What is urinary incontinence?

With urinary incontinence, the person affected loses urine involuntarily. The term urinary incontinence therefore describes the inability to consciously empty the bladder. Urinary incontinence is also colloquially called bladder weakness or urinary incontinence and can affect people of any age. However, the likelihood of urinary incontinence increases with age. Women often suffer from urinary incontinence more often than men because of their weaker pelvic floor muscles. Urinary incontinence is more a symptom than a disease. Urinary incontinence always indicates a disease, which can occur in various degrees of severity and forms.

How does the human urinary system work?

Urine is produced by the kidneys and collected in the bladder. The urethra and the bladder sphincter store the urine in the bladder. When the bladder fills up, the bladder wall expands. The nerves of the spinal cord signal to the brain when the bladder needs to be emptied. Healthy people then feel an urge to urinate. Urination also detoxifies the body.

What are the different forms of urinary incontinence?

There are various causes that can lead to urinary incontinence. In addition to operations on the lower abdomen, these include pregnancy, certain diseases such as diabetes or nerve damage. Depending on the cause and symptoms, a distinction is made between the different forms of urinary incontinence:

• Stress incontinence: urine leakage is often triggered by physical exertion. This form of urinary incontinence is particularly common during coughing, laughing or sneezing. However, some people also suffer from stress incontinence during exercise because the bladder sphincter is too weak and cannot hold back the urine when there is increased pressure in the abdomen.
• Urge or urge incontinence: the bladder involuntarily leaks urine due to a storage disorder of the bladder. Affected persons usually suffer from a sudden, uncontrollable urge to urinate or have to go to the toilet frequently (even at night).
• Mixed incontinence: Combination of urge and stress incontinence, in which the affected person not only suffers from a pronounced urge to urinate, but also loses urine involuntarily during physical exertion.
• Reflex incontinence: results from a disturbed transmission of nerve impulses
• Overflow incontinence: despite a full bladder, only droplets of urine are released. A typical symptom of overflow incontinence is a continuous dribbling of urine.
• Extraurethral incontinence: belongs to a rarer form of incontinence in which the urine does not pass through the urethra but through misdirected ducts. The cause, especially in children, is an organic malformation of the lower ureters. In adults, extraurethral incontinence can be caused by fistulas.
• Laughter or giggle incontinence: This is a special form of urge incontinence, where the involuntary leakage of urine is triggered by a reflex such as laughter. Laughing out loud can lead to complete emptying of the bladder, even though no urge to urinate was felt beforehand.

What are the different degrees of urinary incontinence?

Urinary incontinence can be classified into the following degrees of severity, depending on how much urine leaks involuntarily:

• mild urinary incontinence: the person affected cannot hold urine between visits to the toilet and loses a few droplets, for example when laughing or coughing.
• moderate urinary incontinence: The person affected does not always manage to reach the toilet in time.
• severe urinary incontinence: The affected person has no control over the bladder function. However, the bladder does not empty completely.
• very severe urinary incontinence: The affected person suffers from a gush-like loss of urine that can occur several times a day. The bladder always empties completely.

How is urinary incontinence diagnosed?

A medical examination can usually determine which form of urinary incontinence is present. To do this, the doctor will first discuss the patient's symptoms and carry out a physical and clinical examination. Based on this, the doctor will prescribe a suitable treatment to relieve the symptoms of urinary incontinence.

How can urinary incontinence be treated?

The different treatment options depend on the different forms of urinary incontinence:

• Stress incontinence: Regular pelvic floor exercises can strengthen the muscles of the ligaments of the holding apparatus and sustainably strengthen the pelvic floor. Medication can also help. If both measures are unsuccessful, surgery can be performed in particularly severe cases. In this case, a tension-free band is placed under the urethra to stabilise the holding structures.
• Urge incontinence/urge incontinence: can be caused by inflammations, tumours or bladder stones, which then have to be treated first. In addition, those affected should visit the toilet regularly before the urge to urinate arises. Medication or herbal remedies such as cranberry juice can also help.
• Mixed incontinence: treatment usually consists of a combination of pelvic floor muscle training and medication.
• Reflex incontinence: if there are neurogenic causes, the therapy must first be aimed at treating these. A catheter is usually used for this purpose. However, electrostimulation or even surgery may also be considered.
• Overflow incontinence: The obstruction that prevents the bladder from emptying must be removed. This is usually done through surgery. However, the activity of the bladder muscle can also be stimulated by electrical stimulation and helped by certain medications.
• Extraurethral incontinence: if the cause is a malformation, an operation is performed or the urine is drained via a catheter.
• Giggle incontinence/laughing incontinence: occurs in most cases in children and disappears on its own with the onset of puberty. Doctors recommend consistent pelvic floor training. In adults, Botox injections into the bladder muscle can also be used.