There are different causes of urinary incontinence. An exact diagnosis is important so that the subsequent therapy can be tailored to the individual patient as much as possible.       

Stress incontinence (effort incontinence)
In stress incontinence, urine is passed during sudden changes in intra-abdominal pressure caused by e.g. coughing or sneezing. Positional changes such as standing up after sitting down can also lead to loss of urine.     

Stress incontinence is the most common form of incontinence in middle-aged women. It is commonly caused by damage to the sphincter muscle of the bladder after giving birth or hormone deficiency (lack of oestrogen) during the beginning of the menopause.

Urge incontinence
In urge incontinence patients experience an urgent need to urinate which is very difficult to stop. In most cases, patients do not manage to make it to a toilet in time before they pass urine.

Urge incontinence is commonly a symptom of another, underlying disease such as a bladder infection. Once the cause of the infection has been identified and treated with an antibiotic, the symptoms disappear quickly. Tissue changes or bladder stones as well as neurological disorders can also cause urge incontinence.
Overactive bladder is a condition where patients constantly feel the need to urinate and go to the toilet even though there are no large amounts of urine in the bladder. In this form, there is no real loss of urine. This condition may be a neurological disorder called sensory urge incontinence.

Reflex incontinence
This form of urinary incontinence is caused by an impairment of the nerves and usually results in the leaking of large amounts of urine. Depending on the site of the neurological impairment; in the brain, spinal cord or nerves, the typical incontinence occurs because of a spontaneous and involuntarily increased activity of the bladder muscles. There is a high amount of pressure on the urinary bladder. This partial or complete dysfunction of the urinary bladder and the sphincter muscle results in unexpected leaking of urine which cannot be controlled by the patient.

Residual amounts of urine are retained in the bladder and can become infected with bacteria. Physicians will detect this in exams and treat patients accordingly. Conditions such as multiple sclerosis, paraplegia or Parkinson’s disease are examples of such underlying neurological diseases.

Overflow incontinence
This form of incontinence mostly affects men. Often, overflow incontinence is caused by a blockage in the area of the bladder outlet such as an enlarged prostate. The bladder muscle is stretched by the unnoticed growth of the prostate and the urinary bladder “overflows”, causing the involuntary loss of very small amounts of urine.

Every new drop from the kidney through the ureter into the urinary bladder causes further “overflow” and is described by patients as constant “dripping”.

Urinary incontinence cannot be prevented in all cases. Women in particular, however can try and prevent urinary incontinence early on by reducing their weight in case of obesity or doing pelvic floor exercises after giving birth.

Losing weight helps reduce overall pressure on the pelvic floor. If there is beginning pelvic floor weakness with only occasional urinary incontinence, heavy physical work should be avoided.

Both men and women are encouraged to go to regular physical check-ups.

The first step is consultation of a doctor. Patients will describe their symptoms whereas involuntary loss of urine is typical. Physicians will then ask targeted questions to gather important information for deciding on subsequent examinations. Once all results have been assessed, a suitable treatment strategy will be developed and discussed with the patient.

When patients are asked their history such as when the condition first appeared it is particularly important to tell doctors about previous surgeries. In men this applies for instance to prostate surgery, in women to surgery on their uterus. A very important question is: When and under which conditions does the involuntary loss of urine happen?

Physicians will determine the form of urinary incontinence by examining the organs of the urinary tract: Kidneys, urinary bladder and the urethra including the outer urethral opening.

This includes the outer and inner reproductive organs and the other surrounding organs.

Following the physical examinations, other examinations may be indicated:

• blood test including determination of blood sugar levels
• in men, palpation through the rectum for assessment of e.g. the prostate
• gynaeocological exam in women
• urine assessment
• ultrasound
• bladder pressure measurement
• x-ray
• cytoscopy

There are different treatment options for the various forms of urinary incontinence:

Stress incontinence
In mild stress incontinence pelvic floor exercises under professional supervision can tighten and strengthen the tissue. The physical therapy also helps strengthen the urethral muscles. These exercises train patients’ control of their urinary bladder.

In severe stress incontinence, i.e. when urine leaks even during easy day-to-day activities, a combination of non-surgical and surgical intervention has to be considered.

Urge incontinence
Besides training the urinary bladder, where patients practice emptying their urinary bladder regularly, many patients can experience relief or even a cure with the help of certain medicinal products. These medicinal products have an effect on the nervous system. They impact the tone of the urinary bladder muscle, and take effect after approximately four to six weeks. As an alternative treatment, electric stimulation of the pelvic floor muscles can be used. It may take six months before this method shows any results.

Reflex incontinence
Regular draining of the urinary bladder with a catheter can help relieve the excess pressure. Patients can learn to do this themselves.

In addition, they are given certain medicinal products to lower the overactivity and tension of the urinary bladder muscles.

A newer treatment method is controlled electric stimulation of the urinary bladder with a device which is implanted under the skin.

Overflow incontinence
Surgical intervention to remove the blockage is the treatment of choice here. As an interim measure until surgery can take place the urinary bladder is relieved through a catheter which is inserted through the abdominal wall in most cases.

Prolapsed bladder
Surgery helps treat a prolapsed bladder in the long term. The tissue right next to where the urinary bladder enters into the urethra is lifted up from inside the abdominal cavity and anchored in the tight abdominal wall.