Incontinence means that you can no longer hold urine or stool - some of it comes off uncontrollably. The reasons for this can be very diverse. Urinary incontinence is usually based on a disorder in the fine-tuned system of bladder muscles, sphincter muscles, and pelvic floor muscles. The reason could be errors in the signal transmission of the nerve cells involved, for example. There are good treatment options for incontinence today.
All you need to know about stress incontinence
Stress incontinence, at 35 to 45%, is the most common form in women. If the pressure in the urinary bladder increases, for example, due to coughing, sneezing, running, or climbing stairs, there is a disturbance in the area of the urethral obstruction.
This form of incontinence is divided into three different degrees of severity:
- Involuntary urine leakage during heavy physical exertion. These include hopping, jumping, coughing, sneezing, and heavy lifting.
- Involuntary loss of urine during light physical exertion such as climbing stairs, walking, getting up, or sitting down.
- Loss of urine at rest without significant stress, but not when lying down (at Engelmann-Sundberg)
What happens with stress incontinence?
The bladder is a hollow organ that consists of three layers of muscle. It serves as a collection container for the constant flow of urine from the kidneys. The urinary bladder expands due to the steadily increasing amount of fluid. This stimulus is passed on to the brain and causes a slight urge to urinate even with a filling volume of 80 ml. The fuller the bladder gets, the greater the need to empty the urine.
The transition from the bladder to the urethra is closed by two muscle rings (sphincters). The inner sphincter cannot be controlled at will. If the urge to urinate becomes too great, it opens up. The outer sphincter, on the other hand, is subject to voluntary control. It normally only opens when the "command" is given.
The pelvic floor muscles play a significant role in the closing mechanism of the bladder. It supports the function of the external sphincter. When she urinates, she also has to relax so that urine can escape.
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Do you know the types of urinary incontinence?
A distinction is made between urinary incontinence and less frequent stool incontinence.
Affected people cannot hold back their urine in a controlled manner. Suffering is often referred to as bladder weakness. The following types are distinguished:
- Stress incontinence (formerly called "stress incontinence"):
The cause of stress incontinence is usually physical stress. With certain movements such as lifting heavy things, coughing, sneezing, or laughing, those affected lose urine without being able to control it. If the incontinence is more pronounced, urine comes off with every movement, even when lying and standing. Those who suffer from stress incontinence lose urine without feeling the urge to urinate.
- Urge incontinence:
The urge to urinate occurs so suddenly that people often cannot make it to the toilet in time. The bladder is usually not full at all, but the urine gushes out.
- Reflex incontinence:
Despite a full bladder, those affected do not feel it. There are always uncontrolled empties, but not complete ones.
- Overflow incontinence:
When the bladder is full, small amounts of urine go off continuously. Many feel an urge to urinate.
- Intraurethral urinary incontinence:
With this form of incontinence, urine is constantly and uncontrollably lost, but not via the urinary tract. The urine goes out through other openings, for example through the vagina or anus.
See the causes of incontinence
In order for the bladder to function properly, the bladder muscle, sphincter, pelvic floor muscles, controlling nerves, and centers in the brain and spinal cord have to interact freely and in a coordinated manner. If this optimally coordinated system malfunctions, this leads to problems.
In the case of fecal incontinence, there is a disorder in the occlusion apparatus and the associated nerve structures.
Urinary incontinence - causes
The different forms of urinary incontinence have one thing in common: the function of the bladder is restricted. The bladder's job is to store urine and empty it at a time that you determine yourself. During urine enrichment, the bladder muscle is relaxed and the sphincter is tense. This prevents the urine from flowing out. If the bladder is to be emptied, the bladder muscle contracts and the sphincter and pelvic floor muscles relax. The urine can then drain through the urethra. If this interaction is disturbed, urinary incontinence can occur.
Existing urinary incontinence can be exacerbated by medications such as diuretics, antidepressants, neuroleptics, and also by the consumption of alcohol.
