Urinary incontinence
introduction
Urinary incontinence is a disease that is roughly twice as many women as men concerns and increases with age. Around the Half of all women and good a quarter of all men Suffer over 65 years of age urinary incontinence. The Prevalence increases with age, and reaches the highest values towards the end of life.
For patients, the disease is usually a high psychological stress as the Urge to urinate not sufficiently restrained can be, there are - depending on the type of urinary incontinence - different forms of Urinary leakage. This one will partly not noticed and only makes itself through the distinctive Urine smell noticeable. Patients suffer a lot from itbecause, for example, theater evenings, long trips, and social events in general become a downright gauntlet.
The word Incontinence comes from the Latin ("incontinentia“), And means something like Non-behavior. Urinary incontinence describes that in general Inability to hold back urine. Urinary incontinence can many different causes underlie. Depending on the mechanism, the therapy is also directed and the chances of recovery look more or less poor. The different forms are discussed below.
Please also read our article on this Bladder weakness.
Stress incontinence
According to the name, this form of urinary incontinence leads to one Urine leakage after or during physical exertion. Physical stress can be the simplest Climb stairs be, but also Laugh, or to cough can lead to leakage of urine.
Of the mechanism behind it is the following: By coughing or laughing, the Abdominal muscles tense, it shortens. This will make the Organs in the abdomen briefly tighter pressed together. In addition, the cough has a short-term, heavy pressure on the abdomen. In combination, this has a significant impact Pressure increase result in that So the bladder is compressed.
This pressure increase can Pelvic floor muscles can no longer withstandso that urine is leaked. The pelvic floor muscles are a multilayered network of musclesthat are stretched in the pool. Through her natural basic tension presses them on the urethra and lock it. But it should for different reasons damaged be, coughing, laughing or climbing stairs can be enough to get them Express urethra.
reasons for one Damage or relaxation of the pelvic floor muscles can include: Operative interventions in pool, Births - the risk of urinary incontinence increases with the number of births until it falls again after the 4th birthThe reasons for this are not known. Furthermore, neurological failures, Tumors and constant, heavy physical exertion as the Main causes viewed for stress or stress incontinence.
Read more about the topic here: Stress incontinence
For a more precise classification, between three degrees of severity differentiated:
Grade 1: Loss of urine in to cough and Laugh
Grade 2: Loss of urine during Go and To run
Grade 3: Loss of urine in Lie without any physical strain
Urge incontinence
In the Urge incontinence (also Urge incontinence, from the English "urge“, The urge) it comes to one sudden, involuntary need to urinatethat can hardly be held back and therefore involuntarily to urine leakage leads. The urge incontinence is one motor or a sensory component too reason too Mixed forms exist.
In the motor urge incontinence lies a Hyperactivity of the voiding muscle - of Detrusor vesicae muscle - in front. This muscle is also called "Urinary expeller“Called and contracts the muscles in the bladder. A Urinary bladder contraction always has one Reduction in volume result in a Discharge of urine from the urinary bladder in the urethra. The pressure is so high that any intact pelvic floor muscles can no longer hold back the urine - urine leakage occurs.
This Hyperactivity of the bladder wall muscles is not at will influenceable and can probably be best illustrated as "Muscle twitching", Or"Muscle spasm" to be discribed. Be accordingly therapeutic also so-called Antispasmodics - so Antispasmodic drugs - administered, which can effectively fight the hyperactivity of the bladder wall muscles. Unfortunately, the effect of these antispasmodics is bought at the price of one Range of side effects, like for example Dry mouth, Racing heart, and Green Star (Glaucoma). These side effects can - but do not have to occur.
The urge or urge incontinence can also be caused by his sensory component triggered: where the Urinary bladder muscles themselves are not overly sensitivebut much more that leading nerve tracts. The "Switching center“Which one of the urinary bladder muscles Emptying commands is with this form of urinary incontinence oversensitive. It sends too many impulses too often. Since the muscles cannot decide whether a constant contraction (and thus emptying the urinary bladder) really makes sense, she bluntly obeys the commands of the overly sensitive switching center and contracts. However, this is different from the motor urge incontinence not to blame the hyperactivity of the urinary bladder muscles, rather the Hypersensitivity of the coordinating switching center. In the end it is Result the same though and relatively insignificant for the patient, but it is important for the attending physician to know the exact cause of the urge incontinence.
The medical therapy does not differ. Means of first choice are here too Antispasmodics. If the side effects are too strong or if it is not possible to take antispasmodics for other reasons, in second instance also one injection from Botulinum toxin (Trade name Botox, BTX) in the urinary bladder muscles. Botox inhibits neuronal transmission between the nerve and muscle cells and leads to a Relaxation of the muscles. That is why it is often used in cosmetic surgery to combat fine lines.
