Incontinence

Overview: What is incontinence?

Normally, the bladder stores urine until it is released in a controlled manner during the next visit to the toilet. Experts refer to this ability as continence. If urinary control is impaired, this is referred to as incontinence, also known colloquially as bladder weakness. This leads to involuntary loss of urine. This can be very stressful for those affected in everyday life. Many people are so uncomfortable with the subject that they don’t even bring it up when they visit the doctor. However, this is important. This is because the right treatment can not only alleviate the symptoms, in some cases those affected regain complete control of their bladder.

Frequency and age

As incontinence is such a shameful topic, it is difficult to say how many people in Switzerland suffer from it. In general, women are more frequently affected by bladder weakness than men, as their urogenital system is exposed to great stress due to pregnancy and childbirth. The number of incontinent people also increases with age.

Incontinence: causes and risk factors

Experts distinguish between different forms of incontinence. Different triggers are also possible, depending on the case.

Stress incontinence

In stress incontinence, formerly also known as stress incontinence, the urethral sphincter mechanism is damaged. Women suffer from this problem much more frequently than men. This is because the pelvic floor, which supports the pelvic organs and holds them in their correct position, is exposed to much greater stress. This is not only for anatomical reasons. A weak pelvic floor muscle can also be caused by pregnancy and childbirth, for example, as well as hormonal changes during the menopause. In men, on the other hand, prostate surgery is often the trigger for stress incontinence.

Urge incontinence

It is also commonly referred to as irritable bladder or overactive bladder. Urge incontinence can have various causes. A hypersensitive bladder wall or an unstable bladder muscle can cause unwanted and uncontrollable contractions. Urge incontinence can also occur if the bladder is irritated over a longer period of time (e.g. due to a urinary tract infection or bladder and urinary tract stones) or if the bladder outlet is narrowed (e.g. due to an enlarged prostate). Tumors and neurological diseases such as Parkinson’s, Alzheimer’s, multiple sclerosis or stroke can also be the trigger. Sometimes there is no recognizable reason. In this case, experts speak of an idiopathic irritable bladder.

Reflex incontinence

In this case, nerve damage means that the bladder sphincter can no longer be controlled. This can be triggered, for example, by neurological diseases such as Parkinson’s, multiple sclerosis or Alzheimer’s as well as impairment of the spinal cord (e.g. due to paraplegia or a severe slipped disc).

Overflow incontinence

With this type of incontinence, the bladder simply overflows when it is full. The most common trigger for this is benign prostate enlargement (benign prostatic hyperplasia or BPH). This is why it is mainly men who suffer from this form of bladder weakness. Other causes may include, for example

• weak bladder muscles (e.g. due to nerve damage as part of a disease such as diabetes) and
• a narrowed or blocked urethra (e.g. due to tumors, urinary stones).

Extraurethral incontinence

If urine passes through misaligned or malformed ducts and not through the urethra, experts refer to this as extraurethral incontinence. In children, for example, malpositioning of the urethra or malformations of the ureter are the cause. In adults, so-called urinary fistulas usually form, i.e. small ducts such as those between the bladder and vagina. Urine constantly drips out of the inside of the body through these ducts.

Risk factors for incontinence

In addition to gender, age and certain illnesses, there are other risk factors that can promote the development of incontinence. These include, for example

• Medication such as antidepressants or diuretics (dehydrating drugs),
• Overweight,
• heavy physical labor,
• chronic respiratory diseases (coughing can increase the pressure on the bladder) or
• weak connective tissue.

Symptoms: Urine loss differs according to the type of incontinence

In all forms of incontinence, those affected lose urine without wanting to. There are the following differences:

• Stress incontinence: Urine leakage occurs mainly when the pelvic floor is under heavy strain, such as coughing, sneezing, laughing, carrying or lifting heavy loads. The urine comes out in splashes.
• Urge incontinence: In this case, an almost overwhelming urge to urinate occurs within a short period of time. Sometimes those affected can no longer make it to the toilet and often lose urine in gushes.
• Mixed incontinence: Symptoms of both urge and stress incontinence occur here.
• Reflex incontinence: Here the bladder empties itself by the bladder muscle contracting reflexively at irregular intervals. Urine often remains in the bladder. Those affected do not feel when their bladder is full and cannot control the emptying process.
• Overflow incontinence: As the name suggests, the full bladder literally overflows. Those affected have the feeling of constantly having to go to the toilet and lose urine in dribbles.

