What is urinary incontinence?
Urinary incontinence means the loss or failure to learn the ability to store urine loss in the urinary bladder and even to determine location and time of evacuation. According to the definition of professional societies incontinence is officially already available from a drop of urine loss.
Types of urinary incontinence
The most common forms are the urge incontinence (ICD-10: N39.4), stress or stress urinary incontinence (ICD-10: N39.3) and overflow incontinence (ICD-10: N39.4).
Urge incontinence
It is characterized by a sudden strong urge to urinate so that the toilet can not be achieved. Reason, the contractions of the bladder Leerungs muscles, often caused by local inflammatory processes (eg. As cystitis), obesity, diabetes mellitus or damage of these muscles controlling nerves, such as in Alzheimer's disease, multiple sclerosis, Parkinson's disease or after a stroke.
Stress urinary incontinence (SUI)
In stress incontinence of increased intra-abdominal pressure due to stress, presses for various reasons triggers the more or less pronounced loss of urine.
Stress urinary incontinence in women is often a result of multiple spontaneous births lead to over-stretching and relaxation of retaining ligaments and pelvic floor. This results in a decrease (descent) of the organs in the pelvis. Thus, in case of increased intra-abdominal pressure, this pressure can no longer reach than the closing pressure urethra, probably still in full force, the urinary bladder. In men, however, this type of incontinence is usually the result of a traumatic injury to the external sphincter by operations (eg. As radical prostatectomy) or accidents.
Therapeutic stand in female stress incontinence in mild cases conservative treatment options in the foreground. For this purpose, for instance, of the antidepressant duloxetine. In more severe cases, a number of operational methods. Here now a minimally invasive procedure in the first place, the TVT surgery (tension-free vaginal tape tension-free vaginal tape =) is performed. This was observed in a 6-year follow-up study success rates of about 74 percent. In 1.6% of women the band had to be removed after surgery due to complications again. Despite the surgery in about 5% of women remained a voiding dysfunction. A Dutch study compared the TVT operation with physiotherapy (with PFMT), the conservative treatment option. The TVT operation here is superior to physiotherapy, the women are more satisfied. Only about one in 10 women suffered minor surgical complications such as bruising or urge incontinence.
In men, the attempt minimally invasive interventions can be made to the sphincter. In therapy-resistant cases, an artificial sphincter can be implanted, in which an inflatable cuff placed around the urethra is filled or emptied by means of pump system. The encapsulation of the urethra with hyaluronic acid leads within the first year in which patients about half an improvement, but the long-term success of this treatment is low and the high complication rate. Also, the use of mechanical aids, such as penis Band / -bändchen or occluder devices for incontinence, externally mounted on the shaft of the penis which exert pressure on the urethra and thus prevent the unintentional loss of urine is a probate therapy for urinary incontinence.
Mixed incontinence
Here urge and stress incontinence are combined.
Overflow incontinence
The overflow incontinence (also: Incontinence in chronic retention, incontinence or ischuria paradoxa paradoxa) is caused by a constantly full bladder as a result of drainage problems. Since the internal pressure will eventually exceed the obstructive wedge pressure, it comes to permanent urinary incontinence.
Cause of overflow incontinence is usually benign prostate enlargement, rare high-grade stenosis (stricture) of the urethra. Also, neurological diseases with a relaxation of the muscle detrusor, as can occur (in reflex incontinence LMNL see) as part of a polyneuropathy in chronically poorly controlled diabetes mellitus, or as a result of lower motor neuron lesion, leading to "overflow incontinence".
Very often it is due to an overflow incontinence in a backup of urine into the ureters and kidneys with the risk of increasing renal impairment (loss of kidney function) to the uremia (uremia).
The treatment consists in a cause where possible elimination (prostate, urethra) in irreversible changes in the use of indwelling catheters or intermittent self.
Reflex incontinence
The reflex incontinence is caused by a disruption or destruction of emanating from the brain inhibition pathways and thus to a preponderance of the activity impulses of the reflex arc between the bladder and bladder center in the cross section of the spinal cord (S2-4). These lead to reflex detrusor contractions with urinary leakage. Another problem is the lack of coordination of the muscles involved, so it often to incomplete emptying of residual urine comes (detrusor-sphincter dyssynergia).
Such a condition occurs, for example after a spinal cord injury above the bubble center on (UMNL, upper motor neuron lesion). Degenerative changes in the central nervous system, such as multiple sclerosis sufferers can show the same effect. When LMNL (lower motor neuron lesion), however, occurs a limp, completely denervated bladder with overflow incontinence.
The treatment is preferably done with medication. The intermittent Selbstkatheterismus allows restharnfreie emptying. The prime objective of Selbstkatheterismus is next to the micturition especially the protection of the upper urinary tract (kidneys).
Extraurethrale incontinence
When extraurethralen incontinence no insufficiency of the closing apparatus of the urethra is present (urethra). The natural Harnausgang, for example, by a congenital mouth of a ureter behind the sphincter (eg, epispadias), a cystocele, Urethrozystozele or injury-related fistula, such as a bladder rectum or bladder vaginal fistula as surgical or radiation episode "bypassed". Treatment is by surgical correction.
Laughing incontinence
Laughing incontinence is considered a unique form of urinary incontinence. Typically, this type of incontinence occurs between the ages of 5 to 7 years and is particularly common in girls at the beginning of puberty. When laughter Affected lose control of bladder function and it is completely empty the bladder. Unlike other forms of incontinence of the bladder apparatus and surrounding organs are completely healthy. A need to urinate is not felt before wetting. The real cause of the laughter incontinence is not yet fully explored, there are several explanations. Treatment with medication can, including methylphenidate or physical therapy, specifically carried pelvic floor exercises.
Psychological Meaning of incontinence
Since the toilet training has an important role in our society, incontinence often leads to social isolation, especially since many incontinence sufferers of shame shy even to consult a doctor (urologist, gynecologist). For this reason it must be assumed that a high number of unreported cases of incontinence sufferers.
Since 2008, observed that several providers of specialized products have changed their marketing strategies and work towards a taboo of the subject. 2013 launched an awareness campaign that advertises on television for a more open approach to the disease.