Can urinary incontinence be treated well

Causes and therapy options

The term urinary incontinence (also: bladder weakness, bladder incontinence) describes the unwanted leakage of urine between visits to the toilet. The urine normally collects in the urinary bladder and escapes in a controlled manner when using the toilet. The ability to control urine output is called continence. It develops in infancy - babies do not yet have this control.

Urinary incontinence can occur at any age, but older people are more often affected by urinary incontinence (women about twice as often as men of the same age). Around 1 million people in Austria suffer from various forms of urinary incontinence. Most people do not talk openly about their urinary incontinence, although in most cases urinary incontinence can be treated very well. Even if the impairment caused by urinary incontinence cannot be completely eliminated in individual cases, a suitable therapy can nevertheless significantly alleviate the urinary incontinence.

What are the causes of urinary incontinence?

The bladder function is very complex: the nervous system, the muscles on the bladder wall, bladder neck and along the urethra, the urethra itself, as well as the muscles, nerves and connective tissue of the pelvic floor are involved. If this interaction is disturbed, urinary incontinence can be the result. The underlying bladder dysfunction can manifest itself either in the form of a storage disorder or a voiding disorder. The causes are manifold

  • Weakness of the muscles involved in bladder function
  • Damage or disease to the nervous system
  • Connective tissue weakness
  • mechanical and functional flow obstruction below the bladder
  • Diseases and malformations of the urinary tract
  • hormonal change or disorder, for example lack of estrogen during menopause
  • Injury, damage from surgery or other medical interventions

Certain circumstances can promote the development of urinary incontinence

  • Age: During the menopause, the estrogen level drops, the connective tissue loses its elasticity, and the bladder lowers. Benign prostate enlargement is common in men.
  • Gender: Urinary incontinence is more common in women. Your connective tissue is more flexible and the pelvic floor is more unstable and larger. In addition, pregnancy and childbirth strain muscles, connective tissue and the pelvic floor in women.
  • Obesity
  • Drinking and micturition behavior (Micturition = emptying the urinary bladder): Many people drink too little, postpone going to the toilet or take preventive measures, although the bladder is not yet filled enough. Both of these can contribute to urinary incontinence by causing the bladder to forget how to fill up sufficiently or to empty completely.
  • Psychological influences: Problems in the relationship are associated with urinary incontinence. How exactly, is still unclear.
  • Physical strain: Some sports strengthen the muscles of the pelvic floor, others are more damaging. This includes, for example, weightlifting. Persistent coughing can also promote urinary incontinence.
  • Nervous system disorders: Stroke, dementia, Parkinson's and other diseases that damage the nervous system (diabetes), as well as recurring urinary tract infections, increase the risk of urinary incontinence.
  • Medical interventions and drugs: E.g. the removal of the uterus, diuretics (water tablets) for high blood pressure or heart failure can promote urinary incontinence.
  • Assessment: increased risk of urinary incontinence if urinary incontinence runs in the family
  • Diseases: Prostate cancer, bladder stones or tumors can lead to urinary incontinence

What types of urinary incontinence are there?

There are different forms of urinary incontinence, which differ in their symptoms and occur at different rates in different ages. The most common forms of urinary incontinence are:

Stress incontinence

In stress incontinence, a sudden increase in pressure in the abdomen - e.g. when laughing, coughing, sneezing or lifting loads - leads to urinary incontinence.

Overactive bladder / urge incontinence

An overactive bladder (also: irritable bladder) manifests itself in the appearance of multiple sudden, barely suppressible urges to urinate, day or night, with or without urine loss (wet or dry overactive bladder). The possible causes of urge incontinence are diverse. Stress and urge incontinence can also occur together (mixed incontinence).

Overflow incontinence

Overflow incontinence is characterized by the fact that an overflowing bladder that cannot be emptied repeatedly leads to uncontrollable leakage of urine in small portions.

Help and therapy options for urinary incontinence

Urinary incontinence can be very stressful. Not only is it a physical problem, it also puts a strain on the soul and self-esteem. No longer being able to hold urine is perceived as a loss of control over one's own body - which is difficult to bear in adulthood. People with urinary incontinence often feel socially excluded and their quality of life is severely restricted. Withdrawal, isolation and even depression are often the result. In most cases, urinary incontinence can be completely eliminated.

