Incontinence (involuntary leakage of urine)

The causes can be very different and include: disorders of bladder function, the nerves that control emptying of the bladder, anatomical features, sphincter and prostate problems, drugs, and generalised diseases (e.g. Parkinson's disease). There are many possible symptoms in addition to the inability to hold urine. A precise diagnosis is often the key to successful treatment. 

The frequency and the risk of incontinence increases with age, and women are generally more affected than men. There are different types of urinary incontinence: The main ones are stress urinary incontinence (SUI), urge incontinence (urge incontinence), and mixed incontinence.

Stress incontinence

In the case of stress incontinence, involuntary loss of urine occurs during physical stress e.g. coughing, sneezing, or lifting heavy loads. It many cases, it only involves a few drops of urine. In others, it involves a complete and uncontrolled evacuation of the bladder. This form of urinary incontinence is caused by a weakness of the sphincter. Women are affected by stress incontinence more often than men are. In men, this problem may occur after prostate surgery.

Urge incontinence

This form of incontinence is characterized by the sudden onset of urination and the immediate loss of urine before the toilet is reached. The problem can be cause by persistent bladder and urethral inflammation, bladder stones, and bladder tumours as well as neurological disorders. Urge incontinence is often accompanied by frequent urination during the day and at night. An over-active bladder is often regarded as a cause.

Mixed incontinence 

This combined form of urinary incontinence involves both a sudden urge to urinate and the involuntary loss of urine during physical stress. Women over 30 are most commonly affected.

Diagnostics

• Physical examination
• Urinalysis
• Measurement of urinary stream
• Ultrasound
• Urodynamics (Measurement of Bladder Pressure)with X-ray view of the bladder and urethra
• Cystoscopy

Treatment of stress incontinence

• Pelvic floor exercises, which may be supported with electrical stimulation of the pelvic floor.
• Medication (no medications approved in Switzerland)
• Mechanical aids such as special tampons in women and penile bands or clamps in men
• Surgical implantation of tension-free tape (TVT) under the urethra: TVT tape in woman , TVT tape or mesh inserts in men
• Injection of collagen-like substances under the mucous membrane of the internal or external urethral sphincter
• Implantation hydraulic Prosthetic Sphincter

Treatment of Urge Incontinence

• Medication with tablets, patches, or instillations of medication into the bladder
• Electrotherapy (TENS units)
• Botox Injections into the urinary bladder
• Neuromodulation through stimulation of the bladder nerves