Urinary incontinence: risk factors & therapy

Urinary incontinence: risk factors & therapy

Around six to eight million people in Germany are affected by urinary Incontinence (a form of bladder weakness). The number of unreported cases is much higher – most suffer in silence because they don’t dare talk about it, and many don’t go to the doctor. Involuntary loss of urine is so embarrassing for those affected that they resort to emergency solutions out of fear of being discovered in public or the family. Urinary Incontinence is predominantly acquired and, more rarely, congenital. It is not a typical symptom of ageing – it can also affect children, young, active women and men. But Nobody has to put up with urinary Incontinence – there are a whole range of treatment options that can cure the condition or at least significantly improve it.

Causes and risk factors of urinary Incontinence

There are various possible causes for urinary Incontinence. One of the leading causes is bladder sphincter weakness, which can be promoted due to various risk factors:

  • In women, recent or recent difficult births or multiple births can overstretch the pelvic floor.
  • During the menopause, the mucous membranes in the abdomen also change. Because hormone levels drop, they become drier, thinner and more vulnerable. The vaginal walls also relax, and the pelvic floor muscles lose strength. Therefore, the bladder sinks and the “occlusion apparatus” fails.
  • Generally, Excess weight puts strain on the pelvic floor and should be used primarily in the case of Incontinence, i.e. in the event of involuntary loss of urine.
  • Sphincter weakness is very rare in men. It usually occurs as a result of prostate surgery, especially after radical prostate cancer surgery (5-10%).

 

Other causes of urinary Incontinence

In addition to sphincter weakness, uncontrolled activities of the bladder muscle are the leading cause of bladder weakness with or without urinary Incontinence. Uncontrolled activities of the bladder muscle (“bladder overactivity”, “bladder instability”) can be either the result of bladder diseases such as cystitis or Bladder cancer, their

  • due to spinal cord and nerve diseases such as multiple sclerosis,
  • due to metabolic diseases such as diabetes mellitus,
  • due to diseases or deterioration processes of the brain, such as a stroke or senile dementia, as well as
  • ultimately also caused by psychological influences.

Bei Kindern und Jugendlichen sind es meist angeborene Fehlbildungen, welche für eine Harninkontinenz verantwortlich sind. Verzögerte Reifungsprozesse oder psychische Probleme können zum nächtlichen Einnässen (“Enuresis”) führen.

Formen der Harninkontinenz

Die Medizin kennt mehr als ein halbes Dutzend Formen der Harninkontinenz. Die wichtigsten sind:

  • Stressinkontinenz
  • Dranginkontinenz
  • Überlaufinkontinenz

 

Belastungs- und Stressinkontinenz

Belastungs- oder Stressinkontinenz nennt man den ungewollten Urinverlust bei körperlicher Belastung (“Stress”). Sie tritt bevorzugt bei Frauen auf, die mehrfach geboren haben. Der Schließmuskel ist dem Druck im Bauchraum und damit in der Blase bei geringer körperlicher Belastung wie Niesen, Husten oder Lachen nicht mehr gewachsen und gibt dem Druck nach. Etwa 50 Prozent aller vorkommenden Inkontinenzformen entfallen auf die Stressinkontinenz.

Dranginkontinenz und Reizblase

Von Dranginkontinenz sind vor allem ältere Menschen betroffen. Die Ursache liegt in einer Überaktivität oder Überempfindlichkeit der Blase. Einerseits werden die Signale über den Füllungszustand der Blase im Rückenmark nicht richtig verarbeitet, andererseits ist die Blase nicht mehr in der Lage, sich “auf Befehl” vollständig zu entleeren.

Daraus entsteht ein Missverhältnis zwischen überfallartigem Harndrang mit Urinverlust und der Unfähigkeit, sich willentlich zu “erleichtern” – und das bis zu 20-mal am Tag. In den Frühstadien spricht man von einer “Reizblase”.

Von der Dranginkontinenz sind 11 Prozent aller über 60-jährigen und 30 Prozent der über 80-Jährigen betroffen; Frauen fast dreimal so häufig wie Männer. Eine Dranginkontinenz kann aber auch die Folge einer Blasenerkrankung, zum Beispiel eine Entzündung oder Krebs sein. Daher ist stets ein urologische Untersuchung erforderlich. Nicht selten sind aber auch psychische Probleme für eine Dranginkontinenz verantwortlich, insbesondere bei Frauen im mittleren Alter.

Überlaufinkontinenz

Die Überlaufinkontinenz tritt hauptsächlich bei Männern auf. Sie ist gekennzeichnet durch einen unfreiwilligen tropfenweisen Urinverlust bei stark gefüllter Harnblase. Häufiges Wasserlassen mit geringer Urinmenge (sogenanntes Miktionsvolumen) sind die Regel. Deshalb bleiben große Restharnmengen zurück.

