Symptoms can be an increased urinary/bowel movement, increased nighttime urination or involuntary urine/stool loss during exercise, e.g. when coughing, sneezing, laughing, running, walking, climbing stairs and carrying heavy loads. Causes can include:
Disposition to a tissue weakness.
Frequent pressure load on the pelvic floor, for example, chronic coughing, sneezing, allergic or digestive problems like constipation.
Special stress on the pelvic floor in childbirth.
Impairment of the closing apparatus of the bladder or intestine, for example, by inflammation, organ reduction, tumours, prostate or urethral disease, nerve damage or surgery.
An involuntary leakage of urine when sneezing, coughing, lifting heavy objects or during physical exertion, but not accompanied by the urge to urinate, indicates a weakness in the bladder closure mechanism.
The bladder acts independently of the brain's control and automatically contracts when a certain capacity level is reached.
An overactive bladder is generally the cause if the urge incontinence coincides with frequent urination during the day and at night.
Medical conditions and events which can lead to incontinence include stroke, Parkinson's disease, multiple sclerosis, dementia, neurological disease, traumatic brain injury, interstitial cystitis, prostate surgery, pelvic surgery and diabetes
Diagnostic procedures include inspection of the rectum (proctoscopy), X-ray examination of the rectum (defecography) and pressure measurement of anal closure system (anal manometry).
Enquiries for incontinence treatment
Continence Dept of a major public sector hospital in Germany, one of the largest private hospitals in Switzerland or university hospitals in Germany and USA.
Incontinence has a wide variety of forms and causes so successful treatments may require neurological experience to select the most effective medical, conservative or surgical procedures.
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In many cases a tension-free vaginal tape can help. In a 30-minute operation an approx. one cm wide band is placed around the urethra and inserted with both ends under the abdominal wall.
The success rate at a good hospital can be high, e.g. 80 to 85 percent of patients reporting a significant improvement
Where incontinence results from a significant reduction of the pelvic floor, the entire internal genitalia of the female (uterus, vagina, bladder wall, bladder and bowel) may be resecured in an intensive operation, where the damaged ligaments are restored by inserting plastic nets.
This is usually treated with medication, or as a last resort, Botox may be used to achieve a temporary relaxation of the bladder muscles.
It takes effect after five to seven days, stabilising an overactive bladder muscle for up to twelve months and may be repeated if the symptoms recur.
Where conservative approaches, such as pelvic floor exercises and/or dietary or drug regimes are not successful, surgery may be an option.
Repair procedures are used to narrow the sphincter and artificial sphincter implants or pacemakers are sometimes fitted to assist the closing muscles in their action.
A few of the more common forms are:
An involuntary leakage of urine with both an urge to urinate and during physical exertion, this is most common in women over 50.
Main treatments for incontinence
Causes of incontinence
It is generally pain-free and is performed primarily for overactive and painful bladder syndrome (interstitial cystitis).
This involves the administration of liquid medicines into the bladder or a catheter permanently positioned in the bladder.
Instillation treatment of the bladder
Selection and dosage of the agents will vary for each individual and this requires neurourological experience to avoid side-effects.
The simplest method is using an ultrasound scan of the urethra to show the proper way to contract the muscles.
Pelvic floor training can be a highly effective way of countering urinary incontinence without side-effects, together with biofeedback and electrical stimulation.
Pelvic floor therapy
Devices for biofeedback training use a probe in the vagina or the intestine to measure the activity of the pelvic floor muscles and show this on a chart.
Some devices can also deliver electrical impulses that train the pelvic floor muscles by stimulating the vagina.
Neuromodulation and neurostimulation
This procedure is of equal help to patients with overactive or underactive bladders.
Neuromodulation applies electrical impulses to fine nerve tracts in the sacral nerves in the small pelvis. Stimulation is then applied for a number of days.
If this is successful a stimulation system can be fully implanted just like a pacemaker.
Urinary incontinence surgery
If the bladder and/or urethral sphincter is damaged, or other treatments are unsuccessful, surgery may be effective.
The Tanzberger concept, combines elements of perception, tension, relaxation, breathing and posture.
Electrical therapies are applied in the form of targeted muscle stimulation of the pelvic floor and biofeedback techniques can be combined with this.
For circulatory disorders and prostate diseases, connective tissue massage therapy and reflexology can achieve a significant reduction in complaints.
Well-tried natural remedies such as hot packs and wraps and warm sitting baths with different additives still have therapeutic value.