Incontinence is the loss of control over the delivery of urine - and more rarely stool. Often the causes of urinary incontinence are in the area of the urinary tract. But also problems in the brain and spinal cord or with the nerves can lead to incontinence. Here you can read about the forms of incontinence in men and women, which aids are available and which therapy helps with incontinence.
Causes of incontinence
Incontinence may be due to either organic causes or illness or injury to the nervous system. This leads to a disruption in the cooperation of the brain and nerves on one side and pelvic floor muscles, bladder muscles and sphincter muscles on the other side.
Depending on whether urine or faeces are given unconsciously, this is called urinary or fecal incontinence. Both types are different forms, each having different causes. Below is an overview of the most common forms and causes of incontinence.
Urethral drip or dribble is when a few drops of urine are released after emptying the bladder. This symptom occurs predominantly in men and has the reason that the urethra, which leads from the bladder to the penis tip, is not completely emptied by the corresponding muscles. As a result, at a low point in the urethra, some urine forms, which then drips off.
Patients suffering from urinary incontinence have problems controlling their urine. Basically, there are five different forms of urinary incontinence:
- stress incontinence
- urge incontinence
- reflex incontinence
- Overflow incontinence
- Extraurethral urinary incontinence
The causes of urinary incontinence do not always have to be in the area of the urinary tract. Disruptions to the nerves, brain or spinal cord can also lead to incontinence. In rare cases, incontinence may also be caused or exacerbated by medication. Therefore, it is important to tell your doctor what medications you are taking regularly.
In a stress incontinence, also known as stress incontinence, it comes through an increased pressure in the abdomen for involuntary loss of urine. This may for example be the case when carrying heavy objects, but also when laughing, coughing or sneezing. In extreme cases, even in normal movements, such as walking, a loss of urine occur. This can range from a few drops to a urine loss in the beam.
If there is a stress incontinence, the connection between bladder neck and urethra is usually impaired. A common cause is surgery and accidents that weaken the pelvic floor or damage pelvic nerves. In men, the risk of stress incontinence following prostate surgery is particularly high. As a result, it can happen that the sphincter of the bladder is lowered.
In women, the pelvic floor muscles are weaker than in men, which is why they suffer more frequently from stress urinary incontinence. Special stress for the pelvic floor is pregnancy and childbirth. During pregnancy, but also after birth, stress incontinence often becomes noticeable. The hormonal changes during the menopause also increase the risk of incontinence.
In urge incontinence (urinary incontinence) occurs suddenly urine urgency, which is so strong that sometimes the affected people do not make it to the toilet in time. Often the urinary urgency occurs several times an hour, although the bladder is not yet completely filled. The cause of urge incontinence is a signal transmission problem: although the bladder is not full, it sends the emptying signal to the brain.
Differences can be made in:
- Sensory urge incontinence: impaired perception of the bladder filling (premature filling feeling), for example due to bladder stones or inflammation of the urinary tract
- Motor urge incontinence: spasmodic, involuntary contraction of the urinary bladder sphincter, as a result of which even a minimal filling of the urinary bladder triggers a strong urinary urgency
Specific causes include surgery leading to nerve damage, inadequately treated diabetes mellitus and neurological disorders such as multiple sclerosis or Parkinson's disease. Likewise, the trigger may be a constant irritation of the bladder by urinary tract infections such as bladder infection or a constriction of the bladder outlet, such as due to a prostate enlargement. In addition, behind a urge incontinence also mental causes can be stuck.
In cases of reflex incontinence, those affected no longer feel whether the bladder is full. In addition, they can no longer control the emptying of the bladder willingly. That's why it empties itself from time to time.
In reflex incontinence, the nerves that control the bladder are disturbed. This leads to a loss of control of the sphincter. This can also be caused by neurological diseases such as multiple sclerosis. In addition, injuries to the spinal cord, such as occur in the context of paraplegia, come into question (spinal reflex incontinence).
Supraspinal reflex incontinence is the term used when control of voluntary bladder emptying due to brain disorders is lost, for example due to Alzheimer's, dementia, Parkinson's or stroke.
In case of an overflow incontinence, small amounts of urine will run off again and again as soon as the bladder is filled.
The cause of the complaints is a drainage problem at the bladder outlet. An obstruction at the exit - such as an enlarged prostate, a tumor, or a narrowed urethra - can not easily drain the urine. Only when the pressure in the bladder continues to increase, small amounts of urine can escape. The overflow incontinence is therefore associated with a feeling that the bladder is never completely emptied.
This form of incontinence is the most common in men.
Extraurethral urinary incontinence
Extraurethral urinary incontinence also leads to permanent loss of urine. However, the urine does not drain through the urinary tract but through a fistula that connects the bladder with other organs such as the vagina or intestine. As a result, those affected have no control over the loss of urine. Extraurethral urinary incontinence is usually congenital.
Patients with fecal incontinence have difficulty controlling their intestinal gases and stool. Depending on the severity of the incontinence, three stages are distinguished:
- Stage 1: There is an uncontrolled discharge of intestinal gases. Under stress, it may also come to partial stool lubrication.
- Stage 2: There is an uncontrolled discharge of intestinal gases and thin stool.
- Stage 3: There is a complete loss of stool control. The result is a permanent chair smear. In addition, not only liquid, but also solid stool is lost.
Depending on the cause of the condition, as with urinary incontinence, there are five different types of fecal incontinence: motor, sensory, reservoir, neural and mental incontinence. In some cases, sufferers still remember the stool urge, but they can not make it to the toilet in time. In other cases, those affected do not feel anything and the loss of stools happens completely unconsciously.
Causes of fecal incontinence
Fecal incontinence may be due to various diseases. In addition to chronic inflammatory bowel diseases such as Crohn's disease and neurological diseases are triggers in question. Tumors in the rectum, a pelvic floor weakness, severe hemorrhoids or constipation can also be the cause.
The sphincter may still be affected by injury after surgery or childbirth. If nerves are damaged, the perception at the intestine outlet can be disturbed. Finally, certain medications such as laxatives, antidepressants or antiparkinson drugs may be the cause.