Clinic for Gynecology and Obstetrics
Chief Physician

Incontinence treatment

PD MD Heiko B. G. Franz

Chief Physician

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Incontinence treatment

Incontinence means that you can no longer hold urine or stool - some of it goes unchecked. The causes can be very diverse. Urinary incontinence is usually due to a disorder in the finely tuned system of bladder muscles, sphincters and pelvic floor muscles. The reason may be, for example, errors in the signal transmission of the nerve cells involved. There are good therapies for incontinence today.

Quick Overview

What is incontinence? Inability to withhold urine (urinary incontinence) or, more rarely, stool (fecal incontinence)

Causes: different depending on the shape, z. As urinary stones, enlarged prostate, tumors, nerve injury or irritation, neurological diseases (multiple sclerosis, stroke, Alzheimer's etc.)

Examinations: Depending on the nature and severity of the incontinence, for example, gynecological examination, proctological examination (examination of the rectum), ultrasound, urine and blood tests, urodynamic examinations (for the determination of bladder function), bladder mirroring, colonoscopy etc.

Therapy: Depending on the form and severity of incontinence, for example pelvic floor training, toilet training, electrotherapy, pacemaker, medication, surgery

Incontinence: description

People with incontinence can no longer control their urine or, more rarely, their stool. One then speaks of urinary or fecal incontinence.

Urinary incontinence

Colloquially, this symptom is also called "bladder weakness". However, the bladder is not always the cause. There are five different manifestations of urinary incontinence:

Stress Incontinence: Formerly known as stress incontinence because it is caused by exercise: when abdominal pressure increases (for example, lifting heavy objects, coughing, sneezing, laughing), patients involuntarily lose urine. In severe cases, urine goes off with every movement, in extreme cases, standing or lying down. The patients do not feel a urge to urinate before the urine goes off unintentionally.

Urge incontinence: In this form of incontinence, the urge to urinate occurs like an attack and very frequently (sometimes several times an hour), although the bladder is not yet full. Often the patients can not make it to the toilet in time. The urine gushes off.

Reflex incontinence: People with reflex incontinence no longer feel when the bladder is full and can no longer control emptying. The bladder empties itself at irregular intervals by itself, but often not completely.

Overflow Incontinence: When the bladder is full, small amounts of urine are constantly flowing away. Patients can also feel a permanent urge to urinate.

Extraurethral urinary incontinence: Here too, urine is constantly lost without the patient being able to control it. However, this does not happen through the urinary tract, but through other openings (mediz .: extraurethral), such as the vagina or the anus.

Fecal incontinence

This form of incontinence is rarer. Patients with fecal incontinence can not retain gut contents and intestinal gases at will in the rectum. Doctors distinguish three severity levels:

  • 1st degree partial incontinence: uncontrolled leakage of air and occasional stool smearing during exercise.
  • 2nd degree incontinence: Patients can not hold intestinal gases and thin stools.
  • Total incontinence: total loss of control of bowel movement associated with constant stool smearing. Patients also lose stool.
  • As with urinary incontinence, there are cases in which the patient may feel that the chair is about to go away, but it does not make it to the toilet in time, and those where the stool exit is quite unexpected (patients do not feel anything in the anal area).

Incontinence: causes and possible diseases

In urinary incontinence, the finely tuned system of bladder muscle, sphincter and pelvic floor muscles and the controlling nerves and centers in the brain and spinal cord no longer work properly. In fecal incontinence, the disorder affects the occlusive apparatus of the anus as well as the corresponding nerve structures. In both cases, the cause can be manifold:

Causes of urinary incontinence

The five forms of urinary incontinence have very different causes, all of which, however, affect the function of the bladder.

This fulfills two important tasks: It must save the urine and (if possible) empty at the desired time. When storing the bladder muscle is relaxed. This allows the bladder to expand and fill up. At the same time, the sphincter muscle is tense, so that the urine can not immediately flow away again via the urethra. To empty, the bladder muscle contracts, while the sphincter relaxes with the pelvic floor muscles. The urine can then drain through the urethra.

Stress incontinence:

In stress incontinence, the occlusion mechanism between bladder neck and urethra is no longer functional. The reason may be that the pelvic floor tissue has been injured, such as during a prostate operation or an accident. Nerve injuries and irritations as well as protrusion of the bladder can also trigger stress incontinence.

