The term urge incontinence describes a sudden, strong urge to urinate followed by involuntary loss of urine. Urge incontinence is very stressful for those affected and should definitely be clarified.
You can find out below which doctor treats urge incontinence and what the therapy looks like
Urge incontinence or urge urinary incontinence is a typical symptom of bladder dysfunction. It is also described by the term "overactive bladder". The terms refer to a sudden, unsuspected urge to urinate, which can be so strong that it leads to involuntary loss of urine.
A typical description of urge incontinence patients is, for example: "When I'm at the front door, already have an urge to urinate and still have to look for the key, the urge gets stronger and stronger and then it happens: I can no longer hold the urine - it goes in my pants - before the door is open."
These people usually have to urinate much more frequently than normal. If they urinate more than eight times in 24 hours, this is called urge incontinence. Their sleep is also considerably disturbed as they have to get up several times during the night to go to the toilet.
With urge incontinence, sufferers have to urinate very suddenly and without warning © doucefleur | AdobeStock
The causes of this form of urinary incontinence, which severely restricts quality of life, lie
In the bladder, a functional disorder of the inner mucous membrane lining (urothelium) of the bladder and the bladder wall muscles can trigger the "overactivity". In this case, increased urge to urinate stimuli (stimulating nerve impulses) flow from the bladder via the spinal cord into the brain. The balance between the stimulating and inhibiting stimuli to the bladder is then disturbed, resulting in an increased urge to urinate.
One example of such a temporary dysfunction of the urothelium is bacterial cystitis.
However, the disorder can also occur in the spinal cord or in the brain itself. The cause can then be other diseases, such as
In this case, the inhibition of the impulses that stimulate the bladder is usually too weak. Urge incontinence therefore occurs even though the bladder itself is still healthy.
If these "centrally" triggered symptoms persist for months or years, the bladder can be severely damaged. Ultimately, the kidneys can also become diseased and severe kidney failure can develop.
Urge incontinence should definitely be clarified. It is sometimes quite difficult to differentiate from stress incontinence (formerly known as stress incontinence). In addition, both clinical pictures often exist together. The treatment methods are very varied, but completely different depending on the type of incontinence.
For this reason, a good and precise analysis of the symptoms and finding the cause(diagnosis) is particularly important. Understandably, urge incontinence patients often want a quick solution to this very stressful problem. However, patience on the part of the doctor and patient is particularly important in the diagnostic process and is very important for the success of the treatment.
Important cornerstones of urge incontinence diagnostics are
As part of a medical history interview, the doctor will ask about, among other things
The patient records the following for several days in a special diary provided by their doctor, together with the time
This recording is often already extremely informative. It is a very important (and painless) examination method, the importance of which is unfortunately often underestimated and neglected.
The physical examination is carried out by a gynecologist or urologist. In particular, it includes an examination of the external genitals and, in women, an examination of the vagina. A brief neurological examination is also carried out.
As part of the imaging diagnostics, an ultrasound examination (sonography) is carried out
In women, a sonography of the vagina (intravaginal sonography) is performed. In men, on the other hand, an ultrasound scan of the rectum (transrectal ultrasound) may be used. An X-ray examination with contrast medium, e.g. of the bladder (cystogram), can also be carried out.
This includes urethroscopy and cystoscopy as well as bladder pressure measurement (cystometry and urodynamics).
Urge incontinence is treated in accordance with the published recommendations (guidelines). They are individually adapted to the circumstances and patient's wishes.
As a rule, the doctor carries out a step-by-step therapy: If one stage of therapy does not have sufficient effect, they move on to the next stage.
The most important modern forms of treatment are briefly described below.
Behavioral training is one of the first measures in step therapy. The doctor first evaluates the micturition diary and then recommends micturition and toilet training.
This is often supported by
The second stage involves drug therapy. Local medication or tablets are available. Women with an age-related oestrogen deficiency, for example, can benefit greatly from local medication such as a topical oestrogen ointment or vaginal suppositories. Hormones can also be administered in tablet form.
Appropriate medication to reduce bladder overactivity (anticholinergics) is also administered in tablet form or as a patch. These must be taken continuously. If the medication is stopped or discontinued, the symptoms return.
These preparations have been continuously developed and improved. Newer generation drugs, which now mainly act directly on the bladder, have significantly fewer side effects. They have no additional effect on the central nervous system(brain).
Some patients are unable or unwilling to take these medications due to unwanted side effects. In this case, botulinum toxin (A) is administered into the bladder as a third treatment option.
The injection is carried out under anesthesia of the lower part of the body or under general anesthesia as part of a cystoscopy. The doctor injects the highly diluted "Botox" into the bladder muscle in 10 to 30 places using a fine, approx. 5 mm long needle.
Botox causes the overactive bladder muscles to relax. The full effect sets in after around one to two weeks and experience has shown that it lasts for around nine months.
The strength of the botulinum toxin effect cannot be precisely controlled. In very rare cases, the bladder can only be emptied with difficulty (with large amounts of residual urine) or not at all. For this reason, all patients who receive this therapy also learn how to perform simple self-catheterization. This means that, if necessary, they drain the urine via a bladder catheter.
Despite this potential inconvenience, more and more people with severe urge incontinence want this very effective treatment.
If the urge symptoms return, the Botox injection into the bladder can be continued as often as required. Side effects on other organs or the entire body have not yet been described.
If this treatment is not possible or not successful, surgical therapy measures such as (sacral) neuromodulation can be considered.
First, test electrodes are attached to the sacrum (lower back at hip level) directly to the nerves supplying the bladder. The effect of the low stimulation current conducted via these electrodes is then determined over approximately five days.
If the urge incontinence improves significantly, the next step follows. The surgeon implants a permanent device in the size and shape of a pacemaker in the subcutaneous fatty tissue of the deep back area.
In some patients, the bladder is severely damaged and structurally already so altered that all other treatment measures are out of the question. If there is still a risk of serious damage to the kidneys, bladder surgery is the last option.
One option is to enlarge the bladder by sewing on the body's own "eliminated" sections (bladder augmentation). These mainly come from the small intestine.
If this is also not feasible, the only other option is to remove the bladder. The urine flow is diverted into an artificial bladder outlet (urostomy, conduit). The artificial bladder outlet is usually attached to the right mid-abdomen.
This last stage of the treatment options mentioned is extremely rarely necessary. The majority of procedures are successful in the first three treatment stages. However, any therapy always requires good cooperation from the patient.
Even if the symptoms improve significantly after treatment, the patient should have regular check-ups. To this end, the patient remains under lifelong specialist urological treatment.
Once a severe structural change in the bladder has occurred as a late consequence of bladder overactivity, it can no longer be reversed. However, in most cases it can be prevented by early detection and treatment.
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