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Incontinence: description, forms, causes, therapy

by Josephine Andrews
Published: Last Updated on 252 views

Incontinence means not being able to hold your urine or stool in – some of it is going out uncontrollably. The reasons for this can be very diverse. Urinary incontinence is usually based on a disturbance in the finely tuned system of bladder muscles, sphincters and pelvic floor muscles. The reason can be, for example, errors in the signal transmission of the nerve cells involved. There are good treatment options for incontinence today. Read here what they are and what you can do yourself if you have incontinence.

quick overview

  • What is incontinence? Inability to hold back urine (urinary incontinence) or – more rarely – stool ( fecal incontinence ) in a controlled manner
  • Causes: different depending on the form, e.g. B. urinary stones, enlarged prostate , tumors, nerve injuries or irritation, neurological diseases ( multiple sclerosis , stroke , Alzheimer’s etc.)
  • Examinations: Depending on the type and severity of the incontinence, for example gynecological examination, proctological examination (examination of the rectum), ultrasound , urine and blood tests, urodynamic examinations (to determine bladder function), cystoscopy , colonoscopy , etc.
  • Therapy: depending on the form and severity of the incontinence, for example pelvic floor training, toilet training, electrotherapy , pacemakers, medication, surgery

Incontinence: description

People with incontinence can no longer hold back their urine or, more rarely, their stool in a controlled manner. This is then referred to as urinary or fecal incontinence.

urinary incontinence

Colloquially, this symptom is also called “bladder weakness”. However, the blister is not always the cause. There are five different manifestations of urinary incontinence:

  • Stress incontinence: Formerly referred to as stress incontinence because physical stress is the trigger: If the pressure in the abdomen increases (e.g. when lifting heavy objects, coughing , sneezing, laughing), those affected lose urine involuntarily. In severe cases, urine comes out with every movement, in extreme cases also when standing or lying down. Those affected do not feel the urge to urinate before the urine escapes unintentionally.
  • Urge incontinence: With this form of incontinence, the urge to urinate occurs suddenly and very frequently (sometimes several times an hour), although the bladder is not yet full. Those affected often do not make it to the toilet in time. The urine comes out in a gush.
  • Reflex incontinence: People with reflex incontinence no longer feel when the bladder is full and can no longer control emptying. As a result, the bladder empties itself at irregular intervals, but often not completely.
  • Overflow incontinence: When the bladder is full, small amounts of urine constantly flow out. Those affected may also feel a constant urge to urinate.
  • Extraurethral urinary incontinence: Here, too, urine is constantly leaking without the patient being able to control it. However, this does not happen via the urinary tract, but through other openings (medical: extraurethral), such as the vagina or the anus.

Some people also suffer from mixed incontinence. This is a combination of stress and urge incontinence.

fecal incontinence

This form of incontinence is rarer. Patients with fecal incontinence cannot voluntarily retain the intestinal contents and intestinal gases in the rectum. Doctors differentiate between three degrees of severity:

  • Partial incontinence of the 1st degree: uncontrolled loss of air and occasional stool smearing under stress.
  • Second degree partial incontinence: Patients cannot hold intestinal gases and loose stools.
  • Total incontinence: total loss of control over bowel movements, which is associated with constant stool smearing. Patients also lose solid stools.

As with urinary incontinence, there are cases in which the person affected feels that stool is about to be passed but does not make it to the toilet in time, and there are cases in which the stool is completely unexpected (the affected person does not feel anything in the anal area).

Incontinence: causes and possible diseases

In the case of urinary incontinence, the finely tuned system of bladder muscles, sphincters and pelvic floor muscles as well as the controlling nerves and centers in the brain and spinal cord no longer function properly. In the case of fecal incontinence, the disorder affects the closing apparatus of the anus and the corresponding nerve structures. In both cases, the cause can be manifold:

Causes of urinary incontinence

The five forms of urinary incontinence have very different causes, but all of them impair the function of the urinary bladder .

