Will wearing diapers make my urinary incontinence worse?

Urinary incontinence

Urinary incontinence (Bladder weakness): Involuntary leakage of urine, differentiation of five different forms depending on the existing cause. Affects the elderly in particular; younger people are affected, then z. B. women after difficult births or men after radical prostate removal.

If the correct diagnosis is made and the incontinence is treated by a specialist doctor, the therapy is usually successful, or at least it brings an improvement.

Leading complaints

  • Involuntary loss of urine, e.g. B. when coughing, running, straining or when you have a strong urge to urinate
  • Burning sensation when urinating and frequent urge to urinate as a result of cystitis, as incontinence often occurs here at times
  • Passing urine, with the bladder still feeling full and painful (with overflow incontinence)
  • If you drink too little: dark, concentrated and unpleasant smelling urine.

When to the doctor

In the next few days, if the symptoms mentioned reappear or worsen.

Even today, when there is involuntary leakage of urine, combined with the feeling that the bladder is still full (overflow incontinence) or when there is a fever.

The illness

Three muscles or muscle groups contribute to the storage and emptying functions of the urinary bladder: the bladder muscle, the urinary bladder sphincter and the urethral sphincter. The bladder muscle is controlled by the autonomic nervous system. Only when the voluntary decision to urinate, controlled by the brain, is given does the bladder muscle contract. At the same time, when you start urinating, the urinary bladder sphincter reflex opens the bladder outlet so that the urine flows into the urethra and finally into the toilet. Only the urethral sphincter, which is part of the pelvic floor muscles, can be tensed at will.

Differentiation. Urinary incontinence is a disorder of at least one of the three muscle groups. In addition, the autonomic nervous system has a variety of effects on the interaction of the muscle groups: Many sufferers have found out that psychological stress such as stress and conflicts increase incontinence, as does incorrect self-therapy, especially too little drinking. Often, two forms of incontinence also occur in combination, above all urge incontinence together with stress incontinence, which makes diagnosis difficult for the doctor. However, it is essential to choose one of the five types of incontinence because they differ greatly in terms of therapy.

The causes of incontinence are distributed differently in men and women.
www.salevent.de, Michael Amarotico, Munich

Stress incontinence (Stress incontinence): Loss of urine as soon as the pressure in the abdomen exceeds the urethral pressure, e.g. B. when coughing, jumping, walking, pressing. Women are predominantly affected. In stress incontinence, the bladder and / or rectum sags and the bladder occlusion is disrupted. Since the bladder blockage is no longer in the area of ​​the pelvic floor muscles, it can no longer be controlled by the pelvic floor muscles. The cause is either a weak pelvic floor after giving birth, or the tissue around the urethra can no longer withstand the pressure exerted (e.g. due to a lack of estrogen during or after the menopause).

In some cases, if the bladder sinks too much and therefore the angle of entry to the urethra changes too much, the result is disturbed emptying of the bladder: This is not an incontinence, but an increased amount of residual urine. The precise diagnosis by the specialist is particularly important here. In men, stress incontinence occurs practically only after accidents, radical prostate removal or complete urinary bladder removal with the formation of a replacement bladder with intestinal parts.

Urge incontinence (Urge incontinence): Very strong and sometimes painful need to urinate, followed by loss of urine. Urge incontinence is usually caused by an overactive bladder muscle, reduced bladder capacity or an acute or chronic irritation of the urinary bladder (cystitis). Sometimes bladder cancer or bladder stones are the cause, which the urologist will clarify with a urinary bladder endoscopy. Urge and stress incontinence sometimes occur together, and the transition to the irritable bladder is fluid.

Overflow incontinence (Overflow bladder): Loss of urine when the bladder is stretched to the maximum as a result of an obstruction to drainage - therefore actually represents urinary retention -, most often with an enlarged prostate. With increasing bladder filling, the pressure in the bladder increases so much that urine involuntarily escapes in small portions. If the obstruction to drainage is left untreated, the disruption of bladder emptying leads to increasing overstretching and sluggishness of the bladder muscle and consequently to complete urinary retention with damage to the bladder muscles. In addition, the risk of bladder infections and - due to the chronic congestion of urine back into the kidneys - of kidney failure increases.

Reflex incontinence (Reflex bladder): reflex-like emptying of the bladder in the case of underlying neurological diseases, such as B. spinal cord injuries in which the nerve connection between the spinal cord and the brain is damaged or interrupted. If the nerve tracts are completely interrupted, the urge to urinate is completely absent, the bladder muscle contracts by itself reflexively and the urethra opens without the affected person being able to influence it. However, there are also weakened forms in which z. B. the urge to urinate is preserved.