In addition, it is favored by risk factors such as:

  • chronic cough
  • overweight
  • frequent lifting of heavy loads
  • Lack of exercise (poorly trained pelvic floor!)
  • (in women) sinking pelvic organs (such as uterine depression)

Stress incontinence is much more common in women than in men. That's because they have a wider pelvis and a weaker pelvic floor muscle. In addition, there are three openings in the female pelvic floor (for urethra, vagina and rectum), while the male has only two. These are "natural flaws". In these areas, the connective tissue may yield, for example, through stress such as pregnancy and childbirth, a lowering of the uterus or hormonal changes during the menopause - urinary incontinence develops.

Urge incontinence:

In this form of incontinence, even with a little filled bladder, the signal "bladder full" is falsely sent to the brain. In response, an uncontrollable urgency sets in. One speaks also of "overactive bubble". Possible causes of urge incontinence are:

  • Nerve damage or irritation as a result of surgery
  • neurological disorders such as multiple sclerosis, Parkinson's, Alzheimer's, a brain tumor or stroke
  • Constant irritation of the bladder, for example due to bladder stones or urinary tract infections (cystitis)
  • Insufficiently Treated Diabetes (Diabetes Mellitus): Toxins caused by elevated blood sugar levels affect the nervous system.
  • psychological causes

Reflex incontinence:

In reflex incontinence, nerves in the brain or spinal cord that control the bladder are damaged. This can be the case with paraplegia or neurological diseases such as Parkinson's, multiple sclerosis, stroke or Alzheimer's.

Overflow incontinence:

In this form, the bladder outlet is blocked and interferes with urinary outflow, for example, by an enlarged prostate (as in benign prostate enlargement) or a urethral constriction. The latter may be caused by a tumor or by stones.

Extraurethral incontinence:

This form of incontinence may be due to congenital malformations or a fistula. In general, a fistula is understood to mean an "unnatural" connecting tubule between two hollow organs or a hollow organ and the body surface. In the context of extraurethral incontinence, a fistula may exist between the urinary system (such as the bladder, urethra) and the skin, intestine or female genital tract. According to this, urine can escape via the skin opening, the anus or the vagina. Such a fistula can develop as a result of inflammatory processes or after surgery or X-ray irradiation.

Causes of fecal incontinence

Rarely, faecal incontinence is innate; it is then based, for example, on malformations. The much more common acquired faecal incontinence is due to a disorder or damage to the so-called continence organ (anorectum). This consists of the rectum, in which the chair is "stored" (reservoir), and the sphincter (sphincter) around the anal canal.

Possible causes of disturbance or damage to the anorectum are:

  • Injuries, such as births or surgery: they can cause dysfunction of the sphincter or interfere with the perception of the gut.
  • chronic inflammatory bowel diseases such as Crohn's disease
  • neurological diseases such as dementia or multiple sclerosis
  • Tumors in the area of the rectum (such as rectal cancer)
  • Constipation and constipation: Fixed stool causes a blockage that only watery stools can pass through.
  • Pelvic floor weakness
  • Medications like laxatives, antidepressants or Parkinson's drugs
  • pronounced hemorrhoids
  • Prolapse of the rectum or rectum

Incontinence: Therapy

There are several ways to treat an incontinence. In individual cases, incontinence therapy is adapted to the form and cause of incontinence as well as to the patient's life situation.

Therapy of urinary incontinence

Pelvic floor training: In case of stress incontinence, pelvic floor training under the guidance of a physiotherapist can be very successful. For example, the patient learns to reduce the strain on the pelvic floor in everyday life, to remove false tension patterns and to strengthen the pelvic floor with suitable exercises.

Biofeedback training: Some people find it difficult to feel the pelvic floor muscles and consciously perceive and control sphincters. In biofeedback training, a small probe in the rectum or vagina measures contractions of the pelvic floor, triggering a visual or audible signal. In this way, the patient can see within the pelvic floor gymnastics whether he really tightens or relaxes the right muscles.

Electrotherapy: Here, the pelvic floor muscles passively trained by painless electrical impulses.

Toilet training (bladder training): Here the patient has to keep a micturition protocol for some time. In each case, he enters when he has felt urinary urgency, when he has excreted how much urine and whether the urination was done controlled or uncontrolled. In addition, the patient must write down what and how much he has drunk over a day or a night. Based on these records, the doctor prepares a drinking and micturition plan. It determines how much the patient is allowed to drink and when to go to the toilet to empty the bladder (even without urination). The aim is to prevent uncontrolled urine output by controlled emptying of the bladder.

