Brief overview
- Causes: Varies according to form, e.g. urinary stones, enlarged prostate, tumors, nerve injury or irritation, neurological disease (multiple sclerosis, stroke, Alzheimer’s disease, etc.).
- Treatment: pelvic floor training, toilet training, electrotherapy, pacemakers, medications, surgery, treatment of the underlying disease.
- When to see a doctor? When the complaints occur, at the latest when they become a burden
- Prevention: do not irritate the bladder, drink adequately, relaxation exercises, reduce excess weight.
What is incontinence?
People with incontinence have problems holding back their urine or, less frequently, their stool in a controlled manner. This is referred to as urinary or fecal incontinence.
Urinary incontinence
Colloquially, this symptom is also called “bladder weakness”. However, the bladder is not always the cause. There are different manifestations of urinary incontinence.
Urge incontinence: In this form of incontinence, the urge to urinate occurs suddenly and very frequently – sometimes several times an hour – even though the bladder is not yet full. Often, those affected no longer make it to the toilet in time. The urine comes out in gushes. Some people also suffer from mixed incontinence. This is a combination of stress and urge incontinence.
Overflow incontinence: When the bladder is full, small amounts of urine constantly flow out. Those affected often also feel a constant urge to urinate.
Extraurethral urinary incontinence: Here, too, urine is constantly leaking uncontrollably. However, this does not occur through the urinary tract, but through other openings (medically: extraurethral), such as the vagina or the anus.
Fecal incontinence
A distinction is made between urinary incontinence and fecal incontinence. This form of incontinence is less common. Patients with fecal incontinence have difficulty retaining intestinal contents and intestinal gases in the rectum.
You can read everything about the causes, treatment and diagnosis of this form of incontinence in the article on fecal incontinence.
Causes of incontinence
This fulfills two important tasks: It must store the urine and empty itself (as far as possible) at the desired time. During storage, the bladder muscle is relaxed. This causes the bladder to expand and fill. At the same time, the sphincter muscle is tense so that the urine does not immediately flow out again through the urethra. To empty, the bladder muscle contracts, while the sphincter with the pelvic floor muscles relaxes. The urine flows out through the urethra.
In stress incontinence, the closure mechanism between the bladder neck and the urethra is no longer functional. Reasons for this are, for example, that the pelvic floor tissue has been injured, for example in an accident or in men after prostate surgery or vaginal birth in women. Injuries and irritation of the nerves as well as a protrusion of the urinary bladder also trigger stress incontinence. In addition, it is favored by risk factors such as:
- Chronic cough
- Frequent lifting of heavy loads
- Lack of exercise (poorly trained pelvic floor!)
- In women: pelvic organs sinking downwards, e.g. uterus sagging
At these points, there is a risk that the connective tissue will give way, for example, due to stresses such as pregnancies and births, a lowered uterus, or hormonal changes during menopause – resulting in urinary incontinence.
Urge incontinence:
- Nerve damage or irritation as a result of surgery.
- Neurological diseases such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, a brain tumor or stroke
- Constant irritation of the bladder, for example due to bladder stones or urinary tract infections (cystitis)
- Insufficiently treated diabetes (diabetes mellitus): Toxins produced by elevated blood sugar levels affect the nervous system.
- Psychological causes
Reflex incontinence:
Overflow incontinence:
In this form, the bladder outlet is blocked and interferes with urine flow, for example, in men due to an enlarged prostate (as in benign prostatic enlargement) or urethral stricture. The latter may be due to a tumor or urinary stones.
Extraurethral incontinence:
Various medications (such as diuretics, antidepressants, neuroleptics) and also alcohol may aggravate existing urinary incontinence.
What can be done for incontinence?
There are various ways to treat incontinence. In individual cases, incontinence therapy is adapted to the form and cause of the incontinence and to the patient’s life situation.
