Incontinence (involuntary loss of urine)

What are the forms and symptoms of urinary incontinence?

There are different types of incontinence that manifest themselves through different symptoms in addition to the involuntary loss of urine.
Below you will find the most common forms of incontinence and their typical symptoms.
The so-called "bladder weakness"

is not a separate form of urinary incontinence.
Rather, the term is commonly used as a synonym for various disorders of bladder function, which are often wrongly dismissed as trivial.
This downplays both the aspect of a medical condition and its treatability.
In most cases, neither an investigation into the cause nor an appropriate therapy is carried out.
Many sufferers unnecessarily resign themselves to their situation.

Stress incontinence (stress incontinence)

Stress urinary incontinence results in the involuntary loss of urine as soon as the pressure in the abdominal cavity - and therefore on the bladder and pelvic floor - increases.
This happens, for example, during physical exertion, coughing or sneezing.
The now outdated but still widely used term "stress incontinence" also seems to define (psychological) stress as the cause of this form of incontinence - this is not the case.
Usually, those affected do not feel the urge to urinate before the loss of urine.
Under stress, urine leakage occurs suddenly, sometimes in dribbles or even in a stream.
Stress incontinence often occurs in women and is caused by a weakening of the pelvic floor muscles.
A weakening of the bladder sphincter is also a conceivable cause of stress incontinence.
The condition can usually be improved with conservative treatment methods (e.g. regular exercises under professional guidance, medication).

→ Find out more about stress incontinence

Urge incontinence (urge incontinence)

A sudden, strong and unstoppable urge to urinate, which seems to come out of nowhere, is the characteristic symptom of this form of incontinence.
However, a glass of water, a cup of coffee or splashing noises can also trigger a sudden urge to urinate followed by involuntary urination.
This form of incontinence is often referred to as irritable bladder, hypersensitive bladder, overactive bladder or sudden urinary incontinence.
Depending on the cause, treatment is conservative, medicinal or surgical.

→ Learn more about urge incontinence

Mixed incontinence

If symptoms of stress and urge incontinence occur at the same time, this is known as mixed urinary incontinence.
Those affected are often tense in public and fear unpredictable pressure (e.g. sneezing, coughing) and sudden, uncontrollable urge to urinate.
They usually scan their surroundings constantly for a toilet nearby.
The frequency of this form is unevenly distributed between the sexes: Women in particular are affected by mixed incontinence.
Treatment depends on the underlying cause of mixed incontinence.

→ Find out more about mixed incontinence

Rarer forms

There are often mixed forms of urinary incontinence as well as much rarer forms of incontinence due to anatomical or disease-related causes.
The rarer forms of incontinence include, for example

• Supraspinal and spinal reflex incontinence: Incontinence caused by nerve damage, for example in Parkinson's disease, dementia, multiple sclerosis or stroke.
  Those affected do not feel when their bladder is full and cannot voluntarily control bladder emptying.
• Incontinence due to difficult and incomplete bladder emptying, formerly also known as overflow incontinence: Usually triggered by a benignly enlarged prostate, which is why men are often affected.
  However, nerve damage as part of a neurourological disease or a narrowed urethra are also possible causes.
  In the case of overflow incontinence, those affected constantly have the feeling that they have to go to the toilet.
• Extraurethral incontinence: Urine is not only passed through the urethra, but also through malformed ducts, e.g. via the vagina or bowel.
• Enuresis: Nocturnal enuresis, especially in children, but also in adults.
  This form of incontinence is caused by physical, psychological or neurological factors.
  We speak of enuresis when involuntary urine loss occurs at least two nights a month after the age of five.

Causes of urinary incontinence: Incontinence can have many causes

Urinary incontinence can have various causes.
Apart from risk factors that can promote the development of bladder dysfunction and incontinence, gender and age also play a role.
In general, the following factors can increase the risk of incontinence:

• certain medications (antidepressants, dehydrating medications)
• Overweight
• Weak connective tissue and a weakened pelvic floor
• Heavy physical work or regular heavy physical strain
• Births - especially multiple and/or difficult natural births
• Chronic cough or constipation increase the pressure on the abdomen, bladder and sphincter muscles
• Operations on the urogenital tract or in the area of the spine
• Neurogenic diseases such as Parkinson's, multiple sclerosis, dementia, stroke, etc.

Incontinence in women

One in two women notice bladder incontinence after the age of fifty during physical exertion, for example when sneezing, coughing, laughing or doing sport.
With increasing age, pregnancy and childbirth as well as hormonal changes, women are affected twice as often as men.
However, typical symptoms of an irritable bladder such as frequent and increased urge to urinate, a shorter warning time and even urinary leakage with urge(urge incontinence) are also increasingly common in women over the age of 50.
Organ prolapse in the pelvis, such as a prolapse of the uterus, can also cause incontinence.
Our urogynaecology specialists will be happy to advise you on risk factors and treatment options.

Incontinence in men

Men over 50 are often plagued by an enlarged prostate with a frequent urge to urinate and annoying urination at night.
The slowly enlarging prostate increasingly restricts the flow of urine and thus irritates the bladder.
This results in frequent urination at night, a generally frequent and increased urge to urinate with a short warning time and urge incontinence.
Overflow incontinence also frequently affects men.
In this case, an enlarged prostate often narrows the urethra and prevents the bladder from emptying completely when going to the toilet.
Due to the permanently overfilled bladder, which reaches the limits of its elasticity, the sphincter muscle eventually becomes tired and urine is lost in dribbles.
Feel free to contact our men's health specialists for a detailed consultation on the subject of incontinence in men.

Physical examination

Following the medical history, the doctor can arrange for specific physical examinations of the suspect organs.
These may include

• Urinalysis
• Palpation examination (urological, gynecological)
• Ultrasound examination
• Urodynamic measurement
• Residual urine determination
• Insole weighing test (pad test)
• Endoscopy of the urethra and bladder
• Neurological examination
• X-ray examination

Incontinence treatment: a wide range of treatment options with good prospects of success

There are different treatment options depending on the type of incontinence, causes and severity of the condition.
How exactly can incontinence be treated?

In many cases, conservative forms of therapy such as pelvic floor training or biofeedback training can already achieve very good results and give affected people a significantly improved quality of life.

Nowadays, modern surgical procedures also often lead to the desired success.
Successful treatment promises lasting help with incontinence and significantly improves the patient's attitude to life: patients can usually take an active part in social life again, play sport and move more easily in all situations.

The following treatment options can be considered for incontinence

What those affected can do themselves

Urinary incontinence is not an inevitable fate.
Rather, there are some measures that patients can take themselves to prevent incontinence or its worsening and to alleviate its symptoms.

• Make sure you drink enough fluids - about two liters a day.
  Acidic fruit juices and cranberry products acidify the urine and support bladder function.
• Avoid caffeine and alcohol, as these further irritate the bladder.
• Watch your weight.
  Being overweight is a risk factor for incontinence as it increases the pressure in the abdominal cavity.
• Go to the toilet regularly, also as a preventative measure.
• Avoid draughts and cold.
• Ensure that your bowel function is balanced and that you have regular bowel movements.
• Regular training of the pelvic floor muscles ensures stability in the urogenital area.
  If possible, incorporate a little pelvic floor training into your daily routine.

In principle, incontinence is easily treatable.
Getting medical advice as early as possible and treating the symptoms and their causes improves the quality of life of those affected.
We would be happy to advise you personally!