Many people who suffer from incontinence or specifically urinary incontinence (lat. :Incontinentia urinae) are ashamed of their condition. However, in Germany about 6 to 8 million people are affected, women more often than men. Incontinence is characterized by various symptoms and can also be the result of a wide variety of diseases.
What is incontinence (urinary incontinence)?
Schematic diagram showing the anatomy and structure of the urinary bladder. Click to enlarge. Incontinence can take many forms. Common to all are problems holding and passing urine on one’s own. With increasing age, the likelihood of particularly severe forms of incontinence increases. In urinary urgency incontinence, the patient feels the sudden need to empty his bladder. In stress incontinence, a strain (coughing, sneezing, etc.) triggers an involuntary loss of urine. In severe cases, simply standing up or even lying down can also cause straining. Overflow incontinence is characterized by unintentional urine dribbling. Reflex incontinence may cause the patient to leak urine without realizing it.
Causes
Incontinence can have many causes, depending on the type of incontinence. In urinary urgency incontinence, the patient has increased bladder sensitivity. The urinary bladder (detrusor) is permanently contracted and the patient feels urge to urinate without his bladder being full yet. Stress incontinence can be caused, among other things, by a functional weakness of the urinary closure apparatus. But especially in women, incontinence can also be caused by pelvic floor weakness. This weakness often occurs as a result of a general lowering of the internal organs due to weak ligaments and muscles, and may be the result of sudden childbirth. Unconscious incontinence is characterized by outflow obstructions. These can be caused by an enlarged prostate. However, incontinence can also be caused by neurological diseases, diabetes or other reasons.
Symptoms, complaints and signs
Urinary incontinence can have different symptoms depending on its type and cause. Stress incontinence can be recognized by the fact that involuntary urine leakage occurs mainly during physical exertion. The loss of urine can vary in severity and typically occurs without a previous urge to urinate. Urge incontinence is manifested by an acute, excessive urge to urinate before urine suddenly passes. This type of incontinence may occur several times per hour, even if the bladder is not yet full. In overflow incontinence, small amounts of urine leak. Patients usually experience dribbling and a constant urge to urinate. Reflex incontinence is associated with irregular emptying of the bladder. Patients can no longer determine whether the bladder is full and usually do not empty it completely. In extraurethral incontinence, urine is constantly lost. This can be accompanied by pain in the area of the ureter and bladder. In young children, urinary incontinence is noticeable in that it occurs at irregular intervals and subsides by the age of four. If symptoms persist well beyond the age of four, there is another underlying form of urinary incontinence that requires medical diagnosis and treatment.
Disease progression
In many cases, treatment of incontinence is not only important for a patient’s lifestyle, but may also be medically indicated. Particularly in the case of overflow bladder, failure to treat incontinence can even lead to urine poisoning (uremia) in the most severe cases. The urine remaining in the bladder then backs up into the ureter and kidneys, causing an increasing loss of kidney function (renal insufficiency). This can then lead to severe consequences such as urine poisoning. However, treatment of incontinence is also important in other cases. Incontinence can also be a symptom of another more serious disease such as prostate cancer or diabetes. These diseases whose concomitant is incontinence usually worsen without therapy and can be fatal.
Complications
Urinary incontinence may be well treated or managed today. However, it also tends to provide room for various complications. If urine frequently comes into contact with the skin, skin irritation can occur.If left untreated, ulcers and inflammations can develop, especially in elderly or bedridden people. The risk of urinary tract infection is also increased with incontinence. In addition, sufferers often feel embarrassed by their inability to hold urine. In some cases, sufferers are also unable to hold their bowel movements. But even urinary incontinence can be a reason for many to withdraw from other people. They fear that the consequences of incontinence will make them a disruptive factor in social life. As a complication of surgery-related incontinence at a younger age, psychological problems can arise. Depression or anxiety can place an additional burden on affected people. In addition, not everyone has the means to provide themselves with the necessary incontinence pads and aids. In the case of stress incontinence after childbirth or a hysterectomy, surgery can provide relief. However, such operations can also lead to complications. Therefore, pelvic floor exercises are initially used to try to counteract urinary incontinence with a conservative treatment approach. Depending on the surgical method, wound healing problems may occur. Postoperative bleeding, urinary tract infections, nerve irritation and damage may occur. Peritonitis is possible but occurs less frequently.
When should you see a doctor?
Many patients with urinary or fecal incontinence avoid going to the doctor out of shame or fear of possible examinations. Nevertheless, those affected who can no longer hold urine or stool should be examined and advised as soon as possible. This is recommended even if it is only a mild form of urinary incontinence. As a rule, incontinence can be treated well after medical consultation. The type of therapy that is suitable for the individual affected can only be determined if the attending physician is able to determine the exact form of incontinence by means of examinations. In some cases, incontinence can worsen significantly without treatment. It usually does not disappear on its own. Sometimes incontinence can also be a symptom of serious diseases. For this reason, it is therefore advisable to consult a doctor as soon as possible after the onset of symptoms. The sooner the affected person takes such measures, the higher the chances of recovery. It is recommended to consult the family doctor first.