Biofeedback training: Some people find it difficult to feel the pelvic floor muscles and to consciously perceive and control sphincters. In biofeedback training, a small probe in the rectum or vagina measures contractions of the pelvic floor and triggers a visual or acoustic signal. In this way, the patient can see whether he or she is really tensing or relaxing the right muscles during pelvic floor exercises.
Toilet training (bladder training): Here, the patient must keep a so-called micturition log for some time. In this log, the patient records when he or she felt the urge to urinate, when he or she passed urine, how much urine was passed, and whether urination was controlled or uncontrolled. The patient must also note what and how much he or she has drunk in the course of a day or night.
Only carry out toilet training under medical supervision.
Hormone treatment: In the case of incontinence due to estrogen deficiency during or after menopause, the doctor prescribes affected women a local estrogen preparation, for example an ointment.
Catheter: With reflex incontinence, the bladder may need to be emptied regularly via a catheter.
Surgery: Extraurethral incontinence is always treated surgically, for example by closing the fistula. If the incontinence is due to an enlarged prostate, surgery is also usually necessary. Otherwise, surgery is only considered for urinary incontinence if non-surgical therapy measures do not bring the desired success.
Urinary incontinence: drinking correctly
Particularly in the case of urinary incontinence, drinking suddenly takes on a decisive role for those affected: Out of fear of uncontrolled urine leakage, they try to drink as little as possible. However, this does not improve the condition – on the contrary: with insufficient fluid intake, the urine becomes more concentrated in the bladder, which often increases the urge to urinate and irritates the mucous membrane of the bladder.
If you have urinary incontinence, discuss with your doctor how much you drink and at what times of day. In a micturition log, you keep a precise record of your fluid intake and urination (see above: Toilet training). Based on these records, the doctor will recommend appropriate drinking amounts and times for you.
Aids for incontinence
Incontinence: When to see a doctor?
Incontinence: examinations and diagnosis
In an interview, the doctor first asks about the patient’s exact symptoms and medical history (anamnesis). In this way, he finds out what form of incontinence someone is suffering from and narrows down the possible causes in more detail. Possible questions in the anamnesis conversation are:
- How long have you had uncontrolled urine leakage?
- How often do you pass urine?
- Do you experience any pain?
- On what occasions does involuntary urine leakage occur?
- Can you feel if your bladder is full or empty?
- Have you had an operation? Have you given birth to a child?
- Do you have any underlying diseases (diabetes, multiple sclerosis, Parkinson’s, etc.)?
Examinations
Various examinations help to clarify incontinence. Which methods are useful in individual cases depends, among other things, on the type and severity of the incontinence. The most important examinations are:
- Gynecological examination: For example, a uterine prolapse or vaginal prolapse can be determined as the cause of urinary incontinence.
- Urine and blood tests: They provide evidence of infections or inflammations.
- Urodynamics: In the case of urinary incontinence, the doctor uses urodynamic examinations to assess the function of the bladder. For example, uroflowmetry uses electrodes to measure the volume of urine during urination, the duration of bladder emptying, and the activity of the abdominal and pelvic floor muscles.
- Cystoscopy: In some cases, this is necessary to detect inflammation of the bladder mucosa or tumors in the bladder, for example.
- Template test: Here, a dry template is first weighed and inserted. At the end of a defined period, with a prescribed amount of drinking and physical exertion, this template is weighed again and shows how much urine has passed involuntarily.
Incontinence: Prevention
There are several measures to prevent incontinence or to prevent it from progressing:
If overweight, possibly reduce weight. Excess weight is an important risk factor for incontinence. It increases the pressure in the abdominal cavity and thus promotes incontinence or aggravates existing incontinence. It is therefore worthwhile to get rid of excess pounds. This also has a positive effect on the success of pelvic floor training.
Eat bladder-friendly food. Avoid foods that irritate the bladder, for example hot spices or coffee.
Frequently asked questions
You can find the answers to the most frequently asked questions about this topic in our article Frequently asked questions about incontinence.
