Ärzte Zeitung online, 21.11.2008

Becoming Continent, Staying Continent

Only one in ten patients with incontinence goes to a doctor about it. In most cases behavioural techniques and "toilet training" are sufficient to deal with the problem.

Becoming Continent, Staying Continent

Incontinence is more common in women. It can be prevented by pelvic floor muscle training. Photo: Lerich©www.fotolia.de

By Sabine Stürmer

When a person loses control over the bladder or the bowels doctors speak of incontinence. It occurs more often in older people and usually has several causes, including pelvic muscle weakness or muscle damage. In Germany an estimated four to eight million adults are affected. But only one in ten goes to a doctor about it. Most of them are too embarrassed to talk about their problems. Yet simple behavioural techniques and training are often enough to deal with the condition. At the Medica in Düsseldorf, the world's largest medical trade fair with associated congress, experts will be talking about the different disorders and the available treatment options.

Incontinence is two to three times more common in women than men. This is because pregnancies often lead to weak pelvic floor muscles which can contribute to the development of urinary or faecal incontinence as the women get older.

There are two main types of urinary incontinence: urge incontinence and stress incontinence. Urge incontinence is also known as irritable bladder. With this type of incontinence patients have to go to the toilet more frequently. In stress incontinence there is involuntary leakage of urine during physical activities that increase abdominal pressure, for example coughing, sneezing, laughing or climbing stairs. Both forms of urinary incontinence can have a considerable impact on the patient's daily life.

Loss of bowel control is even more debilitating. Their fear of an accident and of others noticing is so great that these patients often withdraw completely from society.

Adult toilet training: emptying the bladder consciously

Patients should overcome their inhibitions and talk to their doctor, says Professor Thomas Frieling from the Helios Hospital in Krefeld. In most cases simple measures are enough to solve the problem, he explains. The doctor will begin with a detailed medical history and physical examination. Patients are asked to keep a bladder and bowel diary to document when they accidentally leak urine or faeces. This enables the doctor to identify possible connections between incontinence and triggering situations or activities. A diet diary is also important in order to identify any intolerances which might play a role in faecal incontinence. If necessary, the specialist can perform various examinations to check how well the bladder and rectum are emptied and assess the functioning of the sphincter muscles.

Simple behavioural techniques and "toilet training" teach patients to consciously empty their rectum or bladder. After this they have enough time in which they can pursue their social activities without having to fear incontinence. "Once the bladder or rectum has been completely emptied, no incontinence can occur in the next two to five hours," Frieling sums up the simple principle.

Medication is also an option

In some patients these measures can be supported by medication. For example, if rectal prolapse prevents complete emptying of the bowels. In rectal prolapse a protrusion of the lining or wall of the rectum forms an obstruction. A suppository which produces carbon dioxide in the rectum inflates the rectum a little, pushing back the prolapsed tissue and allowing passage of the faeces. In patients with overactive bladder muscle-relaxing drugs can help, while in the case of an inactive bladder drugs which increase muscle tension are called for. But exercises to strengthen the pelvic floor muscles are also important for the management of bladder weakness.

Operations and nerve stimulation for difficult cases

There are also surgical procedures for incontinence in which the pelvic floor muscles are tightened and the pelvic floor raised. Other special techniques are used to improve the functioning of the sphincter muscle. Gracilis muscle transplantation is a major surgical procedure in which the surgeons support or replace the sphincter by inserting a piece of muscle from the thigh. A relatively new procedure known as sacral nerve stimulation is simpler. This involves implantation of a kind of pacemaker which stimulates the nerves of the pelvic floor and the sphincter muscle. "Experts believe that sacral nerve stimulation will be the procedure of the future for urinary and faecal incontinence," says Frieling. The expert recommends that in difficult cases patients should go to a certified incontinence centre.


Becoming Continent ...

In German

Freitag 21.11.08
14.30 bis 17.30 Uhr
CCD-Süd, Raum 7a
Leitung: Professor Günter H. Willital, Münster, Professor Thomas Frieling, Krefeld

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