The medical term urinary incontinence refers to involuntary loss of urine – regardless of the cause. Because of the distressing nature of involuntary urine loss – incontinence – people often seek medical help relatively late out of embarrassment.
For a basic understanding, you need to know that urination is a process influenced by two components: the bladder wall contracts and the urine is actively pressed out of the bladder while the sphincter opens at the same time. If this interplay is disturbed, involuntary loss of urine can occur. A urological examination can reliably identify the cause responsible for the disorder, so that a targeted therapy can then be recommended.
The good news is that urinary incontinence is generally readily treatable and in many cases also curable.
Urinary incontinence refers to any involuntary loss of urine. The causes range from weakness of the sphincter or pelvic floor to overactive bladder muscles, bladder emptying disorders or neurological diseases.
In principle, a distinction is made between two main forms of incontinence. In stress incontinence, weakness of the sphincter or pelvic floor leads to involuntary loss of urine during physical exertion, for example when coughing, sneezing or lifting. Urge incontinence is characterised by a sudden, barely controllable urge to urinate caused by overactive bladder muscles or a disorder of nerve control. There are also mixed forms in which both mechanisms occur simultaneously.
The classification is often already apparent from the pattern of symptoms. In stress incontinence, the loss of urine occurs exclusively in situations of physical exertion. Urge incontinence manifests itself through a sudden, barely controllable urge to urinate that can lead immediately to loss of urine. The final classification is made by a urological examination.
Treatment depends on the underlying cause. In the case of stress incontinence, the focus is on strengthening the pelvic floor. Urge incontinence is usually treated with medication, provided there is no other cause requiring treatment. In selected cases, surgical procedures are also used.
Yes. Depending on the cause, incontinence can be completely cured with medication or surgical therapies, or at least treated very well. Continence can also improve again over time after operations.
A medical examination is advisable as soon as involuntary loss of urine occurs regularly or is perceived as distressing. The earlier the cause is identified, the more targeted the treatment can be.
In stress incontinence, the external sphincter and possibly the pelvic floor are weakened. Typical is a loss of urine during physical exertion, for example when coughing, sneezing, laughing, lifting or getting up from a lying position.
Urge incontinence is caused by overactive bladder muscles. It often occurs at an advanced age. It is characterised by a sudden, barely controllable urge to urinate that can lead immediately to loss of urine.
Urge incontinence is a subtype of so-called overactive bladder. While overactive bladder initially only describes a sudden urge to urinate, urge incontinence also involves involuntary loss of urine.
In mixed incontinence, stress and urge symptoms occur at the same time. In rare cases, urinary incontinence can also be caused by neurological diseases in which the control of bladder function is impaired.
In men, urge incontinence predominates. The cause is often prostate enlargement from around the age of 50, which leads to a thickening of the bladder wall and, if left untreated, favours overactive bladder muscles after years. Stress incontinence in men, on the other hand, usually occurs in connection with procedures on the prostate. While conventional surgical procedures such as open surgery for prostate cancer or prostate resection with an electric loop (TUR-P) for benign prostatic enlargement carry a relevant risk of incontinence, this risk is significantly lower with modern procedures. In particular, robot-assisted da Vinci prostatectomy and enucleation of the prostate with the holmium laser (HoLEP) for benign prostatic enlargement now enable surgery while preserving continence.
Stress incontinence predominates in women. Common causes are a weakening of the pelvic floor, especially after vaginal births. Pelvic floor prolapse can also lead to incontinence with increasing age.
The symptoms of urinary incontinence differ significantly depending on the form. While women often have stress incontinence, urge incontinence predominates in men. The following overview shows the typical differences:
Neurological causes: In rare cases, urge incontinence can also be triggered by neurological diseases, for example multiple sclerosis, Parkinson's disease, after a stroke or in the case of spinal cord injuries. Here, the control of bladder function is impaired, which can lead to overactive bladder muscles.
A targeted urological examination is required to clarify urinary incontinence. The aim of the diagnostics is to clearly determine the underlying cause of the involuntary loss of urine, as further treatment depends on this. Diagnostics begin with a detailed medical history and a physical examination to classify the symptoms. An ultrasound examination is used to assess bladder emptying and to measure residual urine in order to determine whether the bladder is completely emptied when urinating.
The urodynamic examination (bladder pressure measurement) plays a central role. The bladder is slowly filled via a catheter; pressure sensors record the filling pressure, the urge to urinate and the activity of the bladder muscles. In addition, a stress profilometry can be carried out to assess the function of the sphincter and pelvic floor during coughing. A cystoscopy is performed if structural changes in the urethra or bladder are to be ruled out. Only through this precise diagnosis can the right therapy be selected and carried out in a targeted manner.
The treatment of urinary incontinence depends on the underlying form of incontinence. Accurate diagnosis is crucial, as the appropriate therapy is derived from it. Important to know: urinary incontinence can be caused by two fundamentally different mechanisms: either by overactive bladder muscles (urge incontinence) or by a weakness of the closure mechanism (stress incontinence). Pelvic floor exercises are only effective for a weakened sphincter, but have no influence on overactive bladder muscles. This is why pelvic floor exercises are not useful for every form of incontinence.
In the case of stress incontinence, targeted training of the pelvic floor is the first priority in order to improve the function of the sphincter. If this is not sufficient, surgical procedures can be used. In women, urethral slings or tapes (TVT, TOT, mini-slings) can be used, which are placed under the urethra to stabilise it. In men, this procedure is generally not sufficiently effective. Here, in the case of pronounced sphincter weakness, an artificial sphincter (AUS – artificial urinary sphincter) can be implanted.
The treatment of urge incontinence aims to regulate the activity of the bladder muscles. This includes medication that relaxes the bladder wall and structured bladder training. If these measures are not sufficient, muscle-relaxing medication can be injected into the bladder wall to specifically calm the overactive muscles.
Neurologically caused forms require individual treatment planning based on the respective underlying disease and bladder function.
If conservative measures are not sufficient, modern minimally invasive procedures are available that specifically target the cause of the incontinence.
Do you suffer from a constant urge to urinate or lose urine before you reach the toilet?
Then an overactive bladder – medically known as urge incontinence – could be the cause. In this case, the bladder muscle contracts too early and too strongly.
Contents of the video:
How it works
In this video, you will learn everything important about cystoscopy – an endoscopic examination of the urinary bladder in men and women.
Is an artificial sphincter the solution?
Here you will find everything important about the artificial sphincter: when it is used, how it works and how the operation is performed. Also: who it is suitable for, what components there are and what patients should bear in mind.
Diagnosis & treatment
In this video, Prof. Dr. med. Sven Lahme explains the most important causes of urinary incontinence and shows why the distinction between stress incontinence and urge incontinence is crucial for treatment.
Who does ATOMS surgery help?
Prof. Dr. Sven Lahme explains what components the ATOMS system consists of and how the implant works.
In this video you will learn:
Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.
Member in Scientific Societies and Reviewer of scientific journals.
