Continence

An involuntary leakage of urine that occurs when sneezing, coughing, lifting heavy objects or during physical exertion, but which is not accompanied by the urge to urinate, indicates a weakness in the bladder closure mechanism. Under exertion, the bladder pressure exceeds the closure pressure of the urethral sphincter, resulting in an involuntary leakage of urine.

Functional disorders

This malfunction of the bladder can lead to incontinence if a toilet cannot be reached within a couple of minutes of this moment. Since the leakage of urine occurred with an urge to urinate, this form of involuntary leakage is called urge incontinence. An overactive bladder is generally the cause if the urge incontinence coincides with frequent urination during the day and at night.

Stress incontinence

The bladder is intended to store urine without leakage over several hours. This is expelled by a contracting of the bladder wall, normally after the brain has sent a conscious start signal. If, however, the bladder acts independently of the brain's control, it automatically contracts when a certain capacity level is reached and attempts to expel the urine.

Urge incontinence

Common continence disorders include

Frequent urination during the day	Frequent urination at night
Sudden, frequent and intensified urge to urinate	Lack of sense of bladder filling and weak urge to urinate
Involuntary leakage of urine or urinary incontinence	Hampered and incomplete emptying of the bladder
Incomplete emptying of the bladder	Weak, interrupted urinary stream
Problems starting or initiating urination	Painful bladder filling and emptying

This is attributable to a weak urethral sphincter. The risk of stress incontinence increases with age and is far greater among women than men. In women, a weakness of the bladder sphincter and stress incontinence can be due to a lowering of the bladder and uterus, or a paralysis of the urethral sphincter. In men, a prostate operation is the most frequent cause of stress incontinence.

Mixed incontinence

If an involuntary leakage of urine occurs with both an urge to urinate and during physical exertion, this is known as mixed incontinence. Women aged 50 and over in particular are susceptible by this condition. One cause of mixed incontinence is overactivity of the bladder triggered by physical exertion.

Affected women typically describe a strong urge to urinate arising immediately after coughing or sneezing, when doing sport or even after laughing, which is hard to suppress and requires an immediate visit to the toilet. It is already too late in many cases, and a not inconsiderable quantity of urine is expelled.

Other trigger and causal factors

A wide variety of medical conditions and events can lead to problems of incontinence. These include stroke, Parkinson's disease, multiple sclerosis, dementia, neurological disease, traumatic brain injury, interstitial cystitis, prostate surgery, pelvic surgery and diabetes.

Urinary incontinence has a huge impact on a person’s self-worth and quality of life. Any involuntary leakage of urine is extremely unpleasant and awkward for the person concerned. Although it is far more widespread than assumed, incontinence is largely a taboo subject.

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