Urinary incontinence, or bladder weakness, is the term used to describe the involuntary loss of urine. There are various types of urinary incontinence. The most common types are urge incontinence, stress incontinence, and overflow incontinence. Urinary incontinence is more common in women, as anatomical differences can play a role.
Here you will find further information as well as a selection of specialists and centers for urinary incontinence.
Urinary incontinence refers to the involuntary loss of urine and can occur in various forms, including stress, urge, and exertional incontinence. In addition to urine leakage, typical symptoms of urinary incontinence include a recurring urge to urinate. The doctor also determines the cause of urinary incontinence in order to initiate appropriate measures and uses tests such as dipstick tests, ultrasound, a cough test, or urodynamic testing. Treatment is recommended if the patient feels that her quality of life is impaired. Depending on the type of incontinence, treatment may consist of medication, physical therapy, or even surgery.
The causes of urinary incontinence can vary widely and often depend on the specific type. It is frequently triggered by physical exertion, such as coughing, sneezing, or straining, which creates pressure in the abdominal cavity. Disorders of the bladder muscles, the pelvic floor muscles, or the sphincter can also trigger involuntary urine leakage. Other possible causes include neurological disorders, diabetes mellitus, obesity, urinary tract infections, or incomplete bladder emptying when the bladder is full, which can lead to overflow incontinence. Some individuals are unable to completely empty their bladder, which exacerbates symptoms. The various causes can vary greatly from patient to patient. The triggers vary depending on the different forms of urinary incontinence—therefore, a medical evaluation is crucial for correctly diagnosing the specific condition.
In older patients, polypharmacy and diabetes in old age also play a significant role as risk factors for the development or worsening of urinary incontinence in old age. Existing frailty syndrome or immobility in old age can also make managing incontinence considerably more difficult.
Women are affected by urinary incontinence more frequently than men. Childbirth often plays a role in the development of urinary incontinence. This primarily affects the pelvic floor, which supports the urethra. The anatomy of the pelvis differs between the sexes, and the female pelvic floor is more elastic. Pregnancies and childbirth place additional strain on the pelvic floor.
Urge incontinence is defined by
Urge incontinence can have both physical and psychological causes.
These are the two most common forms of urinary incontinence. Sometimes both may be present.
People with urinary incontinence experience the condition differently. Urinary incontinence rarely requires mandatory treatment. In addition, personal well-being and how one copes with the condition play an important role. Many people with urinary incontinence have to go to the bathroom more frequently, which can be a burden in daily life. A comprehensive geriatric assessment can help determine the individual’s level of distress and identify appropriate treatment options.
Some people affected do not perceive having to change their incontinence pads several times a day as a significant loss of quality of life. For others, however, even a slight leakage of urine can severely impair their quality of life.
The doctor must not base the decision on their own assessment of the severity of the incontinence. Therefore, it is not the doctor who decides whether the patient needs treatment or not. Instead, the decision rests with the patient, and the doctor advises them on the possible treatment options.
This is followed by a dipstick test. By dipping a test strip into a fresh urine sample, it is possible to diagnose whether a urinary tract infection is present.
For women, the diagnosis also includes a gynecological examination with ultrasound. This is primarily used to identify accompanying prolapse conditions, such as pelvic floor prolapse. Gynecological ultrasound is often combined with a pelvic floor ultrasound.
Some patients leak urine even with slight changes in pressure within the body. The doctor may ask the patient to cough while standing and with a full bladder. This often provides a clear indication of the severity of the problem.
In many cases, a so-called urodynamic examination must be performed. This involves measuring the pressure in the bladder and the urethra. This allows for the differentiation and classification of various forms of incontinence.
Many women’s clinics and urology departments offer special consultation hours for these examinations.
Urge incontinence is primarily treated with medication. These medications affect the bladder’s own perception (“I’m full!”). In addition, they prevent the bladder from contracting spontaneously. Medications can be effective for both urge incontinence and bladder weakness or urinary incontinence. In older patients, a structured deprescribing approach is advisable to minimize anticholinergic side effects in the context of existing polypharmacy.
