Urinary incontinence - targeted treatment for involuntary loss of urine

Cause of uncontrolled urine loss

Most women affected, around 50%, suffer from stress incontinence, but overactive bladder also affects quality of life, as do the mixed forms of the two types. It is important to differentiate between the various forms, as their treatment differs. The following symptoms may occur:

• in the case of stress incontinence: loss of urine when straining, such as coughing, sneezing, lifting weights, walking or standing up
• with an overactive bladder: strong, unsuppressible urge to urinate, sometimes with involuntary, sudden, uncontrollable loss of urine, strong urge to urinate, so that you have to get up several times at night to empty your bladder

How do you recognise urinary incontinence?

The description of the symptoms is usually sufficient to make a diagnosis. Nevertheless, a urogynaecological examination, including an ultrasound scan, should be carried out to ensure that residual urine in the bladder is not responsible. It should also be ruled out that the bladder or urethra is inflamed.

It is also helpful to keep a diary in which the woman records how much she drinks and how often she empties her bladder (micturition diary). This can provide information about the bladder's storage capacity. A cystoscopy or urodynamic examination may then be necessary. The latter examines the bladder volume, bladder emptying and bladder closure. This enables more targeted treatment. Radiological examinations are very rarely necessary.

Recognising and treating urinary incontinence individually

Conservative treatment of involuntary loss of urine

The first step is conservative treatment, such as adjusting the amount you drink and bladder/pelvic floor training, often supported by appropriately trained physiotherapists. In physiotherapy, affected women are shown how they can improve their strength, suppress the urge to urinate and optimise bladder emptying with pelvic floor exercises.

Various forms of electrostimulation and medical support are also possible. Various pessaries or tampons, which are inserted into the vagina and support the urethra, can also be used.

Treatment by means of surgery

If conservative methods do not lead to the desired result, surgery may be necessary. In the case of stress urinary incontinence, a bladder tape can often be inserted to support the urethra and prevent urine leakage under stress in many cases.

If the bladder is overactive, a medication can be injected into the bladder wall with the help of a cystoscopy. This relaxes the detrusor muscle (the smooth muscles inside the bladder), reducing the urge to urinate, improving the bladder's ability to fill and thus preventing urine leakage.

At the Pelvic Floor Centre at Bethesda Hospital, we can also treat complex cases on an interdisciplinary basis and are happy to help you.

Almost every third woman is affected

Urinary incontinence is one of the most common disorders in women. On average, 30% of the female population is affected, with the different forms occurring with varying frequency at different stages of life. In general, stress urinary incontinence is the most common, accounting for 50% of cases. This is followed by overactive bladder (15%), which can occur either as a dry form without urine loss (60%) or as a wet form (40%). In 30 % of cases, there are mixed forms.