Stress incontinence
definition
Stress incontinence is one of the most common forms of incontinence. There it comes unconsciously and involuntarily to urinate with light to heavy loads. By straining and tensing muscles in the body, the urethral sphincter becomes permeable for a brief moment and urine emerges. Women are far from this problem more often affected as men.
Read more about the topic here: Incontinence
causes
The cause of stress incontinence is one in both women and men Weakness of the lower bladder muscles. Once a increased pressure on the bladder arises, the sphincter gives way and can no longer completely block the access to the urethra. As a result, urine drains from the bladder.
Increased pressure on the bladder can be caused by a strong filling of the urinary bladder or through Changes in pressure in the abdomen come. Such changes in pressure can be triggered by heavy lifting, coughing, laughing, and movements such as standing or walking. In severe cases, even without an apparent cause, the muscles can become slack with mental distraction or while lying down.
The causes of such advanced bladder weakness are numerous. At Men is stress incontinence significantly less often than with women. In men, the pelvic floor muscles remain largely untouched and intact for life. Only Operations in the pelvic area can lead to unwanted muscle injuries. Prostate operations, for example for cancer, are a typical cause of stress urinary incontinence in men.
The pelvic floor muscles will develop in women throughout life significantly more stressed than with men. An important factor in stress urinary incontinence in women is one pregnancy. Pregnancy itself expands the uterus in the pelvis and exerts pressure on the surrounding organs - especially on the bladder and pelvic floor muscles. A subsequent vaginal birth leads to a widening of the muscles, which can largely regenerate, but in some cases can cause permanent damage.
In addition, there are many births emergency interventionswhere the pelvic floor muscles are widened and cut to make labor easier. As women get older, there may be Organ subsidence the organs of the pelvis and abdomen (see: pelvic floor depression) occur as well gynecological interventions occurrence.
For anatomical reasons, women are generally affected by weak bladder neck muscles as they get older. Women are particularly affected who additionally strenuous physical work perform, overweight are and not muscular or are sporty.
Here you can find more information about: Urinary incontinence
Post-pregnancy stress incontinence
A pregnancy is probably that most common reason for stress incontinence. By the Growth of the child itself arises increased pressure on the bladder and even at this point in time, stress-dependent incontinence can occur. But especially the process of birth can Damage to the pelvic floor muscles leave. Vaginal birth stretches the muscles a lot. In some cases they tear or an incision needs to be made by an obstetrician. As a rule, the pelvic floor muscles recover from childbirth, but in rare cases permanent damage can occur. By targeted training after the birth, the quick healing be promoted and accelerated.
Symptoms
The sole symptom of stress incontinence is that uncontrolled and unconscious urination in everyday life. Those affected feel the urine immediately with large amounts, with smaller amounts only the next time they go to the toilet. The accompanying circumstances of stress incontinence result from the three different degrees of illness. The loss of urine is sometimes triggered by coughing, but sometimes while lying down.
diagnosis
A detailed anamnese provides the decisive information for the diagnosis of stress incontinence. Often the patients make small amounts Urine discharge firmly short after physical exercise. In this case, a detailed list of the frequency and the amount the urination of the past few days. Does incontinence go with one greatly increased amount urine production, the cause may be found elsewhere. The doctor can then issue a physical examination the genital region. There are also one Ultrasound examination the lower urinary tract, as well as a digital rectal exam.
Information about the extent of incontinence can be provided by a so-called "Pad test" give. One is weighed beforehand inlay worn and subsequently several movement sequences carried out. These include running, climbing stairs, coughing, jumping and other movements. It is then measured at what load the amount of urine excreted involuntarily.
Grade 1
The Graduation with stress incontinence depends on the Severity of stressthat leads to involuntary urination.
Grade 1 represents the heavier loads These include heavy lifting but also to cough, Sneeze or Laugh. During the last three activities in particular, the body exerts pressure on the abdomen, which is a burden on the bladder. As a result, the bladder presses on the urine and the bladder neck muscle cannot withstand this pressure.
Grade 2
Of the Grade 2 represents a further progression of stress incontinence. Yes lower pressure increases in the abdomen affect the bladder in such a way that the pelvic floor muscles cannot hold back the urine. Everyone counts at this stage faster body movements and efforts. Like that, for example Straighten up, Sit down, Go and Leap.
Grade 3
Of the Grade 3 represents the final stage of stress incontinence in which it hardly a burden must come. Light movements are sufficient to trigger uncontrolled urination. Incontinence too without movement and laying is counted at this stage.
treatment
Stress incontinence and weakness of the pelvic floor muscles is common very easy to handle. The numerous conservative therapeutic approaches alone offer good results, but surgical procedures are also used.
The conservative therapy is designed to strengthen the weak bladder neck muscles and pelvic floor muscles in general. This can be done through targeted pelvic floor training or with medication. There are many new therapeutic approaches in the context of pelvic floor training. These include Electrical stimulation, Vaginal weights, gymnastic exercises and many more. These exercises require precise instructions from the attending physician so that they can be performed correctly. Medicinal can with Estrogens or certain Antidepressants be treated. Both cause the pelvic floor muscles to contract more intensely.
Only when the conservative possibilities have been exhausted can stress urinary incontinence operative treatments be considered. In many cases, with Ribbons or loops the pelvis and pelvic organs supported to take pressure off the pelvic floor muscles. The urinary bladder is also supported and strengthened. Likewise, the fabric can with Collagen be injected under to strengthen the hold of the pelvic organs and to relieve the muscles. Artificial occlusion mechanisms that are used under the urinary bladder are less common.
Exercise for stress incontinence
In addition to electrical stimulation and drug treatment of muscle weakness, one can do so under the guidance of a doctor or Physiotherapists With targeted exercises treat incontinence.
Probably the simplest exercise can be while sitting To run. To do this, you tense the urethral sphincter consciously and as hard as you can. This tension is held for up to 10 seconds. If you repeat this tension several times, you should give the muscle some time to recover. This means that the exercise can be carried out several times a day and anywhere, even on the go, at any time. Care must be taken to only tense the pelvic floor muscles and not to use the gluteal muscles. While lying down or standing, you can also check that the gluteal muscles are not tense.
In another exercise, the laying different muscles should be tensed one after the other. First the abdominal muscles, then the glutes and finally the pelvic floor muscles are contracted. This not only strengthens the muscles, but also gives you a feeling and control over the individual muscle parts.
Ask more exercises Variations of the basic exercise Afterwards, the sphincter should be squeezed tightly in various positions, for example in a crouch, cross-legged position or bent over while standing. By varying the positions, you gain new control over the muscles in various everyday situations. In addition, the repeated tension increases the strength of the muscle.
Duration
The duration of the treatment and thus the incontinence depends on various factors. The duration depends primarily on the pelvic floor training and the success of the treatment through targeted muscle exercises. Muscle function can only be sustainably built up through consistent training. To first improvement it can few weeks last.
However, there is one severe damage to the pelvic floor muscles, for example through injuries after childbirth or in men after prostate surgery, it happens rarely for complete healing. Targeted training can only strengthen the remaining healthy muscles.
