Urinary incontinence therapies (Urology)

Overview

Often, the family doctor 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 remedied 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 improvement.

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

Urodynamics for root cause analysis

If the cause of the incontinence remains unclear or initial therapy attempts are unsuccessful, a urodynamic examination may be required. This can be used to check the function of the bladder and sphincter 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 indwelling catheters, self-catheterization or pelvic floor rehabilitation, medication, Botox injections, electrical stimulation 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 in a first step under local anesthesia. If the bladder dysfunction improves during a test phase of at least two weeks, the neuromodulator is implanted in the hip area in a second step. The battery lasts from three to eight years. If the test phase is not successful, the electrodes are removed again. Sacral neuromodulation is a compulsory benefit of the health insurance. SNM has a success rate of up to 80%.
• Percutaneous tibial nerve stimulation (PTNS): This electrical therapy uses an acupuncture needle and electrode to apply electricity to the area of the left or right foot once a week for 30 minutes. The therapy takes place during a total of twelve weeks and is performed on an outpatient basis in the polyclinic. Subsequently, it must be repeated every two to four weeks, depending on the success. 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 performed.

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

Operations

Depending on the form of urinary incontinence, patients may be offered tape surgery, artificial sphincter (AMS-800® prosthesis) or a combination of both surgeries (ATOMS® prosthesis).

Ligament surgery or sling surgery for the treatment of incontinence is a surgical procedure. This usually involves placing a band of synthetic material or the body’s own tissue under the urethra or bladder to support and stabilize the urethra. The tape acts as a kind of “sling” that lifts the urethra and keeps it closed to prevent uncontrolled urine leakage.

Band surgery is often used for women with stress incontinence, in which there is uncontrolled leakage of urine during physical activities such as coughing, sneezing, laughing, or exercising. The procedure is usually minimally invasive, often using laparoscopic or robotic-assisted techniques, and typically 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 bladder outlet and prevent uncontrolled urine leakage. The artificial sphincter usually consists of a cuff or band placed around the urethra or bladder and connected to a control unit. The control unit can be controlled externally, for example by the patient himself or by a physician, 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 urine leakage.

Pelvic floor physiotherapy

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

Here women can find tips for a strong pelvic floor: These tips and exercises strengthen the pelvic floor