Hormone treatment: In the event of incontinence due to estrogen deficiency during or after menopause, the doctor may prescribe a local estrogen preparation (such as an ointment) to affected women.

Medicines: Depending on the form of incontinence, anticonvulsant medication (urge incontinence) or so-called alpha-receptor blockers are suitable for treatment. The latter can loosen the bladder closure (overflow incontinence) or inhibit the spontaneous activity of the bladder muscles (reflex incontinence).

Catheter: In cases of reflex incontinence, the bladder may need to be drained regularly via a catheter.

Surgery: Extraurethral incontinence must always be treated surgically (for example by closing the fistula). If incontinence is due to an enlarged prostate, surgery is usually necessary. Otherwise, a urinary incontinence surgical procedure only comes into consideration when non-surgical therapeutic measures do not bring the desired success.

For example, then the urethra can be closed by an artificial sphincter or an adjustable loop. A similar effect is achieved by an implant that compresses the urethra so far that the urine can no longer flow away involuntarily. In certain cases, the urethra is stabilized with collagen or silicone to relieve the symptoms of incontinence. An implanted "bladder pacemaker" can help calm down an overactive bladder or stimulate a bladder that can not deflate on its own.

Incontinence: You can do that otherwise

Yes, an incontinence means loss of control. But it does not mean that those affected are helpless. There are many things that anyone can do to help them cope with incontinence or prevent incontinence:

Use incontinence aids: Templates with different absorbency levels, disposable panties with an included mask, incontinence briefs or anal tampons can help you deal with incontinence in everyday life. Men with urinary incontinence can use a condom urinal. This is a kind of condom, through which the urine is passed into a bag.

Reasonably often go to the bathroom: Anyone who goes too often or too rarely to the toilet, does nothing good for his bladder and can significantly increase his risk of urinary incontinence. If urination is too frequent, the bladder eventually becomes used to the small amounts of urine and is then no longer able to store large quantities of urine. Those who rarely go to the bathroom constantly overstretch their bladder muscles and risk malfunctioning.

Reduce weight: Obesity is an important risk factor for incontinence. It increases the pressure in the abdominal cavity and thus promotes incontinence or increases existing incontinence. If you weigh too much you should try to lose weight. This also has a positive effect on the success of pelvic floor training.

Caring for the body: Careful personal care helps to prevent skin diseases as a result of bladder weakness.

Avoid bladder-friendly foods: Avoid foods that can irritate the bladder, such as hot spices or coffee. With fecal incontinence, a high-fiber diet can normalize stool output. You should largely refrain from bloating foods.

Incontinence: examinations at the doctor

Many people are embarrassed if they can not hold their urine or stool properly. They endure their illness quietly and do not even dare to talk to their doctor about the subject. A mistake, because there are effective aids. Patients should be examined and treated by a doctor as soon as possible.

Investigations

Various investigations help with the clarification of an incontinence. Which methods are useful in an individual case depends, among other things, on the type and severity of the incontinence. The most important investigations are:

Examination of the external genitalia and the rectum: it provides information on the causes of incontinence. This allows the doctor to sometimes detect fistulas or an enlarged prostate. He can also check the tension of the sphincter muscles.

gynecological examination: For example, it is possible to detect uterine hypertrophy or a reduction of the vagina as the cause of urinary incontinence.

Urine and blood tests: they can give indications of infections or inflammations.

Ultrasound examination: Ultrasound can be used to estimate any amount of residual urine in the bladder during urinary incontinence. In addition, kidney or bladder stones, tumors or congenital malformations can be detected. Even injuries after surgery can be detected by ultrasound.

Urodynamics: In urinary incontinence, the doctor can assess the function of the urinary bladder by means of urodynamic examinations. For example, in the context of uroflowmetry using electrodes during urination, it is possible to measure the amount of urine, the duration of bladder emptying and the activity of the pelvic floor and abdominal muscles.

Bladder or colonoscopy: It may be necessary to detect, for example, inflammation of the bladder or intestinal mucosa or tumors of the bladder or bowel.

X-ray contrast images: They can give information about a malfunction of bladder or rectum. For this purpose, the bladder or the rectum is first filled with a contrast agent. Then x-rays are taken during urination or bowel movements. In this way functional processes can be analyzed as well as identifications of bulges and invaginations or internal incidents as the cause of incontinence.

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