Bladder weakness

definition

A weak bladder, also called in medicine Urinary incontinence describes the unwanted and uncontrolled loss of urine. This is a very common disease that can have a variety of causes and by far not only affects older people: are in Germany about 6 million people have a weak bladder, here are Women almost twice as often affected. In the following, we will introduce you to the various causes and treatment options for bladder weakness.

causes

The causes of a weak bladder are very different and cause different clinical pictures. The clinical picture of Stress incontinence mostly arises from a weakened one pelvic floor. This is understood to mean different muscles, ligaments and connective tissue that limit the pelvis from below and thus ensure that the pelvic organs are held securely in position. They also support the bladder's sphincter muscle, which ensures that no urine can leak out unintentionally.

If this pelvic floor is weakened, be it through a previous operation, childbirth, a traumatic injury to the pelvis or hormonal changes (especially during the menopause) that can change the tissue, urine can inadvertently leak if the pressure on the bladder is increased the pelvic floor no longer provides enough support for the sphincter. Such increased pressure can already result from contraction of the abdominal muscles when laughing or coughing arise. Women are particularly often affected by this form of incontinence, as they generally have a less favorable pelvic floor anatomy and the pelvic floor is weakened by pregnancy or childbirth, as well as by the hormonal stress during menopause.

Read more about the topic here: Stress incontinence

Another clinical picture is called "Urge incontinence". Here, the bladder and the pelvic floor are mechanically intact, but with even small amounts of urine in the bladder, there is mistakenly communicates to the nervous system that the bladder is full and, accordingly, contraction of the bladder muscle (M. detrusor vesicae) Urine missed.
The causes for this also called "overactive bladder"Disease designated are diverse. They can be in the context of nerve damage from previous operations, but also through accompanying diseases such as diabetes, multiple sclerosis, Parkinson's or frequently recurring Urinary tract infections and Bladder stones occur. Also disturbances of the urine flow through urethral stones or constrictions and a enlarged prostate are possible causes. Finally, a psychological component often also plays a role here.

Further possible clinical pictures are on the one hand the so-called "Overflow incontinence"In which the bladder cannot be emptied properly because the drainage path is e.g. is narrowed by an enlarged prostate and so urine always leaks out of the overcrowded bladder. On the other hand there is the so-called "Reflex incontinence“, In the case of damage to the brain or spinal cord, for example in a Alzheimer's diseaselead to the loss of voluntary emptying.Finally, various drugs can lead to bladder weakness as an undesirable side effect.

Concomitant symptoms

The Leading symptom in all forms of bladder weakness is of course the unwanted urine leakage. However, depending on the clinical picture, additional symptoms occur that allow an assignment.
In the Stress incontinence is noticeable that the leakage of urine occurs frequently when the Pressure in the abdomen increases. Specifically, this means in situations in which the muscles are tense, such as when coughing or laughing.
The underlying weakness of the pelvic floor shows other accompanying symptoms: It can Abdominal pain come because the pelvic organs cannot be kept in their correct position. Here it can even be used Lowering of the pelvic organs come. A strong pelvic floor weakness can also cause a Fecal incontinence occur. The lowering of the bladder can lead to incomplete emptying of the bladder, there is a sensation of residual urine and frequent cystitis.
If there is urge incontinence, the patient has a constant Feeling of need to urinate. This feeling is due to the fact that the bladder reports that it is full, even when it is not full, and that patients often have to go to the toilet many times a day even after drinking a small amount and sometimes they can no longer get there in time. Pain in the pelvic area can also be important for the diagnosis.
In the Reflex incontinence however, the patients complain Not an increased need to urinate. Since there is usually a neurological disorder and the patients have no control over their bladder, it leaks before the urge to go to the toilet occurs. If the autonomic nervous system is impaired, such as in the case of paraplegia, accompanying symptoms such as headache or dizziness occur.
The Overflow incontinence manifests itself in that the urine drop by drop is lost.

diagnosis

The diagnosis of a weak bladder begins with a detailed one survey by the attending physician. The possible causes of the bladder weakness can be narrowed down, for example by asking whether the urine loss in certain situations occurs (e.g. when laughing) or some of the above Concomitant symptoms exist. The medication currently being taken as well as drinking behavior can also provide important information.
Then one follows physical examination. In particular, the Pelvic region Put in focus, this includes the study of the external genitalia and rectum. With men it can enlarged prostate be excluded. For women there is also a vaginal exam carried out in which a lowering of the pelvic organs due to weak pelvic floor muscles can be excluded.
The urine in the laboratory for possible Germs examined and the Kidney function checked via a blood sample.
There are many different options for further diagnostics. So the patient can be asked to "Micturition diary“In which he should write down how much urine was lost each day under what circumstances. This can also be combined with the so-called. PAD test, in which the patient receives an incontinence pad and can measure the amount of leaked urine after drinking certain amounts and movements by changing the weight of the pad.
Additionally, imaging tests are like a Sonography or a cystoscopy is conceivable.