This fulfills two important tasks: it must store the urine and empty itself (if possible) at the desired time. When storing, the bladder muscle is relaxed. This allows the bladder to expand and fill. At the same time, the sphincter muscle is tense, so that the urine cannot immediately flow out through the urethra . The bladder muscle contracts to empty, while the sphincter muscle relaxes with the pelvic floor muscles. The urine can then drain through the urethra.

Stress incontinence :

In the case of stress incontinence, the closure mechanism between the bladder neck and the urethra is no longer functional. The reason may be that the pelvic floor tissue was injured , for example during prostate surgery or an accident. Nerve injuries and irritations as well as a bulging of the urinary bladder can also trigger stress incontinence. It is also favored by risk factors such as:

Stress urinary incontinence is much more common in women than in men. This is because they have a wider pelvis and weaker pelvic floor muscles. In addition, there are three openings in the female pelvic floor (for the urethra, vagina and rectum), while the male only has two. These are “natural weaknesses”. At these points, the connective tissue can give way due to stress such as pregnancy and childbirth, a lowering of the uterus or hormonal changes during menopause – urinary incontinence occurs.

Urge incontinence :

With this form of incontinence, the signal “bladder full” is falsely sent to the brain even when the bladder is only slightly full. The reaction is an uncontrollable urge to urinate. This is also referred to as an “overactive bladder”. Possible causes of urge incontinence are:

  • Nerve damage or irritation as a result of surgery
  • neurological diseases such as multiple sclerosis, Parkinson’s , Alzheimer’s, a brain tumor or stroke
  • Constant irritation of the bladder, for example due to bladder stones or urinary tract infections ( cystitis )
  • Insufficiently treated diabetes ( diabetes mellitus ): Toxins caused by the increased blood sugar level affect the nervous system.
  • psychological causes

Reflex incontinence :

In reflex incontinence, nerves in the brain or spinal cord that control the bladder are damaged. This can be the case, for example, with paraplegia or a neurological disease such as Parkinson’s, multiple sclerosis, stroke or Alzheimer’s.

Overflow incontinence :

In this form, the bladder outlet is blocked and interferes with the outflow of urine, for example due to an enlarged prostate (as in benign prostate enlargement) or a narrowing of the urethra . The latter can be caused by a tumor or urinary stones.

Extraurethral incontinence :

This form of incontinence can be caused by congenital malformations or a fistula. In general, a fistula is an “unnatural” connecting canal between two hollow organs or a hollow organ and the body surface. In the context of extraurethral incontinence, there can be a fistula between the urinary system (such as the bladder, urethra) and the skin , the intestines or the female genital tract. Accordingly, urine can pass through the skin opening, the anus or the vagina. Such a fistula can form as a result of inflammatory processes or after an operation or X-ray radiation.

Various medications (such as diuretics, antidepressants, neuroleptics) and alcohol can increase existing urinary incontinence.

Causes of fecal incontinence

Fecal incontinence is rarely congenital; it is then based, for example, on malformations. The much more common acquired fecal incontinence is based on a disorder or damage to the so-called continence organ (anorectum). This consists of the rectum, in which the stool is “stored” (reservoir), and the sphincter muscle around the anal canal. Possible causes of disruption or damage to the anorectum include:

  • Injuries, such as those caused by childbirth or surgery: They can lead to dysfunction of the sphincter muscle or impair nerve perception at the anus.
  • chronic inflammatory bowel diseases such as Crohn’s disease
  • neurological diseases such as dementia or multiple sclerosis
  • Tumors in the rectum (such as rectal cancer)
  • Sluggish bowel and constipation : Stuck stool creates a blockage where only watery stool can pass.
  • pelvic floor weakness
  • Medications such as laxatives, antidepressants, or Parkinson’s medications
  • pronounced hemorrhoids
  • Prolapse (prolapse) of the rectum or rectum

Incontinence: Therapy

There are different ways to treat incontinence. In individual cases, the incontinence therapy is adapted to the form and cause of the incontinence as well as to the patient’s living situation.

