Symptoms
The sole symptom of stress incontinence is uncontrolled and unconscious urination in everyday life. Those affected feel the urine immediately when large quantities are passed, and only when the next visit to the toilet is made for smaller quantities. The concomitant circumstances of stress incontinence result from the three different degrees of illness. Urine leakage is sometimes caused by coughing, but sometimes even when lying down.
Diagnosis
A detailed anamnesis provides the decisive information for the diagnosis of stress incontinence. Patients often notice small amounts of urine leakage shortly after physical activity. In this case, a detailed list of the frequency and amount of urination during the past few days is interesting for the diagnosis.
If incontinence is accompanied by a greatly increased amount of urine production, the cause may be found elsewhere. The doctor can then carry out a physical examination of the genital region. In addition, there is an ultrasound examination of the lower urinary tract, as well as a digital rectal examination.
A so-called “pad test” can provide information about the extent of incontinence. In this test, a previously weighed pad is worn and then several movement sequences are carried out. These include running, climbing stairs, coughing, jumping and other movements.
It is then measured how much urine is involuntarily excreted at what strain. The degree of stress incontinence depends on the severity of the load that leads to involuntary urination. Grade 1 represents the heavier loads.
These include heavy lifting but also coughing, sneezing or laughing. Particularly during the last three activities, the body exerts pressure on the abdomen, which is a burden on the bladder. This causes the bladder to press on the urine and the bladder neck muscle cannot withstand this pressure.
Grade 2 represents a further progression of stress incontinence. Even small increases in pressure in the abdominal cavity affect the bladder in such a way that the pelvic floor muscles cannot hold back the urine. This stage includes all faster body movements and efforts.
For example, standing up, sitting down, walking and jumping. Grade 3 represents the final stage of stress incontinence, where hardly any stress is required. Light movements are sufficient to trigger uncontrolled urination. Incontinence without movement and while lying down is also counted towards this stage.
Treatment
Stress incontinence and weakness of the pelvic floor muscles can generally be treated very well. The numerous conservative therapeutic approaches already offer good results, but surgical procedures are also used. Conservative therapy is aimed at strengthening the weak bladder neck muscles and pelvic floor muscles in general.
This can be achieved through targeted pelvic floor training or with medication. There are many new therapeutic approaches to pelvic floor training. These include electrostimulation, vaginal weights, gymnastic exercises and many more.
These exercises require precise instructions from the treating physician in order to be performed correctly. Medicinal treatment can be given with oestrogens or certain antidepressants. Both cause an increased contraction of the pelvic floor muscles.
Only when conservative options have been exhausted can surgical treatment be considered for stress incontinence. In many cases, the pelvis and the pelvic organs are supported with ligaments or loops to relieve the pressure from the pelvic floor muscles. The urinary bladder is also supported and strengthened.
The tissue can also be injected with collagen to strengthen the hold of the pelvic organs and relieve the muscles. Artificial closure mechanisms that are inserted under the bladder are rarer. In addition to electrostimulation and drug treatment of muscle weakness, incontinence can be treated with targeted exercises under the supervision of doctors or physiotherapists.
Probably the simplest exercise can be performed sitting down. To do this, the sphincter muscle of the urethra is tensed consciously and as strongly as possible. This tension is held for up to 10 seconds.
If you repeat this tension several times, you should give the muscle some time to recover. In this way, the exercise can be performed several times a day and anywhere, even when travelling. Care must be taken only to tense the pelvic floor muscles and not to use the gluteal muscles.
While lying down or standing, it is also possible to check that the gluteal muscles are not also tensed. In a further exercise, which takes place while lying down, different muscles should be tensed one after the other. First the abdominal muscles are contracted, then the gluteal muscles and finally the pelvic floor muscles.
This not only strengthens the muscles, but also gives you a feeling and control over the individual muscle groups. Further exercises are variations of the basic exercise. Then the sphincter muscle should be tightened in various positions, for example squatting, sitting cross-legged or standing. By varying the positions, one gains new control over the muscle in various everyday situations. In addition, the strength of the muscle increases due to the repeated tensing.