Ursachen sind Abflussbehinderungen im Bereich des Blasenausgangs oder der Harnröhre durch Tumore, Harnsteine oder meistens durch gutartige oder bösartige Prostatavergrößerungen (benigne ProstatahyperplasieProstatakrebs).

Die Prostata liegt unter der Harnblase des Mannes und umschließt die Harnröhre beim Austritt aus der Blase. Bei Vergrößerung drückt sie die Harnröhre ab. Der Blasenmuskel kann nicht mehr genug Kraft aufwenden, um die Blase zu entleeren, folglich füllt sich die Blase immer weiter. Erst wenn der Füllungsdruck der Blase den Verschlussdruck übersteigt, geht unfreiwillig Urin ab.

Nicht selten aber ist – vor allem bei Frauen – eine Funktionsstörung des Blasenmuskels durch Medikamente, Stoffwechselstörungen, Rückenmarks- oder Nervenerkrankungen (Parkinson-Krankheit) Ursache für Restharnbildung und Überlaufinkontinenz.

 

Auswirkungen einer Harninkontinenz

Bluthochdruck, Fettstoffwechselstörungen, HerzinfarktMagengeschwüre sind längst gesellschaftsfähige Gesprächsthemen geworden, Harninkontinenz ist es (noch) nicht. Betroffenen macht nicht nur ständiger Wäschewechsel, Abhängigkeit von Vorlagen oder Windeln und drohende Geruchsbelästigung zu schaffen. Sie versuchen, ihre Krankheit zu verheimlichen und leben dadurch in pausenloser Angst, entdeckt zu werden. Sie ziehen sich zurück und meiden Kontakte, oft auch zu Freunden oder Verwandten.

Possible consequences are isolation, loneliness, partnership problems and even depression. But Concealment stands in the way of relief or healing.

Which doctor is responsible for urinary Incontinence?

If the suffering increases, a visit to the doctor will help. He carries out a comprehensive examination to clarify the causes of urinary Incontinence. If necessary, a referral to a medical specialist will be made.

For an initial examination, a visit to the family doctor or, in the case of female patients, to the gynaecologist makes sense. When people affected by urinary Incontinence visit a doctor, the first thing they do is talk to them about the history (anamnesis) of bladder weakness. A physical exam then follows to determine the causes.

If necessary, the doctor will carry out or arrange further diagnostic measures. If necessary, referral to a continence and pelvic floor centre, a specialized urologist or a urogynaecologist.

Diagnosis: Identifying and examining urinary Incontinence

During the consultation with the doctor, the doctor will probably ask these questions:

  • How long have you had bladder weakness?
  • How often do you lose urine without wanting to? How much urine are you losing?
  • Does the loss of urine occur in certain situations, for example, during physical exertion?
  • Do you often feel a strong urge to urinate?
  • How many times a day and night do you need to go to the toilet?
  • Do you feel like you can’t empty your bladder?
  • Do you have pain when urinating?
  • Is the urine bloody?
  • Did you have an operation before the bladder weakness?
  • Are you currently suffering from any other medical conditions?
  • Do you regularly take medication? If yes, which?

 

The physical exam

After the anamnesis, the doctor gets an orientation picture through a general physical examination. This includes palpating and delimiting the bladder and the surrounding organs. An assessment of the pelvic floor muscles is necessary in women and the prostate in men.

A urine sample is examined in the laboratory for bacteria, protein, and red or white blood cells. If there are other diseases, such as a bladder infection, these must be treated first. Bladder cancer cannot be overlooked.

Ultrasound examination for urinary Incontinence

The ultrasound examination (sonography) is a routine, painless and side-effect-free examination technique with which internal organs are visualized on a monitor. Here, the position of the kidney and the urinary tract and findings such as kidney or bladder stones, tumours, or congenital malformations can be determined. The emptying function of the bladder can also be easily checked with the help of ultrasound.

The image of the filled and then emptied bladder provides information about the filling volume, the possible amount of residual urine and the bladder contour, including any irregularities (bladder cancer). An examination of the prostate is also possible with an ultrasound examination through the rectum.

Harnflussmessung

With the urine flow measurement, the patient empties his bladder into a measuring funnel or on a special toilet seat. Connected measuring devices register the excreted per second and determine a urine flow curve. From the shape of this curve, the doctor recognizes bladder emptying disorders or outflow obstructions due to narrowing of the urethra or enlargement of the prostate.

 

Bladder and sphincter function diagnostics (urodynamics)

Bladder activity and sphincter function can be measured and documented by simultaneously measuring the pressure in the bladder via a bladder catheter and the flow of urine, depending on how full the bladder is. This examination is essential if a clear distinction between stress and urge incontinence is not possible with simple clinical examinations or if an operation is planned.

