Urinary incontinence

Overview

Urinary incontinence is the uncontrolled leakage of urine. The cause of this functional disorder can lie in the bladder, the pelvic floor or a defective response by the vegetative (autonomic) nervous system. Pelvic floor exercises and avoiding being overweight are examples of preventive measures.

Symptoms

• Leakage of urine when coughing, sneezing, laughing (stress incontinence, “bladder weakness”)
• Strong urge to urinate, urgent need to urinate immediately (urge incontinence)
• Constant dribbling, mostly when the bladder is too full (overflow incontinence)
• Frequent and possibly painful urination
• Complications
  • Overflow incontinence (if left untreated): kidney damage, including kidney failure caused by urine backflow
  • Urosepsis (“blood poisoning”)

Causes and treatment

Causes

Local causes

• Weakness of pelvic floor or bladder sphincter
  • Overweight, constant physical overload
  • Bladder descent, pelvic organ prolapse or descent of the womb
  • Injury caused by giving birth or an operation
• Outflow obstruction: constricting processes around the bladder outlet
  • Prostate enlargement
  • Urethral stricture (narrowing)
  • Urinary stones
• Bladder infection, tumours
• Pelvic radiation
• Bladder fistula (channel/passageway)
  • Vesicovaginal fistula: leakage of urine through the vagina
  • External bladder fistula: leakage of urine through an opening in the skin
• Bladder malformations

Causes that lie outside the bladder

• Neurological and mental illnesses
• Reflex incontinence (automatic bladder)
  • Slipped disc, paraplegia
  • Brain disease (dementia, Parkinson’s, multiple sclerosis)
  • Diabetes
• Medication: sometimes involuntary urine leakage is a side effect
• Bed-wetting at night for children
  • Uncontrolled urinary leakage due to underdeveloped bladder control
  • Usually a psychological cause in older children

Further treatment by your doctor / in hospital

Possible tests

• Urine test
• Measurement of urine leakage (pad testing)
• Blood test
• Further options: ultrasound (sonography), bladder endoscopy, measurement of urine stream (uroflowmetry)

Possible therapies

• Depending on the cause of the incontinence
• Medication
• Situation-specific surgery
• Single-use or permanent catheter to drain urine

What can I do myself?

• Pelvic floor exercises, postnatal gymnastics*
• Avoid being overweight
• Regular urination according to a fixed schedule, progressive lengthening of toilet intervals
• Absorbent sanitary or incontinence pads, vaginal tampons
• Foot reflexology, biofeedback
• Diabetics: good blood sugar regulation
• Not recommended: reduction of fluid intake
  • Reasons: promotes urinary tract infections and the formation of urinary stones; stronger urge to urinate because of highly concentrated urine

* If you have a “Health Account”, CSS pays part of the course costs. Contact one of our agencies for more information.

When to see a doctor?

• Generally if you suffer from regular involuntary urine leakage (identification of cause and form of incontinence)
• Vaginal bleeding after menopause
• Blood in urine or stools
• Pain when urinating
• Stomach cramps, lower abdominal and lower back pain
• Fever, involuntary weight loss
• Feeling of pressure in the pelvic area

Synonyms

urinary incontinence, bladder weakness, stress incontinence, urge incontinence