Causes of stress incontinence
The locking mechanism between the bladder neck and urethra no longer works properly here. Possible reasons for this include an injury to the pelvic floor tissue (for example due to an operation of the prostate or an accident), nerve injuries and irritation, or a bulging of the urinary bladder. A woman is affected by stress incontinence more often than a man because her pelvic floor muscles are weaker. There are also three so-called "natural weak points": the openings of the vagina, anus, and urethra.
The connective tissue can give way in the above-mentioned areas due to stress such as pregnancy, childbirth, a lowering of the uterus, or hormonal changes during menopause. This usually leads to an unwanted loss of urine.
There are also other risk factors that can trigger stress urinary incontinence. These include chronic cough, frequent lifting of heavy objects, overweight, and lack of pelvic floor muscles due to lack of exercise.
Causes of urge incontinence
With this so-called "overactive bladder", the bladder reports, even though it is only slightly filled. The signal that is incorrectly sent to the brain too early ensures that the urge to urinate cannot be controlled. Possible causes are:
Nerve damage or irritation (mostly after surgery), constant bladder irritation from bladder stones or urinary tract infections, neurological diseases (including multiple sclerosis, Alzheimer's, Parkinson's, stroke, or brain tumor), diabetes mellitus (only with insufficient therapy) and psychological factors.
Causes of reflex incontinence
Nerves in the brain or spinal cord that control bladder function are damaged. Often affected are people with neurological diseases such as Alzheimer's, Parkinson's, multiple sclerosis, paraplegia, or after a stroke.
Causes of overflow incontinence
If the prostate is enlarged or there is a narrowing of the urethra (e.g. due to urinary stones), the urine outlet is blocked and the urine drainage is impaired.
The cause of this form of bladder weakness is either a congenital malformation or a fistula. If the fistula is between the urinary system (bladder or urethra) and the skin, intestine, or female genital tract, it can cause urine to leak through the skin opening, anus, or vagina. A fistula arises, for example, due to inflammatory processes, after surgery or after X-ray radiation.
Diagnosing stress urinary incontinence
In the beginning, the doctor will ask questions about the onset of symptoms and the circumstances of incontinence in a detailed discussion. He will also inquire about previous illnesses, operations, and treatments. The course of birth plays a role in women. He will then do a physical exam of the genitals and anus.
Symptoms of stress incontinence
Symptoms of stress urinary incontinence are present when urine is released unintentionally when coughing or sneezing. There are three degrees of severity of stress incontinence :
- Grade one: Urine comes out when coughing, sneezing, or laughing. (Stress incontinence)
- Grade two: urine comes out of abrupt body movements or when getting up and sitting down.
- Grade three: Urine leaks even when there is no movement, for example when lying down.
Treatment options for urinary incontinence
If, for example, stress urinary incontinence has been determined, pelvic floor training can help to strengthen the muscles again. In this way, patients learn to reduce the stresses on the pelvic floor in everyday life and to put down wrong tensioning habits.
In the event of involuntary loss of urine, biofeedback training can also be useful. Those who do not perceive their pelvic floor muscles or the sphincter muscles well can train this using this method.
- With electrotherapy, the pelvic floor muscles can be trained passively - using electrical impulses. The treatment is painless.
- A bladder or toilet training helps to learn how to empty the bladder in a controlled manner. To do this, the patient keeps a so-called micturition protocol (drinking and toilet protocol). On the basis of this, the doctor will then draw up a plan that shows how much fluid can be consumed in the future and how often the toilet should be used.
- If there is reflex incontinence, the bladder may need to be emptied regularly via a catheter. Hormone treatments are useful if incontinence in women has been caused by an estrogen deficiency.
- Medicines can also be supportive in some cases. For example, in the case of urge incontinence, antispasmodic agents are used. Alpha-receptor blockers can loosen the bladder obstruction in overflow incontinence or inhibit the spontaneous activity of the bladder muscles in reflex incontinence.
- Surgery is useful for occlusion with a fistula or for an enlarged prostate.
- If none of the usual therapeutic measures work, surgical interventions can also be useful in other cases. For example: closing the urethra with an artificial sphincter or an adjustable loop, stabilizing the urethra with collagen or silicone, or implanting a bladder pacemaker.
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