Treatment of urinary incontinence

Pelvic floor training : In the case of stress incontinence, good results can be achieved with pelvic floor training under the guidance of a physiotherapist. The patient learns, for example, to reduce the stress on the pelvic floor in everyday life, to discard incorrect patterns of tension and to strengthen the pelvic floor with suitable exercises.

Biofeedback training : Some people find it difficult to feel the pelvic floor muscles and to consciously perceive and control sphincters. During biofeedback training, a small probe in the rectum or in the vagina measures contractions in the pelvic floor and triggers an optical or acoustic signal. In this way, the patient can see during pelvic floor exercises whether he is really tensing or relaxing the right muscles.

Electrotherapy : Here the pelvic floor muscles are trained passively using painless electrical impulses.

Toilet training (bladder training) : Here, the patient must keep a voiding log for some time. In it he enters when he felt the urge to urinate, when he excreted how much urine and whether the urination was controlled or uncontrolled. In addition, the patient must write down what and how much he has drunk over the course of a day or night. Based on these records, the doctor creates a drinking and micturition plan. This specifies how much the patient is allowed to drink and when he should go to the toilet to empty the bladder (even if there is no urge to urinate). The aim is to prevent uncontrolled urinary leakage through controlled emptying of the bladder.

Toilet training should only be done under medical supervision, even if the patient is doing the training themselves at home.

Hormone treatment : In case of incontinence due to estrogen deficiency during or after the menopause, the doctor can prescribe a local estrogen preparation (such as an ointment) for affected women.

Medication : Depending on the type of incontinence, antispasmodic medication (urge incontinence) or so-called alpha-receptor blockers, for example, are suitable for treatment. The latter can loosen the bladder occlusion (overflow incontinence) or inhibit the spontaneous activity of the bladder muscles (reflex incontinence).

Catheter : Reflex incontinence may require periodic drainage of the bladder through a catheter.

Surgery : Extraurethral incontinence must always be treated surgically (e.g. by closing the fistula). If the incontinence is due to an enlarged prostate, an operation is also usually necessary. Otherwise, in the case of urinary incontinence, surgical intervention is only considered if non-surgical therapeutic measures do not bring the desired success.

For example, the urethra can then be closed with an artificial sphincter or an adjustable sling. An implant that compresses the urethra to such an extent that urine can no longer flow out involuntarily achieves a similar effect. In certain cases, the urethra is stabilized with collagen or silicone to alleviate the symptoms of incontinence. An implanted “bladder pacemaker” can help calm an overactive bladder or stimulate a bladder that is unable to empty on its own.

Therapy of fecal incontinence

Pelvic floor training , electrotherapy and toilet training are also effective therapy methods for fecal incontinence. Sometimes patients are also implanted with a pacemaker , which improves coordination between the brain, pelvic floor, intestines and sphincter.

Other possible therapeutic approaches are:

  • Laxatives: They specifically stimulate the excretion of stool.
  • Antimotility medicines: These medicines inhibit bowel movements (peristalsis), thereby reducing the frequency of bowel movements.
  • Surgery: For example, injured sphincters can be sewn up. If the large intestine has fallen due to pelvic floor weakness, the surgeon can reattach it to the sacrum . In some cases of fecal incontinence, an artificial sphincter is used.

Urinary incontinence: drink properly

In the case of urinary incontinence in particular, drinking suddenly plays a decisive role for those affected: they try to drink as little as possible for fear of uncontrolled urination. However, this does not improve the suffering – on the contrary: if there is a lack of fluid intake, the urine in the bladder becomes more concentrated, which can increase the urge to urinate and irritate the mucous membrane of the bladder. In addition, the bladder, ureters and tubes are less well flushed if you drink too little. This makes it easier for bacteria to attach themselves there – resulting in a urinary tract infection .

Therefore, if you have urinary incontinence, you should discuss with your doctor how much you should drink and at what times of the day. He may first ask you to keep a urination log for a few days in which you record your fluid intake and urination (see above: toilet training). Based on these records, the doctor can recommend appropriate amounts and times to drink.

Still water and herbal teas are best for incontinence. A special bladder tea can also help, for example with urge incontinence. Coffee, alcohol and fizzy drinks are less good as they act as diuretics.

