Urinary incontinence

Urinary Incontinence – Widespread, Yet Still Taboo

Diseases that are widespread are called common diseases. The most important among them include coronary heart disease, type II diabetes mellitus, hypertension (high blood pressure), depression, and obesity. However, one condition is missing from this list, even though it is very common: urinary incontinence. People don't like to talk about it publicly because those affected are ashamed of their condition.

What is urinary incontinence?

In medicine, this condition is called incontinentia urinae. In everyday language, it's called bladder weakness. Physicians use this term to describe the loss or failure to learn the ability to store urine in the bladder and to determine the place and/or time of emptying oneself. According to the definition of professional societies, urinary incontinence is already present if even a single drop of urine is involuntarily or unintentionally expelled. Bladder weakness is a condition that affects not only pregnant women and elderly men. It is prevalent in men, women, and children across all age groups.

How common is urinary incontinence?

The frequency of bladder weakness heavily depends on the age and gender of those affected. Across all age groups and genders, statisticians estimate that approximately 13 percent of all people are affected. This percentage continuously increases with age, reaching 23 percent among those over sixty. 18 percent of men in this age group are affected, and 23 percent of women.

For comparison: Approximately 10 percent of all people suffer from coronary heart disease, and about 8 to 9 percent from type II diabetes mellitus. Only obesity is more common than urinary incontinence.

However, health experts assume that the number of people suffering from bladder weakness is much higher. Many affected individuals are not even aware that they suffer from urinary incontinence according to the medical definition, as they consider it normal to lose a few drops now and then. Others know that something is wrong with them but are ashamed to see a doctor.

Why is bladder weakness still a taboo subject today?

This is partly due to the great importance placed on cleanliness and hygiene in our society. Someone who might even wet themselves in public is considered dirty, uncontrolled, weak, or psychologically disturbed. Sometimes it is also assumed that those affected are under the influence of alcohol or drugs. They are stigmatized and, at best, avoided and met with evil glares, but often have to endure suggestive remarks or even insults.

Many people with bladder weakness suffer greatly from this. They withdraw almost completely from social life and avoid appearing in public because they are ashamed. Some only leave the house when there is no other option. This can trigger depression.

What are the different stages of urinary incontinence?

The German Continence Society distinguishes 4 stages of urinary incontinence:

• sporadic incontinence: urine loss is less than 10 ml per hour or occurs only occasionally

• stress incontinence: urine loss is less than 25 ml per hour

• severe incontinence: affected individuals lose less than 50 ml of urine per hour

• absolute incontinence: urine loss exceeds 50 ml per hour.

For comparison: an average, healthy adult produces between 1,000 to 1,500 ml of urine per day and needs to empty their bladder four to six times. The daily urine volume fluctuates significantly and depends on many factors, such as diet.

What causes urinary incontinence?

Urinary incontinence can have various underlying causes. Triggers of bladder weakness can include various diseases. These include:

• Diabetes mellitus

• Lung diseases, including chronic bronchitis

• Neurological diseases such as multiple sclerosis, Parkinson's disease, stroke, or paraplegia

• Urinary tract infections, including urethritis or cystitis

• Enlarged prostate

Weakening or injury of the pelvic floor muscles can also result in urinary incontinence. In women, this often occurs during pregnancy or as a result of childbirth, sometimes also after a hysterectomy, while in men it often occurs after a prostatectomy (removal of the prostate) or radiation therapy.

Certain medications can also trigger urinary incontinence. These primarily include diuretics, so-called water pills, but also antidepressants, opioids, muscle relaxants, and others.

Lifestyle and, of course, age can also contribute to urinary incontinence. First and foremost are obesity and smoking, but also excessive consumption of strong, caffeinated beverages such as coffee, tea, or energy drinks. Heavy physical labor, especially frequently lifting heavy loads, can also trigger urinary incontinence because it damages the pelvic floor muscles.

Urinary incontinence can have various causes and may be a symptom of a serious illness. Patients should therefore not take it lightly and should have it checked by a specialist.

The different types of bladder weakness

In medicine, 5 forms of urinary incontinence are distinguished, which are briefly explained in the following sections:

• Stress incontinence

• Urge incontinence

• Mixed incontinence

• Overflow incontinence

• Reflex incontinence

Stress incontinence

This form of bladder weakness is also called stress incontinence. However, stress here does not refer to the psychological state, but rather a sudden strain on the abdominal cavity, which subjects the bladder's sphincter muscles to sudden, strong pressure. Involuntary urine leakage occurs when coughing or sneezing, laughing, climbing stairs, or lifting heavy loads. The cause of this is weakened pelvic floor muscles. Stress incontinence is more common in women than in men.

Urge incontinence

In colloquial language, urge incontinence is also called an overactive bladder. Affected individuals experience an urgent need to urinate, sometimes at intervals of just a few minutes. If the urge is not acted upon and a toilet is not found in time, involuntary urine leakage occurs. Since the bladder is emptied very often, the amounts of urine passed are usually small. Causes of urge incontinence can include a bladder that is too small, neurological diseases, an enlarged prostate, or a tumor. In older people, urge incontinence is the most common form of bladder weakness.

Mixed incontinence

This refers to bladder weakness where stress and urge incontinence occur simultaneously.

Overflow incontinence

In overflow incontinence, the bladder is constantly full. If the pressure of the urine exceeds the holding capacity of the sphincter muscles, fluid leaks out. This can happen without the affected person noticing. The cause is a disturbed urine outflow, for example due to urinary stones, a tumor, or an enlarged prostate. Patients feel the need to constantly go to the toilet, even if they have only recently relieved themselves. Overflow incontinence is more common in men than in women.