Extraurethral incontinence: Loss of urine outside the urethra (or, better, the urethral sphincter) as a result of congenital disorders such as a ureter that opens directly into the urethra below the sphincter, or a bladder-vaginal fistula (damage to the separating layer between the bladder and vagina after accidents or operations ). With this type of urine leakage, only surgery can restore continence.

That's what the doctor does

Condom urinals are usually much more comfortable for men to wear than "diapers". The left picture shows the application of the rubber sleeve to the penis, the middle picture the urine collection container (called leg bag) and the right picture the attachment of the leg bag to the thigh. The wearing time is usually 24 hours.
Georg Thieme Verlag, Stuttgart

The diagnosis belongs in the hands of a urologist or gynecologist. A detailed questioning of the patient usually provides the doctor with decisive information on the type and extent of urinary incontinence. A micturition log will help identify the cause of bladder weakness. In it, the patient notes the daily amount of water they drink and urine, as well as situations in which urine leaks, such as when sneezing.

This is followed by an ultrasound examination of the kidneys and urinary bladder in order to e.g. B. to exclude stones or an increased amount of residual urine. A thickened bladder wall indicates a chronic obstruction to drainage, e.g. B. in an enlarged prostate, or an underlying neurological disease.

Since a bladder infection can aggravate or temporarily trigger urinary incontinence, the urine is examined (urine culture) and the kidney values ​​in the blood (creatinine), urea are determined. In women over the age of 45, checking the estrogen level is also useful.

The excretory urogram and the urinary examination make it possible to rule out congenital malformations and to detect stones and tumors. The doctor also performs a cystoscopy Stress test by: After filling the bladder with water, the patient is asked to cough in order to be able to assess the occlusive function of the urethra. Sometimes a sagging or prolapse of the uterus is also noticeable.

The doctor uses urodynamics to find out what type of urinary incontinence it is and, based on the measured values, recommends the optimal therapy based on the information from the patient interview. The urethral pressure profile is carried out if stress urinary incontinence is suspected (this particularly affects women in whom the organs in the pelvis have sunk).

Treatment of Stress Urinary Incontinence

The doctor always recommends intensive pelvic floor training, even if an operation is planned. He also prescribes the patient an ointment containing estrogen (e.g. Linoladiol®, OeKolp®) to improve the tissue quality of the vagina, urethral outlet and urethral obstruction, which at the same time also prevents urinary tract infections.

Special text: Pelvic floor training: the be-all and end-all for sagging and incontinence problems

A drug with the active ingredient duloxetine (Yentreve®) can be prescribed for stress incontinence, especially if no improvement has been achieved through pelvic floor exercise. In the beginning there are often side effects such as B. nausea, which usually disappears after about 2 weeks.

If the lowering of the pelvic organs is pronounced or if the urethra can no longer withstand even a slight pressure, conservative methods alone are not enough to get the urinary incontinence under control, so the doctor recommends an operation. Which method he recommends depends on the individual case. The sling plastic, which was only introduced in 1996, has a success rate of ~ 85% if the indication and technique are correct. The aim of all operations is to restore the interplay between the pelvic floor and urethra in continence function. The procedure is carried out in the hospital; the patient then has to stay in the hospital for a few days so that the bladder function can be checked via a suprapubic urinary catheter, which has to be placed during the operation.

A newer surgical procedure for stress incontinence is the sling plastic surgery (also called TVT operation = tension free vaginal tape): Here a plastic tape is looped under the urethra and fixed to the abdominal wall in order to stabilize the position of the urethra. This will help withstand the pressure when the bladder is full.
Georg Thieme Verlag, Stuttgart

Treatment of urge incontinence

If the urge incontinence is not very pronounced, the doctor recommends bladder and / or toilet training. The patient adheres to regular times when he goes to the toilet in order to finally lengthen the time intervals between visits to the toilet step by step.

With medication (Anticholinergics) such as darifenacin (Emselex®), tolterodine (Detrusitol®), oxybutynin (Dridase®, Lyrinel®), trospium chloride (Spasmex®) or solifenacin (Vesikur®) to dampen the bladder muscle or the urge to urinate, urge incontinence can usually be treated well. Most anticholinergics are taken once a day. In principle, these drugs work similarly despite their different composition. They all relax the bladder muscle. Because this no longer contracts so much, the capacity of the bladder and the time intervals between visits to the toilet increase. Side effects are dry mouth, dilated pupils, increased intraocular pressure, accelerated heartbeat, constipation and increased residual urine formation and thus an increased risk of urinary tract infections. Regular medical checks of residual urine by means of a short ultrasound examination are recommended during anticholinergic therapy. If there are side effects, it makes sense to try another preparation. Anticholinergics are contraindicated in the case of cardiac arrhythmias or an increased risk of urinary retention.

