Urinary incontinence – colloquially called bladder weakness – (synonyms: Urge incontinence; Giggle incontinence; Incontinentia urinae; Incontinence; Reflex incontinence; Stress urge incontinence; Stress incontinence; Urge incontinence; Urinary incontinence; Extraurethral urinary incontinence; Neurogenic bladder; Overflow bladder; Overflow incontinence; ICD-10-GM R32: Unspecified urinary incontinence) refers to the inability to retain urine. According to the International Continence Society (ICS), urinary incontinence is defined as any loss of urine. The forms of urinary incontinence, grouped under the umbrella term “lower urinary tract symptoms” (LUTS), can be classified according to various causes:
- Stress incontinence* (formerly stress incontinence) – loss of urine during physical exertion as a result of a bladder closure problem according to various degrees of severity:
- Urine loss during coughing or sneezing and heavy physical work or dribbling while standing (grade 1).
- Urine loss when walking, climbing stairs, standing up or light physical work or urine loss in a stream while standing (grade 2)
- Urine loss while lying down (grade 3)
- Urge incontinence or urge incontinence (urine loss with imperative (unprompted) urge to urinate; synonym: overactive bladder wet), with detrusor instabilities (formerly motor urge incontinence) or without detrusor instabilities (formerly sensory urge incontinence); urge incontinence can occur in various degrees:
- Frequent small losses between micturitions or
- Catastrophic loss due to complete bladder emptying.
- Mixed stress urge incontinence (mixed incontinence) – urine leakage due to insufficiency of the bladder sphincter combined with an imperative urge to urinate.
- Reflex incontinence or neurogenic bladder – urine leakage due to damage or disease of the structures that transmit nerve impulses from the brain or spinal cord to the bladder.
- Overflow incontinence or overflow bladder – urine leakage when the pressure in the filled bladder exceeds the pressure of the sphincter.
- Extraurethral urinary incontinence – the cause is outside the urinary bladder; possible causes are bladder fistulas or ectopic – outside the right place – opening ureter (ureter).
* Uncomplicated stress incontinence is present when there is no history of incontinence surgery, neurological symptoms and no symptomatic genital prolapse (vaginal prolapse) or childbearing. Other forms of urinary incontinence include nocturnal enuresis and nighttime dribbling, as well as other forms of urine loss as a storage problem.Recently, female coital incontinence (CI) has also been addressed. This is loss of urine during sexual intercourse. This is divided into two forms: Incontinence during penetration and incontinence during orgasm. Both forms are associated with symptoms of urge incontinence/overactive bladder (ÜAB) and stress-induced incontinence/stress incontinence.Men are primarily affected by AI after prostatectomy (prostate removal; 20-64%); the cause is stress-induced incontinence. Stress incontinence is the most common form of urinary incontinence in women, accounting for about 40%. About 20 % suffer from urge incontinence, 38 % from mixed forms. All others are very rare with only about 2%.Coital incontinence was reported by more than 20% of patients in a urogynecology clinic. In men, urge incontinence is the most common at 39%. Male stress incontinence, on the other hand, is very rare and in the vast majority of cases iatrogenic or traumatic (especially after radical prostatectomy (prostate removal) due to insufficiency of the external bladder sphincter (urinary bladder sphincter)/the spontaneous course is usually favorable!). Gender ratio: In all age groups, women are much more frequently affected by urinary incontinence than men. Frequency peak: Urinary incontinence represents a frequent and distressing symptom in old age. The prevalence (disease frequency) is 5-50% in Germany, regardless of age and gender. The prevalence of stress incontinence in women is between 5 and 30 %.The prevalence of overactive bladder (overactive urinary bladder) in women is 16-43 % and in both sexes 12-19 %. The prevalence of urge incontinence is on average 1, 5 %.The prevalence of mixed incontinence is 2.4 % on average. When age and gender are taken into account, the prevalence for each type of incontinence is 34% for older women, 22% for older men, 25% for younger women, and 5% for younger men. The prevalence for people 70 years and older is 30%. Course and prognosis: Urinary incontinence may be transient or may be a permanent condition. Urinary incontinence in childrenSee Enuresis. Comorbidities: Children are more likely to have gastroenterological complaints (constipation; fecal incontinence), child and adolescent psychiatric complaints (social behavior disorder; hyperkinetic disorder (ADHD); anxiety disorders; depressive disorders), developmental disorders, and sleep disorders. Urinary incontinence in women The course and prognosis can vary widely. They depend on the degree of predisposition (connective tissue weakness), damage to the pelvic floor, e.g. due to childbirth or heavy physical labor, the age of the patient and physical activity. Reduction of risk factors (e.g. weight loss, avoidance of chronic constipation, treatment of chronic bronchitis, discontinuation of urinary incontinence-inducing drugs, etc.) and early initiation of therapeutic measures are of particular importance. In the beginning, conservative measures such as pelvic floor exercises, biofeedback training, electrostimulation, and possibly pessary therapy are the most important. Only in advanced stages or if the conservative approaches are not effective are various surgical measures considered. While there is currently only one drug therapy option for stress incontinence, urge incontinence is the domain of drug therapy in combination with the above-mentioned conservative methods. Surgical interventions are contraindicated here. Comorbidities (concomitant diseases): Patients with bladder dysfunction more often have psychological abnormalities (anxiety, depression, hypochondria). Furthermore, sexual dysfunction is more common. Urinary incontinence in men The course and prognosis depend on the cause. While stress incontinence is the main cause in women, men are more often affected by urge incontinence or urge symptoms. The causes are usually prostatic hypertrophy or overactive bladder (OAB), which increases steadily with age. The latter can be treated well with medication, whereas in the case of prostatic hypertrophy this is only an option in the early stages. After prostate surgery (due to hypertrophy, carcinoma) incontinence occurs in 2 – 5 % due to injury of the sphincter muscle. Therapeutically, as in women, the reduction of risk factors and a healthy lifestyle as well as pelvic floor exercises and sphincter training are the first priority. In addition, minimally invasive surgical measures are available in the form of injections of the sphincter muscle, e.g. with collagen, Teflon or silicone. Ultimately, an artificial sphincter in the form of a fluid-filled sleeve around the urethra can also be implanted.