X-ray examination

In the X-ray image, a contrast medium is required to show the kidneys, the bladder, and the urinary tract. Depending on the question, this can be fed into the bloodstream via the veins, the bladder via a catheter, or the renal pelvis via the ureters. An X-ray examination is rarely necessary.

Cystoscopy for urinary Incontinence

A cystoscopy enables the inside of the bladder and prostate to be viewed through an endoscope inserted through the urethra. In this way, the doctor assesses the condition of the bladder’s lining (inflammation) and determines whether there are stones, tumours or abnormalities. The decision on the need for such an examination should be made by a specialist doctor (urologist); if bladder cancer is suspected, it is essential.

 

What helps with urinary Incontinence?

Expenditure on incontinence aids is increasing every year. It has become a significant health policy goal, not only to treat the “widespread disease” of bladder weakness but also to avoid it through targeted prevention or to improve the chances of recovery through early detection.

Therapy for stress incontinence

If the cause of urinary Incontinence is weak pelvic floor muscles, active training of the muscles will help in addition to any weight reduction that may be necessary. Daily gymnastics, initially with professional guidance, later alone, tighten the pelvic floor muscles, strengthen the sphincter and straighten the urethra again. Physical therapy has a supporting effect. If there is no satisfactory treatment success after a few months, an operative intervention must be considered.

If the bladder is sinking, pelvic floor training is also the first choice. In severe cases, correction of the position of the bladder by surgery is indicated. If the urethral obstruction is weakened by menopause, medication to replace the missing estrogens (with a prescription) can eliminate the symptoms, but this should only be done under the supervision of a specialist (gynaecologist).

treatment of urge incontinence

In the first place, a bladder infection or bladder cancer must be ruled out and treated if necessary. If the bladder receptors are overstimulated, bladder tea and heat or phytotherapy, i.e. taking herbal medicines, can help in mild cases. These include, for example, extracts from pumpkin seeds, nettle root, goldenrod or nasturtium oil. Some of these drugs are only available in pharmacies, and some are also available in drugstores.

More severe forms require medical treatment. Effective here are antispasmodic drugs from the group of anticholinergics, such as

  • Oxybutynin
  • Propiverin
  • Tolterodine or
  • Trospium chloride (all prescription only)

They inhibit the contraction of the bladder muscle, which reduces the strong urge to urinate. Treatment should last at least six weeks.

Some of the medications initially cause dry mouth, but you should still continue the therapy. After just a few days you will feel a dry mouth. Until then, just suck candy or chew chewing gumto stimulate salivation to promote.

In addition, physiotherapeutic measures should not be missing. For example, those affected can forestall the urge to urinate and avoid unwanted loss of urine through toilet training, i.e. emptying their bladder at set times. Autogenic training, for example, often helps with psychological causes.

 

Therapy for overflow incontinence

Early forms of prostate-related bladder emptying disorders can be favorably influenced by herbal medications (see also benign prostatic hyperplasia). Extracts from pumpkin seeds, sabal fruits, nettle roots or beta-sitosterols from vegetable oils (some of which are available in pharmacies) are effective here.

Medications from the group of alpha receptor blockers (prescription only) are also possible. Among other things, they inhibit the alpha receptors on the bladder neck, which are responsible for good bladder closure. This loosens the bladder seal and reduces the outlet resistance.

So-called 5-alpha reductase inhibitors (prescription only) can also lead to an improvement in bladder emptying by reducing the size of the prostate. In advanced stages, removal of the prostate may be necessary. If prostate cancer is suspected, specialist treatment (urologist!) is essential.

Urinary incontinence: prevention

The first priority in prophylaxis for urinary incontinence is a healthy lifestyle, especially Normal weight, due to a healthy diet and sufficient exercise.

A balanced mixed diet, avoiding too much fat and sweet, prevents excess weight from developing in the first place or helps to lose it again if necessary. A sensible diet also helps with regulated digestion. Constipation leads to excessive strain on the pelvic floor due to strong straining during defecation, which in turn promotes incontinence.

Exercise burns calories, helps reduce weight and promotes better body awareness. All measures that promote blood circulation (sauna, Kneipp treatments, alternating baths, etc.) are useful.

Stress incontinence primarily affects mothers. Even during pregnancy, your pelvic floor is heavily burdened by the weight of the child. A controlled episiotomy during childbirth helps prevent muscle tears to avoid incontinence in later years. After childbirth, good postnatal exercises include intensive pelvic floor training to strengthen the overstretched muscles again.

Pelvic floor training is a prevention against urinary Incontinence at any age, even at a young age, especially for people in “sedentary jobs”. With targeted prevention and therapy, urinary Incontinence is easy to control.

 

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