Oxybutynin is also available as a plaster for patients with swallowing problems, which is applied to the stomach, hip or thigh twice a week.

With certain forms of glaucoma and increased eye pressure, these medications should not be taken or only under regular ophthalmological control.

With the onset of menopause, it is often advisable for women to use estrogen preparations in the form of creams or vaginal suppositories in the area of ​​the vagina and the external urethral opening. This improves the "tissue cushion" around the urethra, the urethra is no longer as mobile and the urge to urinate is reduced.

However, it is not possible to use hormone replacement therapy to prevent urinary incontinence in women during menopause. More recent studies have even shown that the risk of developing urinary incontinence in later years increases by at least a third.

If there is no improvement in sight despite bladder training and medication, complementary medical therapy such as acupuncture, homeopathy or neural therapy should be considered.

Treatment of overflow incontinence

The aim is to first enable complete emptying of the bladder, be it via an indwelling catheter or a single catheterization several times a day (single discharge of urine via a catheter). Then the doctor must clarify the cause of the overflow incontinence and - if possible - eliminate it, e. B. as part of an operation to remove an enlarged prostate.

Treatment of reflex incontinence

In the case of reflex incontinence, single-use catheterization is the therapy of choice, performed by the patient himself or by a nurse - possibly combined with medicinal bladder suppression. The risk of damage to the kidneys is often increased by an enormously increased bladder pressure and the resulting vesicorenal reflux. Regular urodynamic measurements are therefore essential. A catheter for the permanent drainage (permanent catheter) of the urine should only be inserted in exceptional cases and only temporarily, because there is an increased risk of the development of a shrink blister or an infection.

Since there is often a slight loss of urine in the time between evacuations of the bladder using catheters due to the overactive bladder muscle, a condom urinal is the best solution for men. Similar to a normal condom, it is slipped over the penis and connected via a hose to a drainage bag that is attached to the thigh (leg bag). The fall arrest systems offered for women are unfortunately less sophisticated.

If the domestic conditions do not allow a short walk to the toilet or even if there are stairs to climb in the dark at night, the classic toilet chair is a sensible and not too expensive purchase.
www.hilfsmittelbedarf.de, auxiliary supplies Gutzeit, kernels

Your pharmacy recommends

  • Even if you are embarrassed - talk about your incontinence symptoms: with relatives, friends and of course with your doctor. Most of the time, leisure activities or a vacation are still possible with a little support and good planning.
  • Refrain from breaking off contact with other people because of your incontinence problems and try to keep up your hobbies.
  • Drink enough (2–2.5 l per day) - too little fluid reduces the annoying toilet visits, but promotes infections of the kidneys and the bladder because bacteria, which invariably enter the urinary tract in tiny amounts, are no longer flushed out.
  • Empty your bladder completely before bed. Many sufferers get along well with setting the alarm clock so that they can go to the toilet at night. Others prefer thick panty liners, incontinence pads or incontinence briefs at night, which are available in all sizes and strengths in pharmacies and medical supply stores.
  • If the doctor has determined that you have pelvic floor weakness, then you should regularly perform special exercises as part of the pelvic floor training. The symptoms can be significantly improved in many of those affected. Pay attention to your weight and your digestion: Eat a balanced diet, because obesity and constipation can make pelvic floor weakness worse.
  • Exercise strengthens the body and mind and often alleviates minor incontinence symptoms. Your doctor can discuss with you which sport is best.

Further information

  • www.inkontinenz-selbsthilfe.com - website of the nationwide incontinence self-help e.V., Pohlheim: Numerous information and (literature) tips, e.g. B. to aids, also offers further links.
  • www.kontinenz-gesellschaft.de - website of the Deutsche Kontinenz-Gesellschaft e. V., Kassel: Offers specialist information, comprehensible specialist knowledge for those affected and caregivers as well as a micturition diary to order or to download as a PDF. With addresses of self-help groups, medical advice centers, literature and links.
  • M. Goepel: Patient's Guide to Bladder Disorders in Adults and Children. Springer, 2001. Provides a lot of information on dealing with urinary incontinence as well as tips on social and legal issues.
  • H. Höfler: Pelvic floor exercises. FSVO, 2007. With illustrated training instructions for men and women.
  • H. Gotved: Successful help against urinary incontinence. Triassic, 2003.Very good and detailed guide that gives a lot of tips suitable for everyday use and offers a pelvic floor training program.
  • B. Sachsenmaier: Incontinence. Help, care and care. Schlütersche, 1991. Technically well-founded guide that covers all aspects of care for urinary and faecal incontinence and offers a detailed list of aids.

Authors

Dr. med. Martina Sticker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 09:49


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.