Incontinence

Definition

We talk about bladder or urinary incontinence when urine cannot be held in and is released uncontrollably. The problem is twice as common in women as in men and gets worse with age and according to the number of times a woman has given birth.

The two most common forms are stress incontinence and urge incontinence. Overflow incontinence, which is mainly seen in men, should also be mentioned. There are often mixed forms, as well as rarer types due to anatomical or illness-related reasons.

Causes

Stress incontinence

Stress incontinence can occur when there is increased pressure on the abdominal region, e.g. from laughing, coughing, sneezing or lifting heavy loads. The urethra is often overactive and the sphincter cannot withstand the sudden pressure. This then leads to uncontrollable urination.

Urge incontinence (irritable or overactive bladder)

Symptoms may be triggered by overactivity of the bladder muscles. If pressure in the bladder exceeds pressure on the urethral sphincter, there is involuntary release of urine.

Overflow incontinence

Permanent overfilling of the bladder because of an obstruction means urine continuously drips out, because the pressure inside the bladder exceeds the pressure of the closing muscle. This often happens in the case of an enlarged prostate.

Contributing factors:

·         Urinary tract infections

·         Chronic diseases (such as diabetes)

·         Atrophic (loss of) mucous membranes

·         Limited storage capacity of the bladder (e.g. because of bladder stones, tumours or cysts)

 
 
Symptoms
  • Frequent and sometimes uncontrolled urination
  • Pain when passing water
  • Loss of urine at night
  • Potentially blood in urine
Diagnosis (tests)
  •  Medical history and sympto
  •  Gynaecological examination
  •  Cystoscopy to investigate urinary organs
  •  X-rays with imaging agents
  •  Urine tests to exclude a bacterial infection
  •  Ultrasound or inserting a catheter to establish the quantity of urine left over (after deliberate urination)
  •  Urodynamic examination: measuring the pressure and flows in the urinary tract
Treatment

Stress incontinence

  • Special, regular pelvic-floor exercises
  • Medication
  • Minor surgery: currently consists mostly of inserting tension-free vaginal tape

Urge incontinence (irritable or overactive bladder)

  • The cause should first be eliminated, where possible (e.g. by treating an infection)
  • Drugs that relax overactive bladder muscles
  • Targeted drinking and bladder training
  • Preparations containing oestrogen for menopausal women

Overflow incontinence

  • Eliminating the cause (e.g. prostate operation)
  •  In the worst cases, inserting a catheter

What can be done about the condition or to prevent it?

  •  Targeted pelvic-floor exercises
  •  Wearing special inserts
  •  Removing risk factors (e.g. smoking)
  •  Change of diet if there is constipation
  •  Weight reduction if overweight
  •  Drinking enough, particularly in the morning
  •  Emptying the bladder well
  •  Recording when you go to the toilet (micturition diary)