Urinary incontinence

What is urinary incontinence?

Urinary incontinence is a very common symptom: urine is passed unintentionally from the bladder.

The social consequences of urinary incontinence are of particular importance for those affected:

social isolation and massively restricted mobility often result.

Urinary incontinence is a very common disorder, affecting men and women of all ages equally. Increasing life expectancy means that this disorder is acquiring increasing medical and social significance. Some six million people suffer from urinary incontinence in Germany.

Urinary incontinence is curable or can be significantly improved in the majority of cases. However, it is important to be examined and then treated by a urologist.

What are the causes and risks for the development of urinary incontinence?

Incontinence has various causes. An accurate diagnosis is important so that the subsequent treatment can be optimally adapted to the patient.

Stress incontinence involves urine being passed as a result of sudden changes in the pressure in the abdomen, caused by coughing or sneezing, for example. Postural changes, such as standing up from a sitting position can also result in loss of urine.

Stress incontinence is the most common form of incontinence in women of middle age. The causes are often damage to the urethral sphincter muscles in childbirth or hormone deficiency (oestrogen deficiency) at the start of the menopause.

Urge incontinence
Urge incontinence involves a very intense urge to pass urine that can only be suppressed with considerable difficulty. The patient generally does not manage to get to a toilet in time before passing urine.

Urge incontinence is often a symptom of another underlying disease, such as inflammation of the bladder for instance. Once the pathogen has been identified and treated with the appropriate antibiotic, the symptoms will quickly disappear. Tissue changes or bladder stones may also cause urge incontinence, and neurological diseases may result in urge incontinence of the bladder as well.

Overactive or irritable bladder results in a constant urge to urinate, causing the patient to go to the toilet even though the bladder does not contain very much urine. Genuine loss of urine does not usually occur with this form of the disorder. A neurological disorder, known as sensory urge incontinence, may be involved here.

Reflex incontinence
This form of urinary incontinence is caused by a nerve disorder that normally results in genuine loss of urine, depending on the site of the damage (brain, spinal cord or nerves), spontaneously and unconsciously increased activity of the muscles of the bladder causes a typical emptying disorder. There is high pressure in the bladder. This partial or complete malfunction of the control of the bladder and sphincter muscles results in unexpected loss of urine that cannot be controlled by the individual.

Residual urine remains in the bladder and may become infected with germs. The doctor will detect this in his examinations and treat the patient as appropriate. Diseases, such as multiple sclerosis, paraplegia or Parkinson’s disease, are some examples of neurological disorders of this type.

Overflow incontinence

This form of urinary incontinence mostly affects male individuals. The cause of overflow incontinence is often an obstruction to drainage in the area of the outlet of the bladder, such as an enlarged prostate, for example. The bladder muscle is stretched by the unnoticed growth of the prostate gland and the bladder “overflows” with the involuntary loss of small amounts of urine.

Each new drop of urine passed from the kidneys via the ureter into the bladder causes further “overflowing”, described by the patient as a constant “trickling”.

What role does lifestyle play in urinary incontinence?

It is not possible to prevent the occurrence of urinary incontinence in every case. However, women, in particular, can take relevant steps in good time to prevent urinary incontinence: these include weight loss if they are overweight or pelvic floor exercises after giving birth.

Weight loss reduces the overall pressure on the pelvic floor. If the first signs of pelvic floor weakness are present with urinary incontinence occurring only occasionally, heavy physical work should be avoided.

Preventive examinations are recommended for both men and women.

How is urinary incontinence diagnosed?

The most important first step is speaking to the doctor. The patient describes the symptoms, with involuntary urine loss being typical. The doctor asks additional specific questions to obtain important information that will decide on the correct implementation of subsequent investigations. Finally, by evaluating all the findings, the treatment will be determined and discussed with the patient.

In the case of questions about the history of the disorder, such as when the problem began, it is particularly important to mention any previous operations: prostate surgery in men, for example, or an operation on the uterus in women. One very important question relates to when and under what conditions uncontrolled urine loss occurs.

The doctor determines the form of urinary incontinence by examining the organs of the urinary tract: starting with the kidney, moving on to the bladder and then to the urethra with its external opening.

The external and internal reproductive organs and all other organs in the vicinity are included in the examination. Other investigations may follow the physical examination, depending on whether they are required:

  • a blood test plus a blood glucose test
  • in men, a digital examination via the rectum to assess the prostate, for example
  • in women, a gynaecological examination
  • analysis of the urine
  • an ultrasound examination
  • measurement of bladder pressure
  • x-ray images
  • bladder examination (cystoscopy)

How is urinary incontinence treated?

Different treatment options are available for the various forms of urinary incontinence:

Stress incontinence
Pelvic floor exercises under appropriate specialist instruction may tighten up and strengthen the tissue in mild cases of stress incontinence. This physiotherapy also strengthens the closure mechanism of the urethra. These exercises provide training in voluntary control of the bladder.

In more severe cases of stress incontinence, in other words if urine is passed even when performing simple everyday activities, a combination of non-surgical and surgical treatment must be considered.

Urge incontinence
In addition to training the bladder by means of specifically practising regular emptying of the bladder, many patients find relief and recover when they are given certain medicines. These medicines act on the nervous system. They influence the tension of the bladder muscles. The effect begins after about four to six weeks. An alternative treatment is provided by electrical stimulation of the pelvic floor muscles. Again, this may take six months before it is successful.

Reflex incontinence
Regular emptying with a catheter is used to reduce the increased pressure in the bladder. The patient can learn to do this on his own.

In addition, specific medicines are given to reduce the hyperexcitability and tension of the bladder muscles.

More recent options are the controlled, electrical stimulation of the bladder with a device that can be implanted under the skin.

Overflow incontinence
A surgical procedure will be attempted in these cases to remove the obstruction. The bladder is relieved by inserting a catheter, usually via the abdominal wall, as an interim measure before the operation.

Dropped (prolapsed) bladder
Surgery provides a permanent solution for a dropped bladder. Working from the abdomen, the tissue immediately adjacent to the transition from the bladder to the urethra is raised and anchored in the taut abdominal wall above.