Stress incontinence (stress incontinence) – causes, complaints & therapy

Stress incontinence, also stress incontinence is divided into three degrees:

• 1st degree: Incontinence with increased pressure in the abdominal and chest area. (sneezing, coughing))

• 2nd degree: Incontinence during movements such as standing up and sitting down

• 3rd degree: Incontinence during non-strenuous movements or lying down

Women are affected far more often than men. Due to pregnancies and births, the symptoms can occur at a young age. In addition, in women, only the pelvic floor muscles support the closing apparatus. In men, stress incontinence usually occurs after prostate surgery.

Causes

In men, stress incontinence / stress incontinence is mainly triggered by surgical removal of the prostate. In women, causes ranging from cystitis to cancer are possible. However, the most common cause in women is the changes during and after pregnancy. As the child grows, the pelvic floor muscles weaken.Likewise, the surgical removal of the uterus can be the cause. The most common causes are pregnancy, weak pelvic floor muscles, cystitis, pathological malformations from birth and cancer.

Symptoms and course

An overactive bladder is spoken of when no uncontrolled loss of urine, but only an excessively frequent toilet visit is described. Furthermore, the disease is shown in the fact that when noticing the urge to urinate, the toilet must be visited immediately, otherwise it comes to uncontrolled urine loss. Likewise, the obvious urge to urinate can be completely absent, which inevitably leads to unstoppable bladder emptying.

Diagnosis

In the first place, the anamnesis in the form of questioning the patient. With the help of an exclusion diagnosis, the severity can be determined and recorded. On the basis of urine diagnostics, the presence of a urinary tract infection should be excluded. Imaging examinations in the form of an ultrasound provide information about the function of the urinary tract. The kidneys, the bladder and the residual urine measurement are in the foreground.

In men, palpation examination, as well as ultrasound of the prostate, are recommended. A cystoscopy may be necessary if inflammatory changes in the bladder mucosa or tumors are to be excluded. In addition, a urodynamic examination can provide information about the bladder pressure. In addition, the function between bladder and sphincter as well as the bladder capacity can be examined in this way.

In order to obtain objective values on the frequency of toilet visits and the amount of urine delivered, logging by the patient is advisable. Such a toilet diary (micturition diary) should be kept for at least 48 hours.

Treatment and therapy

If there is a tissue or muscle weakness, the disease can be treated very well with conservative therapies up to surgical interventions. An operation is only possible for serious indications with high levels of suffering. Nevertheless, a cure is possible. However, if the cause is found in the weakness of the sphincter muscle due to organic damage, the therapy can prove problematic.

In the presence of muscle weakness of the pelvic floor, it is specifically treated to strengthen it. Pelvic floor exercises are gender-independent and lead to very good results with correct and regular use. For women, other treatment options such as biofeedback training, pessaries, vaginal weights and electrostimulation are also suitable. In the treatment with medication, duloxetine is often used. Duloxetine increases the concentration of neurotransmitters and thus contributes to a significant improvement in urinary incontinence.

If an operation cannot be avoided, there are a number of variants available. With TVT (tension-free vaginal tape), a mesh tape is inserted from the front wall of the vagina, along the urethra to the abdominal wall, thus restoring continence. There is also implantation therapy, which involves tissue strengthening by means of an injection of microparticles in hyaluronic acid. The tissue is lined and the incontinence is eliminated.

A more invasive measure is the artificial sphincter, which is placed around the urethra like an inflatable balloon system. The patient can use a pump to control when the bladder should be emptied.

Another possibility is sacral neuromodulation. A small probe is implanted in the nerve plexus in the area of the sacrum and coupled with an electrical pulse generator. During a two-week trial period, the patient should achieve a satisfactory result using this external pulse generator. Once this has been achieved, a permanent bladder pacemaker can be placed subcutaneously with the values determined. This method is not an option for patients with paraplegia .

Prevention

Many patients are tempted to break the cycle by trying to drink less. However, this measure can aggravate the disease because the low volume permanently reduces the general capacity.A high fluid intake, on the other hand, will train the bladder muscle. Tuxedo should be stopped at the latest when there is already a persistent cough and the abdominal pressure is constantly being maintained. Pelvic floor exercises can be carried out almost anywhere and are probably the best prophylaxis.