When the bladder no longer holds tight

Last updated on April 10, 2024 First published on August 14, 2023

Involuntary urination restricts many women in their activities. In summer, they suffer even more than usual from not having their bladder under control. Unnecessarily so, because there are also therapies for severe cases of incontinence. Cornelia Betschart is a senior physician at the Department of Gynecology and a specialist in urogynecology at the University Hospital Zurich and knows the treatment options.

Ms. Betschart, the topic of incontinence is being dealt with more openly in advertising, special hygiene products are advertised and offered in supermarkets. Has the shame on the subject disappeared?

First and foremost, we can see that the problem is widespread. These products are of course helpful for those affected. However, they should not lead to the impression that there are no effective treatment options. And: the shame is still there. Those affected often try to cope on their own for far too long and only talk to their family doctor or gynecologist when the level of suffering has become too high. However, the right treatment can not only alleviate the symptoms, but in some cases also restore complete control over bladder emptying.

When exactly is incontinence diagnosed?

In the case of incontinence, those affected can no longer control the emptying of their bladder. There is an involuntary loss of urine. The extent of this can vary greatly, but it severely restricts the quality of life of all those affected. Depending on the cause, incontinence is also associated with other symptoms.

Why are women affected in the vast majority of cases?

The female anatomy makes women more susceptible to bladder weakness. Many people are aware that a weakening of the pelvic floor due to pregnancy and childbirth can be the cause of incontinence. But other changes around the bladder, in the bladder itself, heavy lifting or simply old age can also lead to incontinence.

So the first step is to clarify the exact cause?

For targeted and effective therapy, it is essential to determine whether the cause is organ prolapse, pelvic floor weakness or problems with the bladder itself, for example with the sphincter. We also distinguish between different forms of incontinence, depending on whether urine leakage occurs during exertion, e.g. when coughing or during sport, or whether there is a constant urge to urinate. The first point of contact for clarification is your family doctor or gynecologist.

What treatment options are available?

The spectrum ranges from toilet training with a “bladder diary” and exercises to strengthen the pelvic floor and individual pelvic floor physiotherapy to various interventions. Depending on the cause, medication or hormone preparations can also help. However, some forms of urinary incontinence can only be corrected surgically.

Can you explain the surgical procedures performed at the USZ?

We most frequently restore the tightness of the urethra. This can be achieved with a band that is inserted around the urethra. To support the urethra, it can also be narrowed with filling agents known as gels. Extra-urethral incontinence is one of the rarer forms of incontinence. The urine passes through the wrong channels, via fistulas. These corrections should definitely be carried out by doctors at specialized pelvic floor centers. In the case of organ prolapse, it is possible to surgically lift these again and thus reduce the pressure on the urethral obstruction, which leads to loss of urine. An overactive bladder can be calmed with a so-called bladder pacemaker. A bladder that no longer empties itself can also be reactivated by changing the settings of the pacemaker. Whenever possible, all operations should be minimally invasive and performed without an abdominal incision. Some procedures can also be performed on an outpatient basis or only require local anesthesia.

At the USZ, patients with incontinence problems are treated by a specialized team. How is it put together?

Assessments and treatments are carried out in our urogynaecology specialist consultation at the Women’s Clinic by experienced urogynaecology specialists who also carry out research themselves and are familiar with the latest therapies. Behind this is an interprofessional team of specialized urotherapists and doctors for the various therapies. We also advise patients who would like to obtain a second opinion before deciding on treatment.

What can be done to prevent incontinence?

A strong pelvic floor can not only prevent incontinence, but also helps to avoid back pain and tension in the neck and shoulder girdle. Regular training therefore not only leads to the controlled release of urine, diapers or bowel movements and pays off in various ways. Being overweight can further weaken the pelvic floor and worsen existing incontinence. To reduce the strain on the pelvic floor, you should therefore try to lose excess kilos.

Responsible specialist

Cornelia Betschart Meier, Prof. Dr. med.

Senior Attending Physician, Department of Gynecology

Tel. +41 44 255 53 26
Specialties: Further training specialist in urogynecology, consultation hours and operations, Laparoscopic gynecology, Vulva consultation

Responsible Department