Incontinence: Diagnosis with us

At the beginning of the examination, we will have a detailed discussion with you (anamnesis). For example, we will want to know what complaints you have, how long they have existed and whether you suffer from any other illnesses. Sometimes we also ask more detailed questions, such as how much urine you are losing, whether urine loss occurs during certain activities or whether you experience pain when urinating and then feel you need to go to the toilet again. All this helps us to find out the exact cause of the incontinence.

Following the consultation, we will also examine you physically. With the help of an ultrasound device, for example, we can determine whether the bladder and urinary tract are clear and healthy. It can also be used to determine the amount of residual urine that may be in the bladder after using the toilet. In women, this is followed by a gynecological examination to rule out possible causes such as uterine prolapse. In men, the rectum and prostate are usually palpated. A blood and urine test will show whether there is possibly an inflammation in the body (e.g. urinary tract infection).

We will probably also ask you to keep a so-called micturition diary (micturition = urination). This is a standardized questionnaire in which you regularly note down the following, for example:

• How strong was the urge to urinate before going to the toilet?
• When and how much did you have to urinate?
• How much did you drink?
• Was there an uncontrolled loss of urine?

A micturition diary can help you get to know your drinking and toilet habits better and make it easier to classify your symptoms.

Further methods for diagnosis

To determine the cause of the incontinence even more precisely, we can use other examination methods. These include, for example, imaging procedures such as computer tomography or cystoscopy. If prostate cancer is suspected, the value of the prostate-specific antigen (PSA) is usually determined. Urological examinations can also help to detect bladder dysfunctions or measure urine flow and bladder pressure.

Incontinence: prevention, early detection, prognosis

There are no early signs of incontinence. However, various measures can help to prevent the typical complaints:

• Train the pelvic floor: It makes sense to pay attention to the pelvic floor after giving birth and to strengthen it in a targeted manner. Group offers are useful if you have no complaints.
  If you already have symptoms, targeted therapy by a physiotherapist specializing in pelvic floor rehabilitation with training tailored to your needs is promising.
• Pay attention to your body weight: Being overweight can promote or worsen incontinence. Therefore, make sure you maintain your weight with a healthy diet and sufficient exercise or try to reduce excess weight
• Avoid strain in everyday life: This includes not only heavy physical work, but also sports such as jogging. The lower pelvic region is exposed to increased pressure and this can weaken the pelvic floor. Sports such as cycling, Nordic walking or swimming are gentler. Chronic coughing and constipation can also put a lot of strain on the pelvic floor.
• Drink properly: A lack of fluids leads to concentrated urine. This can irritate the bladder muscle. But you shouldn’t drink too much either. The optimum amount is one and a half to two liters per day.

Progression and prognosis (incontinence)

The course and prognosis of incontinence depend on how severe the symptoms are and what the underlying causes are. In many cases, treatment is possible that can alleviate the symptoms or even restore complete control over bladder emptying. However, incontinence is not only associated with physical symptoms. The shame is so great for some sufferers that they withdraw more and more from social life. It is therefore important not to make the involuntary loss of urine a taboo subject, but to talk openly about the problems with us – even if it may be difficult at first. This not only reduces the physical discomfort, but also the emotional strain.

Incontinence: treatment depends on the cause

There are various ways to treat incontinence. The therapy depends on the underlying cause and takes into account the type of incontinence you suffer from. We decide which measures are recommended for you individually and together with you in a detailed discussion. The health insurance company may also contribute financially to any necessary incontinence material (pads, “pants”). If the criteria are met, we can issue a corresponding material prescription for you during the appointment and will be happy to advise you.