How does the doctor diagnose urinary incontinence?

In most cases, the various forms of urinary incontinence can be differentiated using the so-called basic diagnosis. Don't be ashamed to turn to a GP or specialist with your problem. He will approach the topic routinely based on his experience. The appropriate therapeutic measures can then be initiated.

In a detailed doctor-patient discussion (anamnesis), the doctor will ask about the exact complaints.

A "bladder diary" gives the doctor valuable information: The person concerned should note the amount of fluid he consumed, as well as the time and amount of urine (ml) each time he emptied the bladder and whether he was already wet or dry at that time. The basic diagnosis also includes the examination of the lower abdomen, genital area, urine (exclusion / evidence of a urinary tract infection) and checking for the presence of residual urine (whether the bladder is completely emptied). Nowadays this is done completely painlessly with an ultrasound examination of the bladder before and after emptying.

Depending on what causes the doctor suspects the urinary incontinence, other diagnostic methods are used, such as

  • Computed tomography (CT)
  • Cystoscopy
  • Urological exams to test urine flow, bladder pressure and, in women, uterine pressure
  • Determination of PSA (prostate-specific antigen) levels in men

What treatments are there for urinary incontinence?

The targeted treatment of urinary incontinence depends on the present form. However, measures to eliminate possible other causes must be carried out beforehand, such as the treatment of a cystitis, hormone replacement therapy in the case of hormone deficiency or the removal of an obstruction to drainage, e.g. due to an enlarged prostate in men.

At a Stress incontinence Pelvic floor exercises and behavior therapy can help. The Behavior therapy includes controlled drinking, regular urination, weight loss, bowel control and, in the case of smoker's bronchitis, stopping smoking. The Pelvic floor training is a very effective measure. This requires instruction and supervision by a physiotherapist. If properly learned, pelvic floor training should also be carried out consistently at home and over many years.
If these therapeutic measures for the treatment of urinary incontinence are not sufficient, a little stressful treatment can be used surgery achieve a satisfactory result in about 80 percent of the patients treated in this way.

The treatment at Urge incontinence In most cases it is done non-surgically and consists of various forms of bladder training as well Medicationthat counteract the frequent, strong urge to urinate and thus also the urge incontinence (so-called antimuscarinics, also muscarinic receptor antagonists or anticholinergics). There are numerous preparations to choose from for the treatment of urinary incontinence. In older patients, who often have to take several drugs at the same time, substances have proven their worth which, due to their molecular structure, cause fewer drug interactions and no side effects of the central nervous system.

For patients who have a Mixed incontinence a combination therapy of urge and stress urinary incontinence therapy approaches is recommended.

At Overflow incontinence The urologist can use special examinations (urodynamics) to clarify the causes of the impossibility of emptying the bladder and initiate the appropriate therapeutic measures against urinary incontinence. The first step is always to empty the overcrowded bladder, usually with the help of a catheter.

What can you do yourself against urinary incontinence?

Physical and mental fitness counteract the development of urinary incontinence. At the first signs, you should consult a doctor and seek advice. Preventive pelvic floor training is also useful. More tips to prevent urinary incontinence

  • Drink plenty of fluids. Pay attention to low-irritant drinks such as herbal teas or juices.
  • Do not drink large amounts before bed. This increases the risk of involuntarily getting wet at night.
  • Take your time using the toilet and try to empty your bladder completely. The urge to urinate then occurs less often and bacteria are less able to multiply.
  • Relaxation exercises such as autogenic training, breathing therapy or massages can help relieve psychological tension.
  • Micturition or bladder training can be helpful. After consulting your doctor, you should keep a bladder diary (as described above) for a few days. By actively lengthening or shortening the intervals, you can achieve more efficient bladder emptying.

Food can also cause temporary urinary incontinence because it stimulates the bladder and has a diuretic effect. These include

  • alcohol
  • caffeine
  • decaffeinated tea or coffee
  • carbonated drinks
  • artificial sweeteners
  • Citrus fruits and other foods that are high in acid, sugar, or spices

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