Bladder weakness - symptoms, causes and treatment options

It is estimated that around 30 percent of all women after the menopause and around 10 percent of men suffer from urinary incontinence, and the number of unreported cases is likely to be even higher. And yet the topic is still a taboo, most people are uncomfortable talking about it. However, openly dealing with bladder weakness (incontinence) also means the possibility of getting help, curing the bladder weakness or at least reducing the symptoms and thus significantly improving quality of life. There are many different ways and methods of successfully treating bladder weakness.

Table of contents

• What is bladder weakness?
• Causes of bladder weakness
• Treatment of bladder weakness
• Prevention of bladder weakness

What is bladder weakness?

Bladder weakness, also known as urinary incontinence, is when urine can no longer be stored in the bladder and this results in involuntary and uncontrolled loss of urine, from a few drops to larger quantities. The term “bladder weakness” is somewhat misleading, as the bladder itself is not responsible for incontinence. In medicine, the terms urinary incontinence or urinary incontinence are used.

Bladder weakness should not be confused with an irritable bladder, in which those affected constantly feel the need to go to the toilet even with the smallest amounts of urine. However, this condition is sometimes accompanied by urge incontinence.

There are various forms of urinary incontinence, some of which can have different causes:

Stress incontinence

If urine leaks involuntarily when sneezing, coughing, laughing, doing sport, lifting heavy objects or even during sex, those affected suffer from so-called stress incontinence. The loss of urine is caused by the high pressure on the bladder. In the past, this type of incontinence was also known as “stress incontinence”. The term “stress” did not refer to psychological but physical strain. Stress incontinence mainly affects women who suffer from a weakened pelvic floor.

Urge incontinence

Patients with this type of incontinence feel a sudden urge to urinate, even when the bladder is barely full. In most cases, they cannot hold the urine long enough to make it to the nearest toilet. Urge incontinence is often also a symptom of an irritable bladder (overactive bladder), which has other causes than bladder weakness.

Mixed incontinence

Patients with mixed incontinence suffer from both stress and urge incontinence.

Other forms of incontinence

There are also other forms of incontinence that occur much less frequently than bladder weakness:

• Incontinence with urinary retention (overflow incontinence): There is no complete emptying of the bladder, urine flows uncontrollably almost constantly. Patients with this bladder dysfunction usually suffer from an underlying neurological disease such as dementia, Parkinson's disease or multiple sclerosis.
• Reflex incontinence (neurogenic urinary incontinence): When the bladder is full, there is no urge to urinate and the bladder empties itself. Reflex incontinence is caused by impaired impulse transmission between the brain or spinal cord and the bladder.
• Extraurethral incontinence: Urine is not lost via the urethra, but via the skin, anus or vagina. This is caused by fistulas between the bladder and the respective organ.

Causes of urinary incontinence

Bladder weakness can have various causes, the most common being a weakened pelvic floor and/or hormonal changes after the menopause. This is why women are affected by bladder weakness much more often than men.

There are also various reasons for this: For one thing, the pelvic floor in a woman is naturally somewhat smaller than in men. On the other hand, it may have to endure more: Pregnancy and childbirth put a strain on the pelvic floor so that it can no longer provide proper support for the pelvic organs. For example, around 20 percent of mothers have problems with urinary leakage after a vaginal birth. However, even without childbirth, patients with weak connective tissue are often affected by urinary incontinence due to a weakening of the pelvic floor.

In men, diseases of the prostate (benign tumors, cancer) or abdominal surgery are the main causes of urinary incontinence.

Obesity and chronic coughing (e.g. in COPD) as well as chronic constipation, which leads to constant straining, can lead to excessive strain on the pelvic floor in both men and women, which can result in bladder weakness. In addition, bladder or ureteral stones, other diseases or infections of the urinary tract, certain medications, abdominal surgery or neurological diseases can lead to urinary incontinence.

Treatment of bladder weakness

The good news first: bladder weakness can be treated in almost all cases. We therefore advise all those affected to contact their family doctor or gynecologist with confidence at the first signs of possible incontinence in order to find the cause of the condition and treat it successfully. There is no one-size-fits-all therapy, which means that an individual treatment must - and can - be found for each woman.

First and foremost, attempts are made to treat bladder weakness with conservative means. These include:

• Pelvic floor training: accompanied by a physiotherapist, exercises are carried out to strengthen the pelvic floor and thus eliminate the most common cause of stress incontinence.
• Bladder training: Bladder training is helpful for urge incontinence. Toilet visits are carried out according to a specific plan and the urge to urinate is consciously suppressed until the bladder can be emptied according to plan. This helps the organ to “learn” its function again.
• Weight reduction in the case of incontinence caused by obesity..
• Changes in everyday life: for example, those affected should no longer consume strongly diuretic drinks (coffee, black tea, but also fruit juices and carbonated drinks), have a chronic cough treated or do less heavy lifting. If you are sporty, you should do yoga, swim or cycle instead of jogging or playing tennis, for example, as the vibrations caused by these sports further weaken the pelvic floor.
• If the bladder weakness is caused by a change in the hormonal balance, oestrogen-containing medication is often a successful treatment method.

If these measures are not sufficient, there are other treatment options:

• Incontinence tampons or vaginal pessaries can be used to increase the pressure on the urethra, which is then supported. These aids are made of silicone, natural rubber or plastic and can be used by yourself or by your gynecologist.
• Medication with the active ingredient duloxetine helps with stress incontinence. However, they have the disadvantage that they sometimes have severe side effects and must be taken permanently. Anticholinergics are an option for urge incontinence, but these also have severe side effects.

Patients whose quality of life is severely affected by bladder weakness and for whom the above-mentioned treatment methods do not work are usually recommended surgery.

The standard operation is the application of a “tension-free vaginal tape”: a plastic band that is placed around the urethra and then grows into place. This supports the bladder closure and keeps urine leakage permanently in check.

If the cause of the bladder weakness is a drop in the pelvic floor, a plastic mesh can be implanted to provide additional support for the pelvic organs.

There are other invasive methods available, some of which are still very modern and therefore not often used, but which are increasingly being recommended:

• Gel implants to cushion and thus support the urethra
• Laser therapy to stimulate collagen formation so that the urethra is better supported
• Botox injections for urge incontinence to strengthen the bladder muscle
• Insertion of an artificial urinary bladder sphincter

Prevention of bladder weakness

As many women suffer from urinary incontinence in the course of their lives, it makes sense to prevent it, which is certainly possible:

• Drinking enough is always the be-all and end-all - only then will the urinary tract be well flushed and not be impaired in its function.
• Gentle sports such as yoga or Pilates strengthen the pelvic floor, but regular walks are also a good way of keeping the abdomen fit.
• Pelvic floor training in general should be considered by every woman from the age of 25, as the muscles start to break down from around this age.
• Postnatal exercises help the pelvic floor to return to its former shape and strength.