treatment

Bladder weakness can be managed well with a suitable therapy.
A first important approach in treatment is to strengthen the pelvic floor muscles. You can find out more about this in the next separate paragraph.
In addition, with all forms of bladder weakness it is important that the weight of the patient is within the normal range in order not to put additional pressure on the bladder. The patient should also learn to go to the toilet regularly so as not to overfill the bladder and thus build up pressure again.
For stress incontinence there is the possibility of giving the drug "Duloxetine", which has a strengthening effect on the contraction of the bladder sphincter. There are also various surgical procedures that can help the patient. Depending on the cause of the bladder weakness, supporting ligaments or even artificial sphincters can be used. It should be noted, however, that an operation should only be considered after all conservative measures have been exhausted.

Various drugs have proven to be helpful for urge incontinence. The first choice are the so-called anticholinergics, which inhibit the vegetative nervous system (more precisely the parasympathetic nervous system) and thus prevent a feeling of urgency to urinate when the bladder is not filled enough. A typical active ingredient in this class is called "Oxybutynin". If the effect is insufficient, these drugs can also be combined with other drugs such as Combine alpha blockers.

If the bladder weakness cannot be brought under control with medication alone, there is also the possibility of injecting botulinum toxin, better known under the name "Botox", into several places on the bladder wall and directly inhibiting the nerves there. As a last resort, there is also the option of diverting the urine surgically through the intestine.
The method of choice for reflex incontinence is the insertion of a urinary catheter. Injecting botulinum toxin is also an option here. The operative use of a bladder pacemaker is also conceivable.
In overflow incontinence, the cause of the disturbed drainage should be eliminated. For example, an enlarged prostate can be brought back to its normal size using medication. As a result, the high pressure in the urinary system decreases and the bladder weakness disappears.

In addition, the herbal medicinal product is used to strengthen or strengthen the bladder function. Get more information about this drug and its effects at: Granufink®

Read more about this under Therapy for urinary incontinence

Pelvic floor exercise to treat bladder weakness

One of the most important pillars of therapy for bladder weakness is that Pelvic floor training. Since the pelvic floor holds all organs of the pelvis down, it has to withstand high loads. If the muscles are not strong enough, this can not only cause incontinence but also lower bowel sections or the uterus to lead. Sexual dysfunction can also be caused by a weakened pelvic floor.
Targeted training of the pelvic floor should be given to the patient by a trained specialist such as shown to a physical therapist so that the execution is correct.
Other ways of strengthening the pelvic floor can also be found in physiotherapy. The pelvic floor muscles can be contracted and strengthened through electrical stimulation. Something similar is possible with magnetic stimulation, which uses a magnetic impulse field. The use of a so-called “biofeedback procedure” can also be helpful in strengthening the pelvic floor. Here a sensor shows the patient graphically how strong the pelvic floor muscles are at the moment. This allows the patient to get a feel for doing strengthening exercises.

Please also visit our page "Pelvic floor training"Which provides examples of strengthening exercises.

Consequences of a weak bladder

A weak bladder in itself is not to be regarded as a dangerous disease. However, the topic is very uncomfortable for many patients and often it is very difficult for many to go to the doctor. Unfortunately, a frequent consequence is increasing isolation, as those affected no longer want to go out or do sports for fear of inadvertent loss of urine. The consequences are loneliness and possibly even depressed moods.
Bladder weakness becomes problematic if its cause could lead to complications. If, for example, cancer is present, it can have life-threatening consequences and must always be clarified and treated by a doctor.
Recurring bladder infections can also damage the natural bladder mucosa, injuring it and causing chronic irritation.
Therefore, to avoid possible serious consequences with every beginning bladder weakness of the Family doctor to be visited. Together, the cause can be clarified and a suitable therapy that improves quality of life can be found.

Bladder weakness in men

In older age men are increasingly affected by bladder weakness. However, the main cause is not a weakened pelvic floor, but one Enlargement of the prostate. The so-called benign prostatic hyperplasia occurs mainly between the ages of 40 and 60 and is one of the most common diseases in men.
The enlarged prostate can press on the ureter and thus increase the pressure on the bladder - the result is bladder weakness.
However, an operation on the prostate, for example as part of a reduction in size, can lead to incontinence if the Accidentally injured bladder sphincter becomes.
In younger patients, inflammation of the prostate can temporarily cause bladder weakness, which patients describe as "dripping".
Of course, the above-mentioned causes of bladder weakness, such as a weak pelvic floor or cancer, are also conceivable in men and should always be clarified by a doctor.