When the urinary bladder muscles relax, the permanent contraction of the urinary bladder decreased and a Improvement in urinary incontinence reached. However, it is important here that correct dose to find botox as one too little application no effect will show while a dose too high to the Urinary retention can lead. In any case, the Application repeated after 2-6 months be carried out as the Botox is slowly broken down and thus loses its effect.
Mixed incontinence
Mixed incontinence is a form of urinary incontinence in which urine leakage occurs under stress as well as through hyperactivity of the bladder wall muscles or hypersensitivity of the bladder itself.
This form is particularly agonizing for patients, as they are more or less helplessly exposed to the urge to urinate. Even not doing any physical activity would continue to leak urine due to urge incontinence. The therapy consists of simultaneous drug treatment and training of the pelvic floor muscles.
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Reflex incontinence
With reflex incontinence it comes to Dyssynergy effects between the musclesthat drains the bladder and the muscles that block the bladder. Logically, the occluding muscles (the "Sphincter muscles“) relax, if the Urinary bladder wall muscles contractto expel urine from the bladder.
With reflex incontinence however, the interaction between these two muscle groups does not work more so both muscles contract at the same time, what a Increase in pressure in the bladder with strong Stretching of the bladder wall has the consequence. Since the accumulated urine cannot escape through the blocked urethra it backs up in the kidneys and in the long run leads to them damage.
The Stretching of the urinary bladder wall leads to severe painbecause in her Nerve fibers that signal to the body that it should empty the bladder, please. However, precisely this is not possible because the Outflow blocked by the sphincter muscles is. In addition to the severe pain, there is also one Damage to the kidneys.
target so must one immediate emptying of the urinary bladder to take the pain away from the patient and to protect the kidneys. For this there is different methods, where in Acute case but simply with one long, sterile needle through the abdominal wall into the bladder is stung and the excess Urine aspirated becomes. This brings a immediate relief of discomfort. However, this can no permanent solution represent as that Micturition behavior permanently disturbed is and it is at the same time also to the opposite Muscle behavior can come. Then relax both the bladder wall muscles and the occlusive muscles and the urine runs out of the urinary bladder unhindered - this is called urinary incontinence.
root cause reflex incontinence is one spinal damage to the nerve roots Height S2 - S4. This is how they are Nerve bundles named that between the second and fourth sacral vertebrae emerge, i.e. in the lower back just above the tailbone. Such damage can after an accident, one Entrapment through incorrect lifting, but also through Viruses be conditional.
Neurological tests and a Anamnesis interview, in which the complaints are precisely determined provide information about the type of damage.
Overflow incontinence
The overflow incontinence describes a form of urinary incontinence in which it becomes one steady overflow of the urinary bladder comes like when a full water barrel is filled and then overflows drop by drop.
So that first time has to get that far Urinary bladder bulging be what not the rule corresponds. After all, we usually go to the bathroom as soon as we feel the bladder full. In overflow incontinence, however, it comes to chronic urinary retention, there one Relocated structure of the lower urinary tract and blocked.
Such structures are in men usually Prostate enlargement (Prostatic hyperplasia). These press the urethra off and do extremely high pressures necessaryin order to be able to get a little urine out of the bladder at all. One speaks of a "Voiding disorder". In addition to prostate hyperplasia, this can be also a tumor of the urethra or Narrowing of the urethra to be responsible.
While the Bladder completely filled is is that Urinary bladder occlusion always on "open" because the body wants to empty the bladder. The occlusive muscles are then wrongly put under strain, they would not want to drain urine from the bladder, since an obstruction of the lower urinary tract is responsible for the lack of micturition. Since from one certain point the pressure within the urinary bladder the Pressure exceeds that prevails in the constriction, it happens from time to time involuntary leakage of urine. This will then perceived as incontinence, while actually a voiding disorder present.
The therapy aims the Eliminate constriction in the urethra and thus enable an undisturbed urine flow. Therapy of the bladder obstruction muscles or the bladder wall muscles is usually not necessary, as these usually still function well. Here, too, the Acute case with a long, sterile needle punctured the bladder through the abdominal wall be to the to drain pent-up urine. This promises a immediate relief of discomfort.
Since the Jam mostly over a long period of time happened is one too rapid drainage of urine however with Attention to enjoy: The body has mostly taken months Accustomed to the blocked urinary tractwhat if it is emptied too quickly the danger there is excessive water loss. In fact, several liters of urine could be pumped through the artificial bladder outlet for days, but this would disrupt the patient's electrolyte balance. Hence a slow and controlled emptying the urinary bladder is important.