Reflex incontinence

It can occur as one of the consequences of a spinal cord injury. Due to the paralysis, the nerves no longer function, and patients no longer notice when their bladder is full. When the pressure on the sphincter muscles becomes too great, the bladder empties at irregular intervals.

Childhood urinary incontinence

The condition appears in 2 forms: bedwetting, medically called enuresis, and daytime wetting. Doctors refer to bedwetting when a child over the age of 5 wets the bed at least twice a month during sleep, without a urinary tract infection or daytime wetting being present.

If children wet themselves during the day, urge incontinence is often behind it. Some children also don't want to use the toilet for various reasons and postpone it until the bladder empties involuntarily. This is called urinary incontinence due to voiding postponement.

Nocturia

This is the medical term for the nocturnal urge to urinate in adults. They cannot sleep properly because they wake up sometimes hourly and have to empty their bladder. The causes are often diabetes mellitus, heart disease, medication, hormonal disorders, or excessive fluid intake before bedtime.

Therapeutic measures for urinary incontinence

The treatment of urinary incontinence depends on its form and any other associated illnesses. Bladder weakness is usually not an independent disease, but rather occurs either in conjunction with other diseases or is a symptom of other conditions or health problems. In women, it often occurs during pregnancy and shortly after childbirth, and in men after prostate surgery or radiation therapy. An enlarged prostate or urethral stones can also be underlying causes. Only when a doctor has identified the cause of urinary incontinence can treatment begin.

In severe cases, an artificial sphincter can also be implanted. However, this operation is not without risk and is only performed in exceptional cases.

How curable is urinary incontinence?

That depends on the underlying cause of the bladder weakness. For example, if it was due to urethral or bladder stones or an enlarged prostate, an improvement occurs on its own once the problem has been eliminated, i.e., the stones have been removed or the prostate has been resected.

If it is due to weakened pelvic floor muscles caused by pregnancy or a medical intervention in the abdomen, at least an improvement in the condition can be achieved through regular

pelvic floor training.

However, if urinary incontinence is severe, affected individuals usually have to accept that this problem will accompany them for the rest of their lives.

They must learn to live with urinary incontinence.

Living with urinary incontinence

Fortunately, today there are a number of aids that, while they cannot stop the involuntary leakage of urine, do prevent it from becoming visible externally. They enable people suffering from bladder weakness to lead a near-normal life and remain socially active. These products essentially include absorbent and collecting incontinence aids.

Collecting incontinence aids

This category includes, for example, the various types of catheters. They are often used in hospitals after operations or for bedridden patients. A catheter is a hollow needle that drains urine. It is led into a bag, which is usually made of silicone.

Another variant are urinal condoms. They are intended for men, but there are also versions for women. However, they are not very popular with women because they do not adhere firmly. As the name suggests, a urinal condom is applied like a normal condom, but the tip is open. A tube attachment with an adapter is located on it. A tube with a urine bag is connected to this. Urinal condoms are useful aids for people who sit a lot, such as wheelchair users or professional drivers. For active people who move a lot, however, they are less suitable because they detach easily.

Absorbent aids

These are products that absorb and bind urine. There are the following sub-groups:

• pads

• briefs

• diapers

Most aids in this category are disposable products, but reusable pads and briefs that can be washed are also available online. Absorbent incontinence aids come in various absorbencies, for
women and men, or as unisex products. They are available in every drugstore and also in many discount stores and supermarkets.

The functional principle of absorbent aids

Regardless of their shape, all consist of several layers of different materials. The inner layer, which comes into direct contact with the skin, is made of a soft fleece. It is designed to quickly wick away urine, keeping the skin dry. Beneath it is a thick layer of a special substance. When it comes into contact with liquid, it doesn't just absorb it, but transforms it into a gel. If only simple foam were used, it would release the urine again, for example, when under pressure from sitting. The outer layer is a barrier layer made of a thin plastic film.

Advantages and disadvantages of the various absorbent aids

Pads

They are among the most commonly used absorbent aids and look like sanitary pads, but are larger and thicker. Pads have the advantage that they can be worn with normal underwear, as they are simply placed in the briefs. They are very comfortable and allow enough fresh air to the genital area. Their disadvantages are that they quickly slip and have limited absorption capacity.

Ordinary sanitary pads are not suitable for urinary incontinence. They are not absorbent enough and are designed to absorb thicker menstrual blood.

Briefs

These products look like normal underwear and are worn in the same way. There are briefs that at first glance are indistinguishable from normal underwear. They offer better protection than pads, as their design prevents slipping. They fit snugly around the legs, preventing any liquid from escaping. Briefs are particularly suitable for severe urinary incontinence. Their disadvantages are that they are harder to change than pads. To do so, you have to take off your trousers completely. In addition, they completely shield the lower abdomen from fresh air. The warm, moist atmosphere between the briefs and the skin provides ideal conditions for the development of skin fungi.

Diapers

They are, in principle, nothing more than briefs, but they are not put on and taken off like underwear; instead, they are closed or opened with Velcro fasteners or adhesive strips. Diapers are used for bedridden patients because they can be changed without the person having to get up. However, putting on and taking off diapers is cumbersome and requires practice.

Do health insurance companies cover the costs of incontinence aids?

Good quality pads or incontinence briefs are not exactly cheap. A pack of 12 briefs can cost almost 12 Euros. Depending on the severity of incontinence, an average of 2 to 4 briefs are needed per day. This adds up to 6 to 12 packs per month, or 72 to 144 Euros.

First, the good news. Yes, the costs for the provision of absorbent or collecting incontinence aids are covered, once the bureaucratic hurdles have been overcome. Cost reimbursement is applied for as follows:

1. A doctor, either a general practitioner or a specialist, must determine that urinary incontinence is present and that the condition will not change in the foreseeable future.

2. The doctor issues a standing prescription. This prescription is valid for one calendar year.