Diagnosis
The diagnosis of bladder weakness begins with a detailed interview with the doctor treating you. This can help to narrow down the possible causes of bladder weakness, for example by asking whether urine leakage occurs in certain situations (e.g. when laughing) or whether some of the accompanying symptoms mentioned above are present. The medication currently being taken and drinking patterns can also provide important clues.
This is followed by a physical examination. Here, the pelvic region in particular is put into focus, this includes the examination of the external genitals and the rectum. With men, an enlarged prostate can be ruled out.
For women, an additional vaginal examination is carried out, in which a lowering of the pelvic organs due to weak pelvic floor muscles can be ruled out. In addition, the urine is examined in the laboratory for possible germs and the kidney function is checked by taking a blood sample. There are many different possibilities for further diagnostics.
For example, the patient can be asked to keep a “micturition diary” in which he/she should write down how much urine was lost each day under which circumstances. This can also be combined with the so-called PAD test, in which patients are given an incontinence pad and can measure the amount of urine lost after certain drinking amounts and movements by the change in weight of the pad. Imaging procedures such as sonography or cystoscopy are also conceivable.
Treatment
Bladder weakness can be managed quite well with appropriate therapy. A first important approach to treatment is to strengthen the muscles of the pelvic floor. You’ll find more on this in the next separate paragraph.
In addition, for all forms of bladder weakness it is important that the patient’s weight is within the normal range so as not to put additional pressure on the bladder. The patient should also learn to go to the toilet regularly to avoid filling the bladder too much and building up pressure. For stress incontinence there is the possibility of administering the drug “Duloxetin”, which has a strengthening effect on the contraction of the bladder sphincter muscle.
There are also various surgical procedures that can help patients. Depending on the cause of the bladder weakness, supporting ligaments or even artificial sphincters can be used. It should be noted, however, that surgery should only be considered after all conservative measures have been exhausted.
Various medications have been shown to be helpful for urge incontinence. The first choice are the so-called anticholinergics, which inhibit the autonomic nervous system (more precisely the parasympathetic nervous system) and thus prevent a feeling of urge to urinate from developing even when the bladder is only slightly full. A typical active ingredient in this class is called “Oxybutynin”.
If the effect is insufficient, these drugs can also be combined with other drugs such as alpha-blockers. If the bladder weakness cannot be controlled by medication alone, there is also the possibility of injecting botulinum toxin, better known as “Botox”, into several parts of the bladder wall and directly inhibit the nerves there. As a last resort, there is also the possibility of surgically diverting the discharge of urine through the intestines.
The method of choice for reflex incontinence is the insertion of a bladder catheter. The injection of botulinum toxin is also a possibility here. The surgical insertion of a bladder pacemaker is also conceivable.
In the case of overflow incontinence, the cause of the disturbed drainage should be eliminated. For example, an enlarged prostate can be brought back to its normal size with the use of medication. Consequently, the high pressure in the draining urinary system decreases and the bladder weakness disappears.
One of the most important pillars of treatment for bladder weakness is pelvic floor training. Because the pelvic floor holds all the organs of the pelvis in a downward direction, it must be able to withstand high pressures. If the muscles are not strong enough, this can lead to incontinence as well as lowering the lower sections of the bowel or the uterus.
Sexual dysfunction can also be caused by a weakened pelvic floor. The specific training of the pelvic floor should be shown to the patient by a trained specialist, such as a physiotherapist, to ensure that it is carried out correctly. Other ways of strengthening the pelvic floor can also be found in physiotherapy.
Electro-stimulation can be used to contract and strengthen the pelvic floor muscles. A similar approach is possible with magnetic stimulation, which uses a magnetic impulse field. The use of a so-called “biofeedback procedure” can also be helpful in strengthening the pelvic floor.
Here, a sensor shows the patient graphically and directly how tense the pelvic floor muscles are at the moment. This allows the patient to get a feeling for the execution of strengthening exercises. Please also visit our page “Pelvic floor training“, where you will find examples of strengthening exercises.
