• Monday July 13,2020

Incontinence (urinary incontinence)

Many people who suffer from incontinence or specifically urinary incontinence (Latin: Incontinentia urinae) are ashamed of their illness. But in Germany about 6 to 8 million people are affected, women more often than men. Incontinence is characterized by various symptoms and can also be the result of a variety of diseases.

What is incontinence (urinary incontinence)?

Schematic representation of the anatomy and structure of the bladder. Click to enlarge.

Incontinence can take many forms. Common to all are problems of holding and self-directed delivery of the urine. With increasing age, the probability increases especially of more severe forms of incontinence.

In urinary incontinence, the patient feels the sudden need to empty his bladder. In stress or stress incontinence causes a burden (coughing, sneezing, etc.) from an involuntary loss of urine.

In severe cases, even getting up easily or even lying can be a burden. The overflow incontinence is characterized by unintended urine dripping. In reflex incontinence, the patient may lose urine without realizing it.

causes

Incontinence can have many causes depending on the type of incontinence. In urinary incontinence, the patient has increased bladder sensitivity. The bladder (detrusor) is contracted permanently and the patient feels urinary urgency without his bladder being full.

The stress incontinence can be caused inter alia by a functional weakness of the urinary occlusive device. But especially in women, incontinence can also be caused by pelvic floor weakness. This weakness often arises as a result of a general lowering of the internal organs due to weak ligaments and muscles and may be the result of a sudden birth.

The unconscious incontinence is characterized by drainage impediments. These can be caused by an enlarged prostate. Incontinence can also be caused by neurological diseases, diabetes or other reasons.

Symptoms, complaints & signs

Urinary incontinence may have various symptoms depending on the type and cause. Stress incontinence can be recognized by the fact that involuntary loss of urine occurs predominantly during exercise. The loss of urine can vary in severity and typically occurs without previous urinary urgency.

Urge incontinence is manifested by acute, excess urine urgency before the urine suddenly goes off. This type of incontinence can occur several times per hour, even if the bladder is not yet full. In the case of overflow incontinence, small amounts of urine leak out. The patients usually feel a dribble and a permanent urination.

The reflex incontinence is accompanied by an irregular emptying of the bladder. Patients can no longer determine if the bladder is filled and usually do not completely empty the bladder. Urine is constantly lost in extraurethral incontinence. Accompanying this can be pain in the area of ​​the ureter and the bladder.

In infants, urinary incontinence is noticeable by the fact that it occurs at irregular intervals and dies down to the age of four. If the symptoms continue to persist well beyond the age of four, another form of urinary incontinence is the basis, which must be diagnosed and treated by a doctor.

disease

In many cases, treatment of incontinence is not only important for the life value of a patient, but can also be medically indicated.

Especially with the overflow bladder, a non-treatment of incontinence in the most severe cases can even lead to uremia (uremia).

The urine remaining in the bladder accumulates in the ureter and kidneys and causes an increasing loss of function of the kidneys (kidney insufficiency). This can then lead to severe urinary poisoning.

But in other cases, the treatment of incontinence is important. Incontinence may also be a symptom of another more serious condition such as prostate cancer or diabetes. These diseases, the concomitant incontinence, usually worsen without therapy and can be fatal.

complications

Urinary incontinence may be well treated or managed today. But it also tends to leave room for various complications. If urine is often in contact with the skin, skin irritation may occur. Left untreated, ulcers and inflammation can develop in elderly or bedridden people.

The risk of a urinary tract infection is increased in incontinence. In addition, those affected often feel embarrassed by their inability to hold the urine. In some cases, those affected can no longer hold the stool. But even urinary incontinence can be a reason for many to withdraw from other people. They fear that they will become a disruptive factor in social life through the consequences of incontinence.

As a complication of surgical incontinence in younger years, emotional problems may occur. Depression or anxiety can put extra strain on affected people. In addition, not everyone has the opportunity to provide themselves with the necessary incontinence deposits and aids.

In case of stress incontinence after birth or hysterectomy surgery can help. But such surgery can also lead to complications. Therefore, it is first attempted with pelvic floor exercises to oppose urinary incontinence with a conservative treatment approach. Depending on the surgical procedure, wound healing disorders can occur. It may be due to surgery to rebleeding, urinary tract infections, nerve irritation and damage. Peritonitis is possible but less common.

When should you go to the doctor?

Many patients with urinary or fecal incontinence shy away from shame or fear of possible examinations to the doctor. Nevertheless, those who can no longer hold the urine or stool should be examined and advised as soon as possible. This is also recommended if it is just a mild form of urinary incontinence. As a rule, incontinence can be treated well after medical consultation. Which type of therapy is suitable for the respective person concerned can only be determined if the attending physician can determine the exact form of incontinence by means of examinations.

