram-vzp.jpg","_links":{"self":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/279402"}],"collection":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=279402"}],"version-history":[{"count":1,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/279402\/revisions"}],"predecessor-version":[{"id":279404,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/posts\/279402\/revisions\/279404"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=\/wp\/v2\/media\/279403"}],"wp:attachment":[{"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=279402"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=279402"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/zakrasnejsivimperk.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=279402"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}