Incontinence: There are other things you can do

Yes, incontinence means loss of control. But it does not mean that those affected are helplessly at their mercy. There are some things that everyone can do themselves to cope better with incontinence or to prevent incontinence:

Use incontinence aids: pads with different absorbency levels, disposable panties with pads included, incontinence briefs or anal tampons can help to deal with incontinence in everyday life. Men with urinary incontinence can use a condom urinal. This is a type of condom that is used to direct urine into a bag.

Going to the toilet appropriately often: Anyone who goes to the toilet too often or too rarely is not doing their bladder any good and can significantly increase their risk of urinary incontinence. If you urinate too frequently, the bladder will eventually “get used” to the small amounts of urine and will then no longer be able to store larger amounts of urine. If you go to the toilet very rarely, you constantly overstretch your bladder muscles and risk dysfunction.

Reduce weight: Being overweight is an important risk factor for incontinence. It increases the pressure in the abdominal cavity and thus promotes incontinence or worsens existing incontinence. So if you weigh too much, try to lose weight. This also has a positive effect on the success of pelvic floor training.

Taking care of your body: Careful personal hygiene can prevent skin diseases as a result of bladder weakness.

Bladder-friendly eating: Avoid foods that can irritate the bladder, such as hot spices or coffee. In the case of fecal incontinence, a high-fiber diet can normalize the passage of stool. You should largely avoid eating foods that cause flatulence.

Relaxation techniques: Relaxation exercises such as autogenic training can help if incontinence has psychological (co-) triggers.

Incontinence: medical examinations

Many people are embarrassed when they can no longer hold their urine or stool properly. They endure their illness in silence and do not even dare to talk to their doctor about the subject. A mistake, because there is effective help. Those affected should therefore be examined and treated by a doctor as soon as possible .

Medical history collection

In a conversation, the doctor first inquires about the exact symptoms and the patient’s history ( anamnesis ). In this way he can find out what form of incontinence someone is suffering from and narrow down the possible causes. Possible questions in the anamnesis interview are:

  • How long have you had uncontrolled urination or defecation?
  • How often do you pass urine/stool?
  • Does it cause pain?
  • On what occasions does involuntary leakage of urine or stool occur?
  • Do you feel like your bladder/bowels are not emptying completely?
  • Can you tell if your bladder/bowels are full or empty?
  • Did you have an operation? Did you give birth to a child?
  • Do you have any underlying diseases (diabetes, multiple sclerosis, Parkinson’s etc.)?


Various examinations help to clarify incontinence. Which methods make sense in individual cases depends, among other things, on the type and severity of the incontinence. The most important investigations are:

  • Examination of the external genitals and rectum: It provides clues to the causes of incontinence. The doctor can sometimes identify fistulas or an enlarged prostate. He can also check the state of tension of the sphincters.
  • Gynecological examination: Here, for example, a prolapse of the uterus or a prolapse of the vagina can be determined as the cause of urinary incontinence.
  • Urine and blood tests: They can give indications of infection or inflammation.
  • Ultrasound examination: Ultrasound can be used to estimate the possible amount of residual urine in the bladder in the event of urinary incontinence. In addition, kidney or bladder stones, tumors or congenital malformations can be discovered. Injuries after an operation can also be detected by ultrasound.
  • Urodynamics: In the case of urinary incontinence, the doctor can use urodynamic tests to assess the function of the urinary bladder. For example, as part of uroflowmetry, electrodes can be used during urination to measure the amount of urine, the duration of bladder emptying and the activity of the pelvic floor and abdominal muscles.
  • Bladder or colonoscopy: It may be necessary, for example, to detect inflammation of the bladder or intestinal mucosa or tumors of the bladder or intestine.
  • X-ray contrast images: They can provide information about a malfunction of the bladder or rectum. For this purpose, the bladder or rectum is first filled with a contrast medium. X-rays are then taken during urination or bowel movements. In this way, functional processes can be analyzed and protrusions and invaginations or internal events can be identified as the cause of incontinence .

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