Urinary incontinence therapies (Urology)

Overview

The family doctor can often help further: In many cases of urge incontinence without a clear cause, medication such as antimuscarinics or sympathomimetics can alleviate the suffering. In the case of inflammation, high blood pressure or stones in the urethra, the problem can also be treated with medication, such as antibiotics or alpha-blockers. For benign enlarged prostate (BPH), minor surgery can help. If weakened pelvic floor muscles are the cause of stress incontinence, targeted pelvic floor training can bring about an improvement.

For more information on the types, occurrence and causes of incontinence, see Incontinence

Urodynamics for root cause analysis

If the cause of the incontinence remains unclear or if initial attempts at treatment are unsuccessful, a urodynamic examination may be necessary. This allows the function of the bladder and sphincter to be checked by using probes to measure the pressure as the bladder fills and empties.

Depending on the results of the examination, various therapies are available: Conservative options such as permanent catheters, self-catheterization or pelvic floor rehabilitation, medication, Botox injections, electrostimulation or surgery as a last resort.

Electrical therapies

• Sacral neuromodulation (SNM): In this minimally invasive SNM, electrodes are implanted in the back near the sacrum under local anesthesia in a first step. If the bladder dysfunction improves in a test phase lasting at least two weeks, the neuromodulator is implanted in the hip area in a second step. The battery lasts three to eight years. If the test phase is not successful, the electrodes are removed again. Sacral neuromodulation is a compulsory service provided by the health insurance company. SNM has a success rate of up to 80%.
• Percutaneous tibial nerve stimulation (PTNS): This electrical therapy uses an acupuncture needle and an electrode in the area of the left or right foot once a week for 30 minutes. The therapy lasts a total of twelve weeks and is carried out on an outpatient basis in the outpatient clinic. It must then be repeated every two to four weeks, depending on the success of the treatment. PTNS has a success rate of up to 60%.

Drug therapies

Various medications can be used for both stress and urge incontinence. Which medication may be helpful will be assessed after urodynamics have been carried out.

In some cases, Botox injections can be used to treat certain medical conditions such as overactive bladder. Botox is injected into the bladder wall to reduce the activity of the bladder muscles and relieve the symptoms of an overactive bladder. This can help to reduce the frequency of urinary urgency and urinary incontinence.

Operations

Depending on the type of urinary incontinence, patients can be offered tape operations, artificial sphincters (AMS-800® prosthesis) or a combination of both operations (ATOMS® prosthesis).

Tape surgery or sling surgery to treat incontinence is a surgical procedure. A ligament made of synthetic material or the body’s own tissue is usually placed under the urethra or bladder to support and stabilize the urethra. The band acts like a kind of “sling” that lifts the urethra and keeps it closed to prevent uncontrolled urine leakage.

The tape operation is often used for women with stress incontinence, where there is uncontrolled leakage of urine during physical activities such as coughing, sneezing, laughing or sport. The procedure is usually minimally invasive, often using laparoscopic or robot-assisted techniques, and usually requires only small incisions and a short recovery time.

An artificial sphincter is a medical implant. It is a device used to close the urethra or the outlet of the bladder and prevent uncontrolled urine leakage. The artificial sphincter usually consists of a cuff or band that is placed around the urethra or urinary bladder and is connected to a control unit. The control unit can be controlled externally, for example by the patient themselves or by a doctor, to open or close the sphincter. Opening the artificial sphincter allows the patient to urinate, while closing the sphincter stops the flow of urine and prevents uncontrolled urination.

Pelvic floor physiotherapy

If weakened pelvic floor muscles are the cause of stress incontinence, targeted pelvic floor training can bring about an improvement. Our pelvic floor physiotherapists can provide trained guidance here.

Women can find tips for a strong pelvic floor here: These tips and exercises strengthen the pelvic floor