Four million people in Germany are treated medically because of urinary incontinence (a form of bladder weakness) at the expense of the statutory health insurance. The number of unreported cases is much higher - most of them suffer silently because they do not dare to talk about it, only 4 out of 10 people go to the doctor. Involuntary urine loss is so distressing to sufferers that they seek emergency solutions for fear of being discovered in public or in the family.
Urinary incontinence is predominantly acquired and less commonly congenital. It is not a typical aging phenomenon - it can also affect children, young, active women and men. But: No one has to accept urinary incontinence - there are a whole range of treatment options that can cure or at least significantly improve the condition.
Causes of urinary incontinence
For urinary incontinence different causes come into question. One of the main causes is a sphincter weakness. In women, recent or more recent heavy births or multiple births may overstretch the pelvic floor. During menopause, the mucous membranes in the abdomen also change. As hormone levels fall, they become drier, thinner, and more vulnerable. The vaginal walls also sag and the pelvic floor muscles lose their strength. Therefore, the bubble sinks and the "lock apparatus" fails. In general, obesity puts pressure on the pelvic floor and should be broken down especially in the case of incontinence, ie involuntary loss of urine. In men, a sphincter weakness is very rare. It usually occurs as a result of prostate surgery, especially after radical prostate cancer surgery (5-10%).
In addition to sphincter weakness, uncontrolled activities of the bladder muscle are the main cause of bladder weakness with or without urinary incontinence. Uncontrolled activities of the bladder muscle ("bladder overactivity", "bladder instability") can either be the result of bladder diseases such as bladder infections or bladder cancer or spinal cord and nerve diseases such as multiple sclerosis, metabolic diseases such as diabetes mellitus, diseases or brain degradation processes such as Stroke or senile dementia and ultimately also be caused by psychological influences. In children and adolescents, it is usually congenital malformations that are responsible for urinary incontinence. Delayed maturation or mental problems can lead to nocturnal enuresis.
Disease picture urinary incontinence
Medicine knows more than half a dozen manifestations of urinary incontinence. The most important are stress, urgency and overflow incontinence.
Stress or stress incontinence is called the unwanted loss of urine during exercise (English: "stress"). It is a preference for women who have had multiple births. The sphincter muscle is no longer able to cope with the pressure in the abdomen and thus in the bladder with little physical stress such as sneezing, coughing or laughing, and gives way to pressure. About 50% of all incontinence forms in women are caused by stress incontinence.
Urgent incontinence affects older people. The cause is an overactivity or hypersensitivity of the bladder. On the one hand, the signals about the filling state of the bladder in the spinal cord are not processed correctly, on the other hand, the bladder is no longer able to empty itself completely "on command". The result is a mismatch between canine urinary urgency and loss of urine and the inability to "will ease" voluntarily - up to 20 times a day. In the early stages one speaks of a "stimulus bubble".
Urgent incontinence affects 11% of over-60s and 30% of over-80s; Women almost three times as likely as men. Urgent incontinence can also be the result of a bladder disease, eg. As an inflammation or cancer. Therefore, a urological examination is always required. Not infrequently, mental health problems are also responsible for urge incontinence, especially among middle-aged women.
Overflow incontinence occurs mainly in males. It is characterized by an involuntary dropwise urine loss in a heavily filled bladder. Frequent urination with a small amount of urine (so-called micturition volume) are the rule. Therefore, large amounts of residual urine remain behind. Causes are outflow obstructions in the area of the bladder outlet or the urethra due to tumors, urinary stones or mostly by benign or malignant prostate enlargements (benign prostate hyperplasia, prostate cancer).
The prostate lies under the man's bladder and surrounds the urethra as it exits the bladder. When enlarged, it pushes off the urethra. The bladder muscle can not use enough force to empty the bladder, so the bladder fills up. Only when the filling pressure of the bladder exceeds the occlusion pressure does urine involuntarily go off. But not infrequently - especially in women - a dysfunction of the bladder muscle by drugs, metabolic disorders, spinal cord or nerve diseases (Parkinson's disease) cause residual urine formation and overflow incontinence.
Effects of urinary incontinence
High blood pressure, dyslipidemia, myocardial infarction, gastric ulcer have long been socially acceptable topics of conversation, urinary incontinence is not (yet). Concerned not only makes constant change of linen, dependence on templates or diapers and threatening odor nuisance to create. They try to hide their illness and live in constant fear of being discovered. They withdraw and avoid contacts, often to friends or relatives. Possible consequences are isolation, loneliness, partnership problems and depression. But: concealment is a relief or cure in the way.