Extraurethral urinary incontinence
In addition to the five main forms of urinary incontinence already mentioned, there are still a few less frequent special caseswhich should also be mentioned here. In the extraurethral urinary incontinence it comes in women to Short-circuit connections between the urinary bladder and the vagina. There urinary bladder and vagina anatomically right next to each other it can lie through Malformations to a connection come between the bladder and vagina. This connection allows the urinary bladder to reach a certain level Urine spills into the vagina and through this then out of the body.
That I no sphincter muscles in the vagina located that would be sufficient to hold back urine, the urine runs out of the body uncontrollablywhat is perceived as incontinence by the person affected. Here is the however, the actual urinary tract is mostly preserved functionally, however, it is for the patient usually very difficult between urine "from the urethra" and urine "from the vagina" to distinguish. This fact can make the Make it difficult to find the cause.
In addition to the connection between the urinary bladder and vagina, there can also be a Short-circuit connection between the urethra and the vagina come. This form differs symptomatically extraurethral urinary incontinence Not of the above, however, exist Differences in the therapeutic approach.
Next congenital malformations these short-circuit connections can also after radiation therapy or Operations arise. Often times they will not noticed for a long timeas they tiny are or ignored become. However, above a certain volume of urine, incontinence is called disturbing felt, which is why a Consulted a gynecologist should be.
Another Malformation represents the so-called "Urethral diverticulum“Is where in the urethra behind the bladder Urine in one Bulging the lower urinary tract accumulates. This kind of "reservoir" becomes filled with every urination and then involuntarily emptied with certain movement. Since no sphincter muscles can close the urinary tract behind the urinary bladder outlet, the urine flows undisturbed out of the body via the urethra. This Bulges can but also after radiation or surgery without any particular reason, however, can usually be relatively simply surgically remove.
The The causes and forms of urinary incontinence are therefore diverse, however, let yourself be usually give good therapy.
therapy
The Forms of therapy differ strong je according to the type of urinary incontinence.
In the Stress incontinence must be tried the Strengthen pelvic floor muscles. This is going through Pelvic floor training reached. Also Weight reduction can help reduce intra-abdominal pressure. Medicinal can Estrogens given, like "Duloxetine“For Improvement of the occlusive muscle strength. Should a conservative therapy by training the pelvic floor muscles not suffice, so can operational a so-called Tension-free tape (short TVT) are introduced into the pelvic floor, which the Pelvic floor muscles, like that Artificially supported urethra. This procedure usually takes no longer than half an hour.
In the Urge or urge incontinence tries the Reduce hyperactivity of the bladder wall muscles by means of antispasmodics. Since this is relatively side effects are (Dry mouth, tachycardia, glaucoma) can be used as a means of second choice also Botulinum toxin injected into the bladder wall. This creates a Relaxation of the urinary bladder muscles reached. However, this procedure must repeated at regular intervals become.
In the neurologically induced reflex incontinence can include a Bladder pacemaker be implanted which brings the interplay between the urinary bladder wall muscles and the urinary bladder occlusive muscles back into balance. There is also the possibility of the Urine means Self-catheterization prematurely derived from the urinary bladder. However, this procedure is considered by many patients unpleasant felt.
With all forms urinary incontinence stands for that too Means of a surgical procedure for optional. Especially with malformations or tumorous processes there is usually no avoiding an operation. In many cases, however, a Freedom from complaints can be achieved.
Risk factors and prophylaxis
Risk factors for one Urinary incontinence are in addition to permanent, heavier, physical work also surgical interventions in the small pelvis and irradiations. Often, however, these can be avoided do not avoid, So that the Urinary incontinence as a "lesser evil" remains.
The risk also increases with each birthto suffer from urinary incontinence later. After the fourth birth takes this Risk slightly decreased again for an unexplained reason. By a birth becomes the whole small pelvis strongly stretched, the Musculature in this area slack increasingly. As a result, she can no longer adequately close the urethra.
Simple exercises for at home prevent: Pelvic floor training does not necessarily have to be done in a gym or with complex equipment. True will special courses offered and normally also covered by the health insurances, however, the training can also at home respectively. Only one thing is important certain regularity and intensity the training intervals, as the muscles have to be built up in a targeted manner. At consistent implementation arises a significant improvement within a few weeks a. The pelvic floor training can with several forms of incontinence have a supportive effect, with forms of incontinence such as overflow incontinence definitely one further therapy necessary is.
Others
A Special shape the urinary incontinence, especially Children between 5 and 7 years concerns is the so-called Laughing incontinence.
When you laugh it comes to involuntary, complete emptying of the bladder. The root cause the laughing incontinence is not finally clarified.
The Therapy is not that different, however from that of other forms of incontinence: Pelvic floor training and medication also form the here Cornerstones of therapy. As a drug is included Methylphenidate used, which in the broader population especially under its trade name "Ritalin“Is known, and actually used for Combating Attention Deficit Disorder (ADS) was launched.
