Incontinence: description, forms, causes, therapy

Dr. Andrea Bannert has been with NetDoktor since 2013. The doctor of biology and medical editor initially researched microbiology and is the team’s expert for the tiny things: bacteria, viruses, molecules and genes. She also works as a freelancer for Bavarian Radio and various science magazines and writes fantasy novels and children’s stories.

Carola Felchner is a freelance writer in the NetDoktor medical department and a certified training and nutrition consultant. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before her traineeship, she studied translation and interpreting in Kempten and Munich.

incontinence means that you can no longer hold urine or stool – some of it comes off uncontrollably. The reasons for this can be very diverse. Urinary incontinence is usually based on a disorder in the fine-tuned system of bladder muscles, sphincter muscles and pelvic floor muscles. The reason can be, for example, errors in the signal transmission of the nerve cells involved. There are good treatment options for incontinence today. Read here what they are and what you can do for incontinence yourself.

Quick Overview

What is incontinence?? Inability to control urine (urinary incontinence) or, more rarely, stool (stool incontinence) in a controlled manner
Causes: depending on the shape, e.g. B. Urinary stones, enlarged prostate, tumors, nerve injuries or irritation, neurological diseases (multiple sclerosis, stroke, Alzheimer’s, etc.)
investigations: Depending on the type and severity of incontinence, for example, gynecological examination, proctological examination (examination of the rectum), ultrasound, urine and blood tests, urodynamic tests (for determining bladder function), bladder mirroring, colonoscopy, etc.
Therapy: Depending on the form and severity of incontinence, for example, pelvic floor training, toilet training, electrotherapy, pacemakers, medication, surgery

Incontinence: description

People with incontinence can no longer hold their urine or, less often, their stool in a controlled manner. One then speaks of urinary or fecal incontinence.

Image gallery: bladder weakness – no false shame!

Larissa Melville completed her traineeship in the editorial office of NetDoktor.de. After studying biology at the Ludwig Maximilians University and the At the Technical University of Munich she first got to know the digital media at Focus online and then decided to learn medical journalism from scratch.

Bladder weakness is treatable!

Stress incontinence – most common

Typically female

Pelvic floor training for stress incontinence

Help for the woman

Surgery is also an option

You can do that yourself

I have to go again!

Therapy for urge incontinence

urinary incontinence

Colloquially, this symptom is also called “bladder weakness”. However, the bladder is not always the cause. There are five different forms of urinary incontinence:

Stress incontinence: Earlier than stress incontinence referred to because physical exertion is the trigger: If the pressure in the abdomen increases (e.g. when lifting heavy objects, coughing, sneezing, laughing), those affected involuntarily lose urine. In severe cases, urine escapes with every movement, in extreme cases also when standing or lying down. Those affected do not feel the urge to urinate before the urine goes out unintentionally.
Urge incontinence: In this form of incontinence, the urge to urinate occurs very frequently (sometimes several times an hour), even though the bladder is not yet full. Often those affected can no longer make it to the toilet in time. The urine gushes out.
Reflex incontinence: People with reflex incontinence no longer feel when the bladder is full and can no longer control emptying. The bladder empties itself at irregular intervals, but often not completely.
Overflow incontinence: When the bladder is full, small amounts of urine flow out continuously. Affected people can also feel a constant urge to urinate.
Extraurethral urinary incontinence: Here, too, urine is constantly emitted without the patient being able to control it. However, this does not happen via the urinary tract, but through other openings (medical: extraurethral), such as through the vagina or the anus.

Some people also suffer from mixed incontinence. This is a combination of stress and urge incontinence.

fecal incontinence

This form of incontinence is less common. Patients with faecal incontinence cannot arbitrarily retain the contents of the intestine and intestinal gases in the rectum. Doctors distinguish between three degrees of severity:

1st degree partial incontinence: uncontrolled escape of air and occasional chair lubrication when under stress.
Partial incontinence 2nd degree: Patients cannot hold intestinal gases and thin stools.
Total incontinence: total loss of control over bowel movements associated with constant stool lubrication. Patients also lose stool.

As with urinary incontinence, there are cases in which the person feels that the stool is about to go out, but does not make it to the toilet in time, and there are cases in which the stool occurs quite unexpectedly (the person affected does not feel anything in the anal area).

Incontinence: causes and possible diseases

In the case of urinary incontinence, the fine-tuned system of bladder muscle, sphincter and pelvic floor muscles as well as the controlling nerves and centers in the brain and spinal cord no longer work properly. With stool incontinence, the disorder affects the occlusion apparatus of the anus and the corresponding nerve structures. In both cases, the cause of this can be varied:

Causes of urinary incontinence

The five forms of urinary incontinence have very different causes, but they all affect the function of the bladder.

This fulfills two important tasks: It must store the urine and (if possible) empty it at the desired time. The bladder muscle is relaxed when you save. This allows the bladder to expand and fill. simultaneously is the Sphincter tight, so that the urine can not immediately drain through the urethra. The bladder muscle contracts to empty, while the sphincter slackens with the pelvic floor muscles. The urine can then drain through the urethra.

Stress incontinence:

In the case of stress incontinence, the locking mechanism between the bladder neck and urethra is no longer functional. The reason may be that Pelvic floor tissue injured during prostate surgery or an accident. Also Nerve injuries and irritation as well as a Bulging of the bladder can trigger stress urinary incontinence. It is also favored by risk factors how:

chronic cough
overweight
frequent lifting of heavy loads
Lack of exercise (poorly trained pelvic floor!)
(in women) pelvic organs sinking downwards (such as lowering of the uterus)

Stress incontinence occurs much more common in women on than in men. This is because they have a wider pelvis and weaker pelvic floor muscles. There are also three openings in the female pelvic floor (for the urethra, vagina and rectum), while the man has only two. These are "natural weak points". At these points, the connective tissue can give way due to stress such as pregnancy and childbirth, a lowering of the uterus or hormonal changes in the menopause – urinary incontinence arises.

