Urinary incontinence or bladder weakness is the term for involuntary loss of urine. There are different forms of urinary incontinence. The most common are urge, stress and stress incontinence as well as overflow incontinence. Women are mostly affected.
Here you will find further information and selected urinary incontinence specialists and centers.
Women are more frequently affected by urinary incontinence than men. The anatomy of the pelvis differs between the sexes and the female pelvic floor is more flexible. Pregnancy and childbirth put additional strain on the pelvic floor.
Stress incontinence is the loss of urine during physical exertion. It occurs when the pressure in the abdomen exceeds the pressure in the urethra. This is often caused by the urethra's suspension apparatus being torn, which means that the urethra lacks an abutment.
Urge incontinence is defined by
Urge incontinence can be caused both physically and emotionally.
These two forms of urinary incontinence occur most frequently. Sometimes both can also be present.
Urinary incontinence rarely needs to be treated. In addition, the personal condition and how it is handled also play an important role.
Some sufferers do not consider it a major loss of quality of life if they have to change their incontinence pads several times a day. For others, however, even a dribble of urine can severely restrict their quality of life.
The doctor must not use his own assessment of the severity of the incontinence as a yardstick. It is therefore not the doctor who decides whether the patient needs treatment or not. Instead, the decision is up to the patient and the doctor advises them on the possible treatment options.
The discussion between the doctor and the patient, the medical history, is very important. This allows not only the symptoms but also some of the causes, e.g. certain medications, to be identified.
This is followed by a strip test. Using a test strip dipped in fresh urine, it is possible to diagnose whether urinary tract inflammation is present.
In women, a gynecological examination with ultrasound is also part of the diagnosis. This is primarily used to detect accompanying prolapse conditions, such as pelvic floor prolapse. Gynecological ultrasound diagnostics are often combined with a pelvic floor ultrasound.
Some patients lose urine even with slight changes in pressure in the body. The doctor may ask the patient to cough while standing and with a full bladder. This often gives a clear indication of the severity of the problem.
In many cases, a so-called urodynamic examination must be carried out. This involves measuring the pressure in the bladder and urethra. This allows different forms of incontinence to be distinguished and categorized.
Many women's clinics and urology departments have special consultation hours for these examinations.
Urge incontinence can be treated primarily with medication. They affect the patient's own perception of the bladder ("I'm full!"). They also prevent the bladder from contracting spontaneously.
Unfortunately, older preparations also have a strong effect on the salivary glands. This leads to an unpleasant dry mouth. Newer preparations are unfortunately considerably more expensive. However, they have a targeted effect on the cells in the bladder according to the lock-and-key principle.
The medication often helps very well, but must also be taken long-term. Patches are also available for patients who do not want to take tablets long-term.
Physiotherapy for urge incontinence includes
The so-called bladder drill can also help. Here, patients practise holding out a little longer at the first urge to urinate in order to "educate" the bladder.
These measures usually need to be accompanied by medication, but can then be very effective.
Targeted pelvic floor training helps against bladder weakness © Iván Moreno | AdobeStock
There is no direct surgical treatment for urge incontinence. However, there are still options. Surgery for the treatment of nerve-related bladder dysfunction has also proven effective for urge incontinence.
The doctor injects a special substance into the bladder wall under a short general anesthetic. Most patients experience a dramatic improvement in their problems afterwards and can lead a normal life again.
The effects of the treatment wear off after 6 to 8 months and can then be repeated.
There are also medications for the treatment of stress incontinence. However, they are rarely used due to their strong and very troublesome side effects.
As with urinary incontinence, pelvic floor exercises using biofeedback devices also help here. This can achieve similar improvement rates of over 70 % as surgery. The accompanying use of oestrogen vaginal suppositories is helpful in women.
The principle of physiotherapy is the same as for surgery. The aim is to achieve improved support for the urethra.
Many patients with stress incontinence require surgery despite other treatment attempts.
The operation is intended to create an abutment so that the pressure in the urethra exceeds the pressure in the bladder. The urethra can then no longer escape. To give you a better idea, here's an analogy: if a water hose is lying on the floor, you can step on it and interrupt the flow of water. If the hose is hanging freely, this does not work.
The same thing is always attempted during operations: To give the urethra support and create a base.
Today, the procedure is usually minimally invasive. Tension-free tapes are placed under the urethra from the vagina.
In 70 to 80 % of patients, symptoms improve afterwards. The patient can return home two days after the operation. Only minimal scars remain.
Another option is to inject padding around the urethra. This also requires a short operation.
The surgeon and patient decide together which method makes the most sense for each individual case.
Loss of urine is not a fate to be resigned to. Most patients can be helped.
A good first point of contact is the gynecologist. They can refer their patients to a specialist if necessary.
However, the patient must take the first step themselves. Many patients are unnecessarily ashamed of their symptoms and therefore do not go to the doctor.
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