Bladder problems

One in five women complain of bladder weakness at the gynaecologist`s office and at least one in six adults of both sexes suffers from an overactive bladder, making it generally one of the most common disorders across the board. Problems with the bladder and frequent urination severely restrict the personal activities and quality of life of those affected, even to the point of social isolation. But there is almost always a way out.

Frequent urge to urinate / irritable bladder syndrome / incontinence

A frequent urge to urinate can have many different causes. As an affected person, you have no doubt often been told this if you have been trying for some considerable time to get a handle on these unpleasant symptoms, such as a frequent urge to urinate or incontinence by seeking out medical professionals. An increased urge to urinate robs you of sleep at night and restricts your freedom and flexibility during the day. Don't just give up. With the correct diagnosis and treatment, these complaints can be completely alleviated or at the very least, considerably improved.

GNS Therapy: Genital Nerve Stimulation

By means of electro-stimulation to the nerves, it is possible to restore control of the bladder function - without negatively impacting the bladder emptying function.
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Common types of incontinence

There are different types and forms of incontinence - ranging from the frequent urge to urinate - the "weak bladder" - to uncontrolled urinary excretion in virtually every life circumstance. Stress incontinence is the most common type of urinary incontinence. When laughing, coughing, sniffing, doing sports and lifting, urine spontaneously escapes from the bladder. The activity results in increased abdominal pressure, which in turn triggers increased pressure on the urinary bladder, usually due to insufficient counterpressure of the sphincter muscle.

Another common type is urge incontinence, which is characterized by a strong urge to urinate. Urge incontinence leads to repeated, involuntary tightening of the bladder muscles. Such disorders increasingly occur in connection with an overactive bladder - the so-called irritable bladder - interstitial cystitis, prostatitis, prostadynia or benign prostatic hyperplasia.

Stress incontinence
Stress incontinence is the most common form of urinary incontinence. In this type of bladder weakness, urine leakage occurs during light exertion, such as climbing stairs, sneezing, laughing, coughing or during physical activity. If it is severe, the urine can even leak when walking, standing up or without any exertion. The reason for such incontinence is a weakness of the sphincter and pelvic floor muscles, which very often correlates with a lowering of the uterus or vagina. In this case, if the pressure on the bladder suddenly increases and the pelvic floor is loaded, the urine can no longer be retained.  
Urge incontinence / overactive bladder / irritable bladder

Urge incontinence manifests itself in a sudden, multiple and intense urge to urinate. This form of incontinence is the second most frequently diagnosed. Many women only suffer from urge incontinence if they are particularly under stress. The most common form of urge incontinence is the overactive bladder, also known as the "irritable bladder". In most cases, no cause can be found for this problem. In older people, however, it often develops as a result of diseases of the nervous system, such as Parkinson's disease, stroke, diabetes and others.

The irritable bladder is defined by a number of symptoms: an urge to urinate, with or without urge incontinence, mostly frequent and also at night. The main symptom is a frequent urge to urinate - the feeling of constantly having to go to the toilet, which the patient cannot control. Frequent urination" usually means more than eight toilet visits per day. Some patients also unintentionally lose urine (urge incontinence).

Overflow incontinence / Overflow bladder / Mixed urinary incontinence

Overflow incontinence, also called overflow bladder, is accompanied by an overstretching of the urinary bladder. Those affected do not feel the urge to urinate, which warns them in good time. This inevitably leads to an overstretching of the bladder and usually to a backflow of urine into the kidneys, which carries with it the risk of kidney damage.

Urinary incontinence can also be caused by years of infrequent visits to the toilet or too long intervals between visits. In this case the overflow incontinence is so to speak trained.

Mixed urinary incontinence is a combination of stress incontinence and urge incontinence.

Treatment for incontinence

The treatment depends on the type of urinary incontinence, the degree of severity and the underlying causes.
Treatment for stress incontinence
treatment-stress-incontinence

Pessaries, oestrogens

Vaginal inserts - so-called pessaries - to support the urethra can only temporarily eliminate incontinence. Vaginal oestrogens help the mucous membranes of the bladder and urethra, to remain pliable.

