About six to eight million people in Germany are affected by urinary incontinence (a form of bladder weakness). The number of unreported cases is much higher – most of them suffer silently because they do not dare to talk about it, and many do not go to the doctor. Involuntary loss of urine is so embarrassing to those affected that they resign themselves to emergency solutions for fear of being discovered in public or by family members. Urinary incontinence is predominantly acquired and rarely congenital. It is not a typical symptom of old age – it can also affect children, young, active women and men. However, no one has to resign themselves to urinary incontinence – there are a whole range of treatment options that can cure or at least significantly improve the condition.
How does urinary incontinence occur?
There are several possible causes of urinary incontinence. One of the main causes is a weakness of the sphincter muscles of the bladder, which can be favored due to various risk factors:
- In women, just occurred or longer past heavy births or multiple births can overstretch the pelvic floor.
- In addition, during menopause, the mucous membranes in the abdomen change. Because the hormone level drops, they become drier, thinner and more vulnerable. The vaginal walls also slacken and the pelvic floor muscles lose strength. Therefore, the bladder sinks and the “closure apparatus” fails.
- In general, excess weight puts a strain on the pelvic floor and should be reduced, especially in cases of incontinence, i.e. involuntary leakage of urine.
- In men, sphincter weakness is very rare. It usually occurs as a result of prostate surgery, especially after radical prostate cancer surgery (5-10%).
Other causes of urinary incontinence
In addition to sphincter weakness, uncontrolled bladder muscle activity is the main cause of bladder weakness with or without urinary incontinence. Uncontrolled bladder muscle activity (“bladder overactivity,” “bladder instability”) can be either the result of bladder disease, such as bladder infections or bladder cancer, or else
- By spinal cord and nerve diseases such as multiple sclerosis,
- By metabolic diseases such as diabetes mellitus,
- By diseases or degradation processes of the brain as in a stroke or senile dementia, as well as.
- Ultimately also be caused by psychological influences.
In children and adolescents, it is usually congenital malformations, which are responsible for urinary incontinence. Delayed maturation processes or psychological problems can lead to nocturnal wetting (“enuresis“).
Clinical picture of urinary incontinence
Medicine recognizes more than half a dozen forms of urinary incontinence. The most important are:
- Stress incontinence
- Urge incontinence
- Overflow incontinence
Stress and strain incontinence
Strain or stress incontinence is called the involuntary loss of urine during physical exertion (“stress”). It occurs preferentially in women who have given birth multiple times. The sphincter muscle is no longer able to withstand the pressure in the abdominal cavity and thus in the bladder during low physical exertion such as sneezing, coughing or laughing and gives way to the pressure. Stress incontinence accounts for about 50 percent of all forms of incontinence that occur.
Urge incontinence and irritable bladder
Urge incontinence mainly affects older people. It is caused by overactivity or hypersensitivity of the bladder. On the one hand, signals about the filling state of the bladder are not processed properly in the spinal cord; on the other hand, the bladder is no longer able to empty completely “on command.” This results in a mismatch between a sudden urge to urinate with loss of urine and the inability to “relieve” oneself voluntarily – up to 20 times a day. In the early stages, this is referred to as an “irritable bladder“. Urge incontinence affects 11 percent of all people over age 60 and 30 percent of those over age 80; women are almost three times as likely as men. Urge incontinence can also be the result of a bladder disease, for example inflammation or cancer. Therefore, a urological examination is always necessary. Not infrequently, however, psychological problems are also responsible for urge incontinence, especially in middle-aged women.
Overflow Incontinence
Overflow incontinence occurs mainly in men. It is characterized by involuntary leakage of urine in drops when the urinary bladder is very full. Frequent urination with small amounts of urine (called micturition volume) are the rule. Therefore, large amounts of residual urine remain. Causes are outflow obstructions in the area of the bladder outlet or the urethra due to tumors, urinary stones or mostly due to benign or malignant prostate enlargement (benign prostatic hyperplasia, prostate cancer). The prostate is located under the urinary bladder of the male and surrounds the urethra as it exits the bladder. When enlarged, it squeezes the urethra. The bladder muscle can no longer exert enough force to empty the bladder, consequently the bladder continues to fill. Only when the filling pressure of the bladder exceeds the closing pressure does urine pass involuntarily. However, it is not uncommon – especially in women – for a dysfunction of the bladder muscle due to medication, metabolic disorders, spinal cord or nerve diseases (Parkinson’s disease) to be the cause of residual urine formation and overflow incontinence.
Effects of urinary incontinence
High blood pressure, lipid metabolism disorders, heart attacks, stomach ulcers have long become socially acceptable topics of conversation, urinary incontinence has not (yet). Those affected are not only troubled by constant changes of underwear, dependence on pads or diapers, and the threat of unpleasant odors. They try to hide their condition and live in constant fear of being discovered. They withdraw and avoid contact, often with friends or relatives. Possible consequences are isolation, loneliness, partnership problems and even depression. But: concealment stands in the way of relief or healing.