Treatment and therapy
The treatment of incontinence must always be based on the causes. The patient should seek advice from a doctor in this regard. In the case of pelvic floor weakness, the first goal is of course to strengthen the pelvic floor muscles. This can be strengthened by a variety of exercises. Sometimes the support of biofeedback is necessary so that the patient learns to control the muscle movements. For this purpose, a probe is inserted that indicates which muscle is being tensed at the moment. Occasionally, in cases of stress incontinence, estrogen treatment or, in severe cases, the formation of an artificial sphincter is also useful. In mild cases of urge incontinence, bladder teas, medicines made from herbal substances and heat treatment can be effective. Incontinence can also be alleviated by toilet training. For this purpose, the patient goes to the toilet at predefined times and thus anticipates the urge. In more severe cases, advice can also be given on the administration of stronger medication to combat incontinence. Unconscious incontinence can be alleviated in many cases by herbal medicines made from pumpkin, nettle or saw palmetto. In severe cases, the administration of an alpha-receptor blocker is also useful. This loosens the bladder closure and lowers the outflow resistance and can thus combat incontinence.
Outlook and prognosis
The prognosis of incontinence is tied to the age of the patient as well as the underlying disease present. Depending on the disorder present, there may be spontaneous healing or chronic disease development. In children, incontinence occurs during the night sleep as part of the natural growth and development process. The control of the sphincter muscle must first be sufficiently trained before it functions faultlessly. It is a temporary phenomenon with sporadic occurrence, which normally occurs up to the age of six. Within that time, there may be periods of freedom from symptoms.Subsequently, a spontaneous end to the wetting can be expected. In older people, the musculature naturally deteriorates to a certain extent. Incontinence occurs, which in most cases remains until the end of life. There is no prospect of cure in these patients. If the incontinence is caused by paralysis or a viral disease, the prognosis of the causative disease must be considered. This is decisive for the further course and the prospect of relief or cure of the symptoms. If existing germs can be found and treated with medication, recovery will occur within a few days or weeks. If the muscles are paralyzed, freedom from symptoms is often no longer possible.
Prevention
Strengthening the pelvic floor muscles is an effective prevention against incontinence, especially for women. Special exercises are offered in many adult education centers or sports clubs. But a healthy lifestyle also considerably reduces the risk of incontinence. In general, for the prevention of incontinence, one should pay attention to a healthy diet, do not smoke and possibly fight existing excess weight.
Aftercare
Patients require extensive support with incontinence care in their daily lives. Here, ongoing monitoring and counseling by a specialist physician and trained, medical staff in the area of stoma care and therapy is important. In order not to always have the fear of an ailment in everyday life, the use of suitable pads, liners or diaper pants is necessary and recommended by patients. The pads are characterized by size and absorbency and are thus also differentiated for day and night use. With appropriate expert advice, the patient can find the right incontinence material for him or her to get through the day and night with as few restrictions as possible. However, it is necessary to change the patient’s incontinence material in good time in order to avoid unpleasant odors or visible stains. With an individually adapted incontinence care, participation in social life is possible almost without restriction. In addition, measures and therapies should be taken that can improve continence in the long term. This includes strengthening the muscles through targeted pelvic floor training. However, patients need patience, initiative and perseverance for this. Improvement may take weeks or months to occur, if necessary, as the musculature must first strengthen and develop.
What you can do yourself
Targeted gymnastic exercises strengthen the pelvic floor muscles and can significantly alleviate involuntary urination in mild forms of incontinence. However, they must be performed consistently and permanently to achieve a long-lasting effect. Reducing excess weight and eating a high-fiber diet also have a positive effect on the pelvic floor muscles. In many cases, bladder training is helpful, in which the bladder is emptied regularly at specific times before a strong urge to urinate sets in. Nighttime urine leakage can often be prevented with one or two scheduled trips to the toilet. Drinking less when you have urinary incontinence is usually counterproductive: the reduced volume of urine means that the urinary tract is no longer flushed sufficiently, bacteria can multiply and trigger urinary tract infections. These in turn cause a constant urge to urinate, which in turn is accompanied by uncontrolled urination. In order not to slide into social isolation, those affected should continue their daily lives as normally as possible despite urinary incontinence and also not forego their usual leisure activities: Discreet but very absorbent pads provide security at work and during sports, and with special incontinence swimwear, visits to the swimming pool are also possible without any problems. Those who suffer psychologically from incontinence should not be afraid to talk to a psychologist, psychotherapist or in a self-help group.