Surgical Methods

There are a number of surgical methods in which the pelvic floor is tightened and the urethra is raised again. Abdominal incision surgery has been completely replaced by vaginal or minimally invasive procedures. Loop operations are very straightforward interventions with excellent results. The basic prerequisites for these operations are:

  • It is strictly a case of stress incontinence

  • Loop operations must be strictly avoided in the case of irritable bladder (urge incontinence), overflow bladder and mixed form incontinence.

  • The complete emptying of the bladder (without abdominal pressing) has been confirmed by ultrasound. Otherwise, it would lead to an increasingly incomplete emptying of the bladder with the danger of urinary retention or a more and more overstretched bladder with subsequent slackening of the bladder.

 

Genital Nerve Stimulation - GNS Therapy

If loop surgery is not possible or successful, or a combination of bladder and bowel incontinence is present, genital nerve stimulation (GNS therapy) is the treatment of choice.

Through a small incision under the pubic hair, a microstimulator system a few millimetres in size is placed behind the pubic bone on the genital nerve by laparoscopy. A remote control stimulates the genital nerve, which reduces bladder overactivity and improves control of urinary incontinence. The operation is performed on an outpatient basis under local anesthesia and takes less than 30 minutes. In addition to the positive effect on bladder function, stimulation of the genital nerve also improves sexual satisfaction and penile erection. The procedure is reversible and can be interrupted at any time by switching off or removing the device.

Treatment for irritable bladder
treatment-irritable-bladder

Behavioural therapy

In the case of an overactive bladder or irritable bladder, behavioural therapy is the first choice. This can include a change in dietary habits to see if less caffeine, alcohol and spicy foods reduce symptoms. A daily "bladder diary" is usually kept for this purpose in order to be able to check the frequency of bathroom visits. Changes in behaviour can include going to the toilet at certain times during the day and doing a Quick Flick Kegel exercise to relax the bladder muscle. Most patients do not get rid of their symptoms completely by changing their lifestyle habits. However, many have fewer symptoms due to this treatment.

Treatment with medication

Drug treatments - so-called anti-muscarins - do reduce the symptoms, but are only a second choice treatment option due to the fact that they often have troubling side effects such as a dry mouth, constipation, dry or itchy eyes, blurred vision, dyspepsia, urinary infections, urinary problems and cognitive dysfunction and may only be used in patients over 75 years with extreme caution. These side effects are often so difficult to tolerate, which leads to them being discontinued in 60% of all cases.

Botulinum Toxin A

Injections with botulinum toxin A in the bladder may be suggested as third treatment choice option.They come into question if the above therapies were unsuccessful or had too many side effects. Patients must be given comprehensive advice beforehand. Due to the changes in the  bladder caused by the botulinum, the patient must be able to come to the practice for frequent follow-up checks and, if necessary, be able to undergo and perform self-catheterization. Patients must be given comprehensive advice beforehand. Since botulinum therapy requires a bladderoscopy (often under general anaesthesia) and this normally has to be repeated every 6 to 9 months for the rest of the patient's life, which can be difficult for patients to accept.

Genital Nerve Stimulation - GNS Therapy

The electrical stimulation of the pelvic nerves provides a treatment option for an irritable bladder, in particular if it occurs in combination with urinary incontinence. Genital nerve stimulation can alleviate or even completely eliminate the symptoms. Electrical stimulation of the urethra relaxes the bladder muscles. GNS therapy treats the irritable bladder and at the same time urinary incontinence, if present.

Through a small incision under the pubic hair, a microstimulator system a few millimetres in size is placed behind the pubic bone on the genital nerve by laparoscopy. A remote control stimulates the genital nerve, reducing bladder overactivity and improving urinary incontinence control. The operation is performed on an outpatient basis under local anesthesia and lasts less than 30 minutes. In addition to the positive effect on bladder function, stimulation of the genital nerve also improves sexual satisfaction and penile erection. The procedure is reversible and can be interrupted at any time by switching off or removing the device.

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Neuropelveology:
Discovering the pelvic nerves

Neuropelveology is a medical discipline developed by Prof. Possover. It is based on the discovery of the pelvic nerves and includes the diagnosis of the diseases of these nerves by means of gynaecological examination methods and their treatment by means of laparoscopy.

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