In Germany, according to estimates, about 10 million people suffer from incontinence. The term is derived from the Latin “incontinens” and translates as “not keeping with himself”. Incontinence is the inability to keep excretions from the body controlled and to expel them in a specific place as needed. There are 200 million affected patients worldwide who suffer from some type of incontinence. Comparatively few people suffer from fecal incontinence. In Germany, this figure is 4 percent. Urinary incontinence occurs more frequently. In women, it is even the most common chronic disease. The following article therefore clarifies possible causes as well as therapeutic approaches and provides tips for those affected.
Causes of urinary incontinence
Schematic diagram showing the anatomy and structure of the urinary bladder. Click to enlarge. Urinary incontinence occurs in different manifestations. Therefore, various causes underlie this disease. According to the German Continence Society, there are the following forms of urinary incontinence, which is also called bladder weakness:
- Stress incontinence
- Urge incontinence
- Mixed incontinence
- Overflow incontinence
- Supraspinal and spinal reflex incontinence.
- Extraurethral incontinence
- Enuresis
- Nocturia
However, the first three forms occur most frequently. Stress incontinence is triggered by a weakened pelvic floor, injuries in the pelvic cavity or chronic cough. In urge incontinence, the triggers are usually previous diseases such as MS, Parkinson’s disease or Alzheimer’s disease. However, nerve damage or irritation such as bladder stones or urinary tract infections could also be causes of this form of bladder weakness. Mixed incontinence is a combination of the first two forms mentioned, so the causes are also a mixture of the above lists.
Treatment options for bladder weakness
Frequent urination can be defined as increased excretion of urine, reaching at least 2 liters within 24 hours (polyuria). Of course, other possible causes exist that cause bladder weakness. In menopausal women, for example, hormonal changes can be a cause, and in men a general hormonal imbalance. However, malformations of the urinary tract are also conceivable triggers for incontinence. Age, predisposition and gender also play an important role. With all the factors that can lead to this, helpful treatment options for urinary incontinence are all the more important for affected patients of all ages. After all, they not only have to deal with the symptoms of the disease in general, but also with psychological problems. The quality of life is greatly reduced. In addition, sufferers lose much of their zest for life because they feel unwell and leave the house less and less often. For many sufferers, bladder weakness leads to a feeling of loss of control. It is not uncommon for depression to follow if no treatment is given. A clinical study by the University Women’s Clinic in Tübingen has shown that regular pelvic floor training is a great help in cases of stress incontinence as well as mixed incontinence. In fact, it is now always the first step in treatment for a new patient. Today, training of the pelvic floor muscles complements all other therapy options. It is important that the exercises are trained under the guidance of qualified personnel and repeated regularly. Only in this way is it possible to achieve success in the long term. This first step often also includes controlled behavioral therapy. This consists of monitored fluid intake, regular urination, weight reduction and, in the case of smokers, nicotine withdrawal. Another form of therapy is medication. There are specific drugs that help to restore and sustainably strengthen the closure function of the urethra. In general, however, it should be noted that not all patients tolerate these drugs well. Last but not least, there is the option of surgical intervention.In women, for example, a tension-free band is placed under the urethra. In men, on the other hand, a kind of balloon is inserted to seal the urethra. However, the most successful among the surgical measures is the artificial sphincter. In order to regain more quality of life in everyday life, there are various incontinence aids available for sufferers. These range from special protective pads for beds to incontinence briefs, to go out the door again a little more carefree.
Tips for sufferers: how patients recognize incontinence
There are qualified physiotherapists who specifically perform pelvic floor training. After instruction by the physiotherapist, the exercises can also be performed at home. While a urinary tract infection is already recognizable by pain and burning during urination, this is somewhat more difficult with an incontinence condition. The reason for this is that each form of bladder weakness is associated with different symptoms. One characteristic that can always be used to identify bladder weakness is involuntary urination. In the case of stress incontinence, for example, this is the case when the body is under stress. This can be coughing, heavy lifting or hearty laughter. Urge incontinence, on the other hand, can be recognized by the fact that those affected experience an almost sudden urge to urinate when the bladder is empty or barely full. Sufferers are unable to control the urge and have to urinate immediately. In mixed incontinence, the above symptoms are combined and may occur simultaneously or alternately. If reflex incontinence is present, the bladder empties only when a corresponding reflex triggers urination. This is often due to nerve or brain disorders. A consultation with a family doctor, urologist or gynecologist can shed light on the problem. If a bladder problem has been identified, the following further steps often occur:
- Usually, medical professionals clarify the suspicion through various examinations. Among other things, it comes to an ultrasound examination of the bladder, urethra and kidneys.
- Depending on the suspected cause, further examinations are usually necessary to make an accurate diagnosis. These include CT scans, cystoscopies and urological checks.
Preventive measures to prevent bladder weakness.
As mentioned above, pelvic floor exercises are a helpful way to counteract or prevent this condition. In addition, it is important to watch your weight, as being overweight promotes bladder weakness. A healthy diet and sufficient exercise are important for the vitality of the body and help to prevent disease. In individual cases, it can be helpful to exercise the urge to urinate. This works, for example, by patients not immediately giving in to the first feeling of having to urinate, but delaying urination. It is also important to empty the bladder completely. It is advisable to really take your time on the toilet. The feeling of incomplete elimination is not only unpleasant, but also unhealthy. Furthermore, a well-filled fluid balance is one of those measures that prevent incontinence. Drinking enough spares the bladder muscle and prevents a lack of fluid. Low-irritant drinks such as still water, herbal tea and juices are also recommended.