Urinary Incontinence Therapies (Urology)

The condition is common and affects both women and men. The most important question in urinary incontinence is whether the disorder is neurogenic or has another cause. The neurological-urological department has a wide range of diagnostic methods and therapies at its disposal.

With a healthy bladder, you can feel the urge to urinate when it is well filled. After urination this feeling subsides until the next time. However, many people cannot control the appropriate time for the emptying of the bladder. “Depending on the age group, 40 percent or even more can be affected by urinary incontinence,” says Dr. Marko Kozomara, senior physician of the neuro-urological department. Often the problem is concealed and no doctor is consulted.

The condition can come in different forms: There may be steady dripping without any noticeable urge to urinate. Sneezing, coughing, laughing or physical exertion can lead to involuntary loss of urine (stress incontinence). The urge to urinate with loss of urine can come unannounced (urge incontinence). Or there is a combination of both forms, a so-called mixed incontinence.

Because bladder activity and all the muscles involved are controlled by the brain via nerve pathways, damage to these systems can result in incontinence. Therefore, it must first be clarified whether the cause of the disorder is neurogenic or not. “In the case of an underlying neurological disease such as Alzheimer’s, Parkinson’s, multiple sclerosis or a stroke with the clinic of bladder dysfunction, the neuro-urologist or neuro-urologist should be consulted,” says Dr. Kozomara.

Often, the primary care physician himself or herself can help: In the case of urge incontinence without a clear cause, medications such as antimuscarinics or sympathomimetics can relieve the suffering in many cases. In the case of inflammation, high blood pressure or stones in the urethra, the problem can also be solved with medication, such as antibiotics or alpha-blockers. In the case of an enlarged prostate, minor surgery may help. If weakened pelvic floor muscles are the cause of stress incontinence, targeted pelvic floor training can bring improvement.

Urodynamics measures the pressure in the bladder

If the cause of the incontinence remains unclear or initial therapy attempts are unsuccessful, an urodynamic examination may be necessary. This allows the function of the bladder and sphincter to be checked by measuring the pressure as the bladder fills and empties. The higher the pressure, the greater the risk of damage to the upper urinary tract. If there is an underlying neurogenic condition, urodynamic testing can be combined with x-rays. The “video urodynamics” not only shows the pressure, but also the shape of the bladder and, if existing, a urinary backflow into the kidneys.

Depending on the results of the examination, different therapies are offered: Conservative options such as indwelling catheters, self-catheterization or pelvic floor rehabilitation, medication, Botox injections, electrical stimulation or surgery as a last resort. “If urodynamics show an increased risk of damage to the upper urinary tract, effective therapy should be sought,” Dr. Kozomara says. In most cases, however, he advises a slow, step-by-step approach: “First get to know the person and then consider together what might help her or him.”

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