Urge incontinence:

With this form of incontinence, the signal “bladder full” is incorrectly sent to the brain even when the bladder is not full. The reaction is an uncontrollable urge to urinate. One also speaks of "overactive bladder". Possible causes of urge incontinence are:

Nerve damage or irritation from surgery
neurological diseases such as multiple sclerosis, Parkinson’s, Alzheimer’s, a brain tumor or stroke
constant irritation of the bladder, for example due to bladder stones or urinary tract infections (cystitis)
insufficiently treated diabetes mellitus: toxins that through the increased blood sugar levels affect the nervous system.
psychological causes

Reflex incontinence:

With reflex incontinence, nerves in the brain or spinal cord that control the bladder are damaged. This can be the case with paraplegia or neurological diseases such as Parkinson’s, multiple sclerosis, stroke or Alzheimer’s.

Overflow incontinence:

In this form, the bladder outlet is blocked and disrupts urine drainage, for example due to an enlarged prostate (as with benign prostate enlargement) or a narrowing of the urethra. The latter may be due to a tumor or urinary stones.

Extraurethral incontinence:

This form of incontinence can be caused by congenital malformations or a fistula. Generally speaking, a fistula is understood "unnatural" Connection tubules between two hollow organs or a hollow organ and the body surface. In the context of extraurethral incontinence, there may be a fistula between the urinary system (such as the bladder, urethra) and the skin, intestine or female genital tract. Accordingly, urine can escape through the skin opening, the anus or the vagina. Such a fistula can develop as a result of inflammatory processes or after surgery or X-rays.

Various medications (such as diuretics, antidepressants, neuroleptics) and alcohol can aggravate existing urinary incontinence.

Causes of stool incontinence

Rarely incontinence is congenital; for example, it is based on malformations. Acquired incontinence, which is much more common, is based on a disorder or damage to the so-called continental organ (anorectum). This consists of the rectum in which the chair is “stored” (reservoir) and the sphincter (sphincter) around the anal canal. Possible causes of an anorectal disorder or damage are:

Injuries, for example due to childbirth or surgery: They can lead to dysfunction of the sphincter or impair nerve perception at the exit of the intestine.
inflammatory bowel diseases such as Crohn’s disease
neurological diseases such as dementia or multiple sclerosis
Rectal tumors (such as rectal cancer)
Intestinal sluggishness and constipation: Stuck stool causes a blockage that only watery stool can pass through.
Pelvic floor weakness
Medicines such as laxatives, antidepressants or Parkinson’s medication
pronounced hemorrhoids
Incident (prolapse) of the rectum or rectum

Diseases with this symptom

Find out here about the diseases in which the symptom can occur:

Incontinence: therapy

There are several ways to treat incontinence. In individual cases, incontinence therapy is adapted to the form and cause of the incontinence and to the patient’s life situation.

Therapy of urinary incontinence

Pelvic floor training: In case of stress incontinence, good results can be achieved by training the pelvic floor under the guidance of a physiotherapist. The patient learns, for example, how to reduce the stress on the pelvic floor in everyday life, how to remove the wrong tension patterns and how to strengthen the pelvic floor with suitable exercises.

Biofeedback training: Some people find it difficult to feel the pelvic floor muscles and to consciously perceive and control sphincter muscles. During biofeedback training, a small probe in the rectum or vagina measures contractions of the pelvic floor and triggers an optical or acoustic signal. In the context of pelvic floor exercises, the patient can see whether he is really tightening or relaxing the right muscles.

Electrotherapy: Here the pelvic floor muscles are passively trained by painless electrical impulses.

Toilet training (bladder training): Here the patient has to keep a micturition log for some time. In it, he enters in each case when he felt urge to urinate, when he excreted how much urine and whether urination was controlled or uncontrolled. The patient must also note what and how much he has drunk during the day or night. Based on these records, the doctor creates a drinking and micturition plan. It specifies how much the patient is allowed to drink and when he should go to the toilet to empty the bladder (even without urge to urinate). The aim is to prevent uncontrolled urine leakage through controlled emptying of the bladder.

Toilet training should only be done under medical supervision, even if the patient does the training himself at home.

Hormone treatment: In the event of incontinence due to estrogen deficiency in or after the menopause, the doctor can prescribe a local estrogen preparation (such as an ointment) for women.

Medication: Depending on the type of incontinence, antispasmodic drugs (urge incontinence) or so-called alpha-receptor blockers are suitable for treatment. The latter can loosen the bladder obstruction (overflow incontinence) or inhibit the spontaneous activity of the bladder muscles (reflex incontinence).

Catheter: In the case of reflex incontinence, the bladder may have to be emptied regularly via a catheter.

Surgery : Extraurethral incontinence must always be treated surgically (e.g. by closing the fistula). If the incontinence is due to an enlarged prostate, surgery is usually also necessary. Otherwise, surgical intervention in urinary incontinence is only considered if non-operative therapy measures do not bring the desired success.

For example, the urethra can then be closed using an artificial sphincter or an adjustable loop. An implant that compresses the urethra to such an extent that urine can no longer flow out involuntarily has a similar effect. In certain cases, the urethra is stabilized with collagen or silicone to reduce the symptoms of incontinence. An implanted “bladder pacemaker” can help calm an overactive bladder or stimulate a bladder that cannot deflate on its own.