Definition
A bladder weakness, also known as urinary incontinence in medicine, describes the unintentional and uncontrolled loss of urine. This is a very common disease that can have a variety of causes and affects far more than just older people: in Germany, approximately 6 million people suffer from bladder weakness, with women being affected almost twice as often. In the following we’ll introduce you to the various causes and treatment options for bladder weakness.
Causes
The causes of bladder weakness vary widely and cause different clinical pictures. The clinical picture of stress incontinence is usually caused by a weakened pelvic floor. This refers to various muscles, ligaments and connective tissue that limit the pelvis from below and thus ensure that the pelvic organs are held securely in position.
They also support the sphincter muscle of the bladder, which ensures that no urine can escape unintentionally. If this pelvic floor is weakened, whether by previous surgery, childbirth, traumatic injury to the pelvis or hormonal changes (particularly during menopause) that can alter the tissue, increased pressure on the bladder can now cause unwanted urine to leak because the pelvic floor no longer provides sufficient support for the sphincter muscle. Such increased pressure can already be caused by contraction of the abdominal muscles when laughing or coughing.
Women are particularly frequently affected by this form of incontinence, as they generally have a less favourable pelvic floor anatomy and the pelvic floor is weakened by pregnancy or childbirth, as well as by the hormonal stress during menopause. A further clinical picture is called “urge incontinence“. Here the bladder and the pelvic floor are mechanically intact, but even small amounts of urine in the bladder falsely tell the nervous system that the bladder is full, and urine is accordingly discharged through contraction of the bladder muscle (M. detrusor vesicae).
The causes of this condition, also known as “overactive bladder”, are many and varied. It can occur as a result of nerve damage from previous operations, but also as a result of concomitant diseases such as diabetes, multiple sclerosis, Parkinson’s disease or frequently recurring urinary tract infections and bladder stones. Disorders of urine flow due to urethral stones or constrictions and an enlarged prostate are also possible causes.
Finally, there is often a psychological component involved. Other possible clinical pictures are on the one hand the so-called “overflow incontinence“, in which the bladder cannot be emptied properly because the outflow path is narrowed, e.g. due to an enlarged prostate, and thus urine always escapes drop by drop from the overfilled bladder. On the other hand, there is the so-called “reflex incontinence“, in which damage to the brain or spinal cord, for example in Alzheimer’s disease, leads to the loss of voluntary emptying.
Finally, various drugs can also lead to bladder weakness as an undesirable side effect. The leading symptom in all forms of bladder weakness is of course the involuntary loss of urine. However, depending on the clinical picture, additional symptoms may occur, which make it possible to classify them.
In stress incontinence, it is noticeable that the loss of urine often occurs when the pressure in the abdominal cavity increases. This means specifically in situations where the muscles become tense, such as when coughing or laughing. The causative pelvic floor weakness also shows other accompanying symptoms: abdominal pain can occur because the pelvic organs cannot be held in their correct position.
This can even lead to a lowering of the pelvic organs. A severe weakness of the pelvic floor can also lead to faecal incontinence. The lowering of the bladder can lead to incomplete emptying of the bladder, a residual urine sensation and frequent cystitisations.
If urge incontinence is present, patients have a constant feeling of urgency. This feeling is caused by the fact that the bladder signals that it is full, even when it is only slightly full, and that patients have to go to the toilet many times a day, even after drinking only a small amount, and sometimes cannot manage to get there in time. Pain in the pelvic area can also be groundbreaking for the diagnosis.
With reflex incontinence, on the other hand, patients do not complain of an increased urge to urinate. Since there is usually a neurological disorder and the patients have no control over their bladder at all, it will leak before the urge to go to the toilet occurs. If the autonomic nervous system is affected, such as in paraplegia, accompanying symptoms such as headaches or dizziness occur. Overflow incontinence is manifested by the loss of urine in droplets.
