Incontinence is the loss of control over the release of urine – or, less commonly, stool. Often, the causes of urinary incontinence are in the urinary tract. But problems in the brain and spinal cord or with the nerves can also lead to incontinence. Read here what forms of incontinence there are in men and women, what aids are available and what therapy helps with incontinence.
Causes of incontinence
In the case of incontinence, there may be either organic causes or a disease or injury to the nervous system. This causes a disturbance in the cooperation between the brain and nerves on the one hand and the pelvic floor muscles, bladder muscles and sphincter muscles on the other. Depending on whether urine or feces are passed unconsciously, one speaks of urinary or fecal incontinence. Different forms are distinguished for both types, each of which has different causes. The causes of urinary incontinence do not always have to lie in the area of the urinary tract. Disorders of the nerves, brain or spinal cord can also lead to incontinence. In rare cases, incontinence can also be caused or aggravated by medication. Therefore, be sure to tell your doctor which medications you take on a regular basis. Urine dribbling or dribbling after emptying the bladder is when a few drops of urine escape. This symptom occurs mainly in men and is caused by the fact that the urethra, which leads from the bladder to the tip of the penis, is not completely emptied by the corresponding muscles. As a result, some urine forms at a low point in the urethra, which then drips.
Forms of urinary incontinence
Patients who suffer from urinary incontinence have problems passing urine in a controlled manner. Basically, urinary incontinence is divided into five different forms:
- Stress incontinence
- Urge incontinence
- Reflex incontinence
- Overflow incontinence
- Extraurethral urinary incontinence
Stress incontinence
In stress incontinence, also known as stress incontinence, involuntary leakage of urine occurs due to increased pressure in the abdomen. This can occur, for example, when carrying heavy objects, but also when laughing, coughing or sneezing. In extreme cases, urine loss can also occur during normal movements, such as walking. This can range from a few drops to a stream of urine. If stress incontinence is present, the connection between the bladder neck and the urethra is usually impaired. A common cause is surgery and accidents that weaken the pelvic floor tissues or injure nerves in the pelvic area. In men, the risk of stress incontinence is particularly high after prostate surgery. This is because it can cause the bladder sphincter to sag. Women have weaker pelvic floor muscles than men, which is why they are more likely to suffer from stress incontinence. Pregnancy and childbirth are particularly stressful for the pelvic floor. During pregnancy, but also after birth, stress incontinence often becomes noticeable. Hormonal changes during menopause also increase the risk of incontinence.
Urge incontinence
With urge incontinence (also: urge incontinence), an urge to urinate occurs quite suddenly and is so strong that those affected sometimes no longer make it to the toilet in time. The urge to urinate often occurs several times an hour, even though the bladder is not yet completely full again. Urge incontinence is caused by a problem in signal transmission: Although the bladder is not yet full, the signal to empty is sent to the brain. A distinction can be made here between:
- Sensory urge incontinence: disturbed perception of the bladder filling (premature filling sensation), for example, as a result of bladder stones or inflammation of the urinary tract.
- Motor urge incontinence: spasmodic, involuntary contraction of the urinary bladder sphincter, as a result of which even a minimal filling of the bladder triggers a strong urge to urinate.
Specific causes include surgery that has resulted in damage to the nerves, inadequately treated diabetes mellitus and neurological diseases such as multiple sclerosis or Parkinson’s disease. The trigger can also be constant irritation of the bladder due to urinary tract infections such as cystitis or a narrowing of the bladder outlet, for example as a result of prostate enlargement. In addition, psychological causes can also be behind urge incontinence.
Reflex incontinence
In reflex incontinence, those affected no longer feel whether the bladder is full. In addition, they can no longer voluntarily control the emptying of the bladder. Therefore, it empties itself from time to time. In reflex incontinence, the nerves that control the bladder are disturbed. This leads to a loss of control over the sphincter muscle. This can also be caused by neurological diseases such as multiple sclerosis. In addition, injuries to the spinal cord are also a possibility, such as those that occur in the course of paraplegia (spinal reflex incontinence). Supraspinal reflex incontinence is when control over voluntary bladder emptying is lost due to brain disorders, such as Alzheimer’s disease, dementia, Parkinson’s disease or a stroke.
Overflow Incontinence
In overflow incontinence, small amounts of urine keep leaking out as soon as the bladder is filled. The cause of the symptoms is a drainage problem at the bladder outlet. Due to an obstruction at the outlet – for example, an enlarged prostate, a tumor, or a narrowed urethra – urine cannot flow out easily. Only when the pressure in the bladder continues to increase can small amounts of urine escape. Overflow incontinence is therefore accompanied by a feeling that the bladder is never completely emptied. This form of incontinence is the most common in men.
Extraurethral urinary incontinence
In extraurethral urinary incontinence, there is also a constant loss of urine. However, the urine does not drain through the urinary tract but through a fistula that connects the bladder to other organs, such as the vagina or the bowel. As a result, sufferers have no control over urine loss. Extraurethral urinary incontinence is usually congenital.
Fecal incontinence: stages and forms
Patients with fecal incontinence have difficulty passing their bowel gases as well as their stool in a controlled manner. Depending on the severity of the incontinence, three stages are distinguished:
- Stage 1: There is an uncontrolled discharge of intestinal gases. Under load, it may also partially come to stool smearing.
- Stage 2: There is an uncontrolled discharge of intestinal gases and thin stool.
- Stage 3: There is a complete loss over the stool control. The result is a constant smearing of stool. In addition, not only liquid but also solid stool is lost.
Depending on the cause of the symptoms, just as with urinary incontinence, fecal incontinence is also distinguished into five forms:
- Motor
- Sensory
- Reservoir-related
- Neural
- Psychological
In some cases, sufferers still notice the urge to defecate, but do not make it to the toilet in time. In other cases, however, sufferers feel nothing and the loss of stool happens completely unconsciously.
Causes of fecal incontinence
Fecal incontinence can be caused by various diseases. In addition to chronic inflammatory bowel diseases such as Crohn’s disease, neurological diseases are also possible triggers. Tumors in the rectum, pelvic floor weakness, severe hemorrhoids or constipation can also be the cause. The sphincter muscle can also be affected by injuries after surgery or childbirth. If nerves are damaged, this can also disturb the sensation at the anus. Finally, certain medications such as laxatives, antidepressants or drugs for Parkinson’s disease are also possible causes.