Unfortunately, older medications also have a strong effect on the salivary glands, leading to unpleasant dry mouth. Newer medications are, unfortunately, considerably more expensive. However, they work specifically on the cells in the bladder according to the lock-and-key principle.
These medications are often very effective, but they must be taken long-term. For patients who do not wish to take pills long-term, patches are also available.
The so-called “bladder training” can also help. In this approach, patients practice holding it in a little longer when they first feel the urge to urinate, thereby “training” the bladder.
These measures are intended to treat urinary incontinence and usually require medication as a complement, but they can be very effective. For frail patients, integration into geriatric early rehabilitation is recommended.
Targeted pelvic floor exercises help combat urinary incontinence © Iván Moreno | AdobeStock
During the procedure, performed under brief general anesthesia, the doctor injects a special substance into the bladder wall. Most patients experience a dramatic improvement in their symptoms afterward and are able to resume a normal life.
The effects of the treatment wear off after 6 to 8 months and can then be repeated. Urinary incontinence in older adults, in particular, can be significantly improved by this method. The surgical risk in older adults should be assessed on a case-by-case basis.
Although medications are available to treat stress incontinence, they are rarely used due to their severe and very bothersome side effects. Regular pelvic floor exercises can help prevent urinary incontinence. Concurrent fall prevention is particularly important for older female patients, as urinary leakage and rushing to the bathroom increase the risk of falls.
As with urge incontinence, pelvic floor exercises using biofeedback devices are also helpful here. This approach can achieve improvement rates of over 70%, similar to those seen with surgery. For women, the concurrent use of estrogen suppositories is helpful here.
The principle behind physical therapy is the same as that of surgery: the goal is to provide improved support for the urethra.
Many patients with stress incontinence still require surgery despite other treatment attempts.
The surgery is intended to create a support structure so that the pressure in the urethra exceeds the pressure in the bladder. The urethra can then no longer shift out of position. To illustrate this better, consider the following analogy: If a water hose is lying on the ground, you can step on it to stop the flow of water. If the hose is hanging freely, this won’t work.
So the goal of these surgeries is always the same: to provide support for the urethra and create a foundation.
Today, the procedure is usually performed using a minimally invasive technique. Tension-free bands are placed under the urethra through the vagina.
In 70 to 80% of patients, symptoms improve afterward. The patient can go home two days after surgery. Only minimal scarring remains.
Another option is to inject filler material around the urethra. This also requires a brief surgical procedure.
The surgeon decides, together with the patient, which method is most appropriate for the individual case.
Urinary incontinence is not a fate one must simply accept. Most patients can be helped.
A good first point of contact is the gynecologist. If necessary, they can refer their patients to a specialist. For older patients with multiple health conditions, a consultation in geriatrics and geriatric medicine is also recommended, where incontinence can be assessed within the broader context of frailty, dementia in older adults, and depression in older adults.
However, the patient must take the first step themselves. Many patients feel unnecessary shame about their symptoms and therefore do not see a doctor.
1. What are the typical causes of urinary incontinence?
The most common causes include weakened pelvic floor muscles, disorders of the bladder muscles, physical strain such as coughing or sneezing, and urinary tract disorders. Being overweight, diabetes mellitus, or incomplete bladder emptying can also trigger involuntary urine leakage.
2. What are the different types of urinary incontinence?
There are several different types of urinary incontinence, including stress, urge, exertional, and overflow incontinence. Each type has different triggers and is therefore treated differently.
3. How is urinary incontinence diagnosed?
Diagnosis of urinary incontinence involves a medical history, a dipstick test, an ultrasound, and often a cough test with a full bladder. In some cases, a urodynamic study is also performed to better assess the severity and specific type of incontinence.
4. What treatment options are available?
Treatment depends on the specific type of incontinence and ranges from pelvic floor exercises and physical therapy to medication and surgery. The goal is to reduce urine leakage and improve the quality of life for those affected.
