2023-06-26 16:13:00
An estimated 10 million people in Germany suffer from urinary incontinence, but only half of those affected consult a doctor. Ignoring the symptoms – mostly out of shame – is fatal. “With the nationwide World Continence Week, we want to draw attention to the fact that incontinence is common and that it is legitimate to get help without having to find it embarrassing,” said Dr. Annette Maleika, Chief Physician in the Department of Gynecology and Obstetrics at the GRN Clinic in Schwetzingen. “In a family doctor’s practice, the symptom of urinary incontinence is far more common than high blood pressure, diabetes or depression,” the chief physician continues.
If left untreated, the symptoms worsened, according to Dr. Maleika. What helps, according to the expert: education, taking the taboo off the suffering and pointing out possible therapies. The focus was put by Dr. Maleika this year on non-surgical therapies: “You are in demand and your motivation. You can definitely do a lot yourself.”
First, however, one must understand the problem and that is why diagnostics is so important, because the causes of urinary incontinence are very diverse: is it the bladder, i.e. the bladder muscle or the pelvic floor? “Very few people deal with the pelvic floor, although it is actually the most important muscle in our body,” explained the doctor. This layer of muscle holds the organs and the entire upper body rests on them. “But you don’t see this pelvic floor muscle and that’s why it’s neglected at first. That’s the danger,” warned Dr. Maleika. “Because the most common cause of urinary incontinence is a weakening of the pelvic floor.” Various risk factors contribute to this weakening over the course of our lives: pregnancy, childbirth, obesity, heavy lifting and carrying or, ultimately, the age at which the pelvic floor gives way, that is sagging, causing the bladder to slide lower, causing a constant urge to urinate.
But not only the pelvic floor can impair the function of the bladder, but also the bladder muscle itself: The bladder does not function autonomously, but is controlled by the brain. This is very prone to disruption, for example by taking psychotropic drugs, diuretics, which are flushing drugs, or sleeping pills, after a stroke or in times of stress. etc. This means that not only the pelvic floor can impair the function of the bladder, but also the connections to the brain can be disturbed. Various diseases with neurogenic damage can also disrupt the nerve pathways between the brain and bladder and affect the bladder: diabetes, Lyme disease, multiple sclerosis, restless legs or depression. The bladder mucosa also suffers from frequent infections or stimulants such as alcohol, nicotine, roasted substances in coffee or strong spices.
The most common is stress urinary incontinence, which results in uncontrollable leakage of urine during tremors such as coughing and sneezing or physical activity. The cause here is the disrupted closure mechanism because the pelvic floor is too loose or worn out. If there is extra pressure on the bladder, urine is released. There is also very often urge incontinence, in which the frequent urge to urinate and urine loss that cannot be suppressed are the problem. The closure is normal, but the contraction of the bladder is sometimes as violent as in a spasm. Causes are an oversensitive mucous membrane or a motor disorder of the bladder. Neurogenic incontinence is somewhat less common. Then there is overflow bladder and extraurethral incontinence (fistulas). A prolapse of the pelvic organs can occur and the pelvic floor can push through the vagina. This often leads to an uncomfortable urge to urinate.
The chief physician encouraged those listening: “There are now a whole range of conservative treatment options for urinary incontinence that you can easily use at home. It doesn’t always have to be an operation.”
The basic therapy is relatively the same for all types. Behavioral therapy is very important here, in which one should modify one’s lifestyle and ask oneself: What can I change in my diet? Which stimulants can I omit? A medication analysis is also helpful, as some medications promote the flow of urine. Then the doctor recommended keeping a log: “I would find it interesting if you wrote down for three days what you drink and how much, when you have to go to the toilet and how much.”
In addition, vaginal estrogen therapy can help in old age, since many suffer from hormone deficiency. The inner mucous membrane of the bladder then becomes drier and the blood supply is no longer as good. The estrogen estriol is good. “Even a little bit helps,” says Dr. Maleika, “also a vitamin D substitution.”
Of course, exercise is highly recommended because it tenses the pelvic floor, for example with targeted pelvic floor exercises, for example with aids such as vaginal cones (small weights). Pessaries can also support and stabilize the pelvic floor. Furthermore, the expert recommends training with a vibration plate: “As with any weight training: you have to train for at least ten minutes every day. There is simply no other way.”
Also interesting is the treatment with Botox by cystoscopy, which suppresses the urge to urinate. “It works really well with no noticeable side effects,” explained the expert. In the case of both stress incontinence and urge bladder, there is also the option of drug treatment.
Finally, the chief physician gave advice on how to prevent pelvic floor weakness: “It is important to talk about such problems by encouraging young women to do pelvic floor training. Ideally already during pregnancy and then during postnatal recovery and actually then for the rest of your life.”
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