In some cases, there may be significant worsening of incontinence without treatment. It usually does not disappear by itself. Sometimes, incontinence can also be a symptom of serious illnesses. For this reason, it is advisable to consult a doctor as soon as possible after the onset of symptoms. The sooner those affected take such measures, the higher the chances of recovery. It is recommended to first consult the family doctor.

Treatment & Therapy

The treatment of incontinence must always be based on the causes. The patient should be advised by a doctor. In a pelvic floor weakness, the first goal is of course a strengthening of the pelvic floor muscles. This can be strengthened by a variety of exercises.

Sometimes, biofeedback support is needed to help the patient learn to control muscle movement. For this purpose, a probe is introduced, which indicates which muscle is being strained at the moment. Occasionally, stress urinary incontinence may also require estrogen treatment or, in severe cases, the formation of an artificial sphincter. In urge incontinence, bladder teats, herbal medicines and heat treatment can be effective in mild cases.

Even toilet training can help to reduce incontinence. For this purpose, the patient goes to the toilet at pre-determined times and thus comes before the urge. In more severe cases, the use of stronger anti-incontinence medicines may also be advised.

Unconscious incontinence can be alleviated in many cases by herbal medicines from pumpkin, nettle or saw palmetto. In severe cases, the administration of an alpha-receptor blocker makes sense. This loosens the bladder closure and reduces the flow resistance and can thus combat incontinence.

Outlook & Forecast

The prognosis of incontinence is linked to the age of the patient as well as the existing underlying disease. Depending on the disorder, spontaneous healing or chronic disease development may occur.

In children, incontinence sets in during the natural growth and development process during night sleep. The control of the sphincter muscle must first be sufficiently trained before it works properly. It is a temporary phenomenon with sporadic occurrence, which usually occurs until the sixth year of life. There may be periods of discomfort within time. Subsequently, a spontaneous end of the wetting is to be expected.

In older people, of course, the musculature decreases conditionally. It comes to an incontinence, which is preserved in most cases until the end of life. There is no cure for these patients.

If the incontinence is triggered by paralysis or viral disease, the prognosis of the causative disease must be considered. This is crucial for the further course and the prospect of alleviating or curing the symptoms. If existing germs can be found and treated with medication, a recovery occurs within a few days or weeks. With a paralysis of the musculature a complaint freedom is often no longer possible.

prevention

Home remedies ↵ for incontinence Strengthening the pelvic floor muscles is an effective way of preventing incontinence, especially for women. Special exercises are offered in many folk high schools or sports clubs.

But a healthy lifestyle also reduces the risk of incontinence considerably. In general, one should pay attention to a healthy diet for the prevention of incontinence, not smoking and possibly fighting existing overweight.

aftercare

Patients require extensive support in their daily lives in incontinence care. Here continuous monitoring and consultation by a specialist and trained, medical staff in the field of ostomy care and therapy is important. In order not always to have the fear of a nuisance in everyday life, the use of suitable templates, inserts or diaper pants is necessary and recommended by patients.

The templates are characterized in size and absorbency and are therefore distinguished for day and night use. With the appropriate expert advice, the patient will find the right incontinence material for him, in order to get the most out of the day and through the night. A timely change of incontinence material in the patient, however, is necessary to avoid unpleasant odors or visible.

With an individually adapted incontinence care the participation in the social life is almost unlimited possible. In addition, measures and therapies should be available that can improve continence in the long term. This includes the strengthening of the muscles through targeted pelvic floor training. Patients, however, need patience, initiative and perseverance. An improvement can be expected after weeks and months, because the muscles have to strengthen and express.

You can do that yourself

Targeted exercise exercises strengthen the pelvic floor muscles and, in the case of mild forms of incontinence, can significantly reduce the involuntary urine output. However, they must be consistently and permanently performed to achieve a long-lasting effect. The reduction of overweight and a fiber-rich diet also has a positive effect on the pelvic floor muscles.

In many cases, bladder training is helpful in that the bladder is emptied regularly at certain times before a strong urinary urgency sets in. Nocturnal loss of urine can often be avoided by having one or two scheduled toilet sessions. Drinking less with urinary incontinence is usually counterproductive: The reduced urine volume means that the urinary tract can no longer be sufficiently flushed through, that bacteria can multiply and trigger urinary tract infections. These in turn cause a constant urinary urgency, which in turn is accompanied by uncontrolled urination.

In order not to slip into social isolation, sufferers should despite urinary incontinence their everyday lives as far as possible continue normal and do not give up their usual leisure activities: Discrete, but very absorbent deposits provide security at work and in sports, with special incontinence swimwear Swimming pool visits easily possible. Anyone who suffers from severe incontinence mentally should not be afraid to talk to a psychologist, psychotherapist or self-help group.


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