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Pelvic floor therapy

Urinary and faecal incontinence - (not) a taboo topic!

Incontinence (Lat. Incontinentia) is the inability to hold something back. With regard to excretion (urine, faeces) it means the inability to store the bladder contents and/or bowel contents safely and control micturition/defecation at will (self-determined). Involuntary loss of urine or stool is the consequence.
Urinary and faecal incontinence are more common than you would imagine. Only guesses have been made about the number of individuals affected. According to current estimates, 50 - 200 million individuals are affected by incontinence, of whom about 5 to 8 million are in Germany. Based on the sales figures for manufacturers of incontinence aids, the estimated number of unreported cases is likely to be about 10 million in Germany. According to various projections, almost 30 per cent of German citizens will be affected by incontinence by the year 2050.

More than 2 million individuals living in Germany with incontinence requiring treatment or care are over 60 years of age, and among those over the age of 80 the figure is nearly 30%. It is always the case that far more women are affected by incontinence than men.

The most frequent types of incontinence are:

stress incontinence
In stress incontinence, physical stress or tenseness makes it impossible for the person to hold their urine. Typical situations are coughing, sneezing, laughing or lifting heavy loads. It is the most frequent type of urinary incontinence in women. Up to 40 per cent of women with urinary incontinence are affected by this type. The reason for this is the anatomy of the female pelvis. Owing to pregnancy, vaginal childbirth, gynaecological surgery, visceroptosis or visceral prolapse, aging processes (especially due to hormonal changes in the menopause), but also excess weight, lack of exercise and heavy physical work, damage can be caused to the pelvic floor and bladder outlet. Either the urethra is no longer firmly attached in the retention system of muscular and connective tissue or the ability to occlude at all is impaired.
The average age of women with stress incontinence is 47.3 years and is thus much lower than that of women with urinary incontinence (51 years). Consequently, the problem also occurs at a younger age.

In men, stress incontinence can be caused by damage to the external vesical sphincter in the course of lower abdominal surgery, e.g. for cancer disease or prostate enlargement. Heavy physical stress tends to be a rare cause.

Urge incontinence (also referred to as overactive bladder)
Urge incontinence is a disturbance in the storage ability of the bladder, in which the bladder muscle involuntarily contracts even though the amount of bladder contents is still low. This causes an insuppressible urge to urinate and an involuntary urine loss occurs.

Overactive bladder refers to a complex of symptoms consisting of frequent micturition with small quantities of urine, in some cases nighttime micturition and the occurrence of an insuppressible urge to urinate, whereby urine loss can occur but does not necessarily occur. For many patients, just the severe, insuppressible episodes of an urge to urinate constitute a major limitation in their daily activities.

Whilst in men urge incontinence is the prevailing type of urinary incontinence at any age in life, women under the age of 50 tend to suffer more rarely from plain urge incontinence than from stress incontinence.

Mixed incontinence
Mixed incontinence is a combination of urge incontinence and stress incontinence. The symptoms of the two types of incontinence may be more or less severe. With mixed incontinence one of the two types of incontinence is often more prevalent. In over 30 per cent of cases the dominant type is stress incontinence.
The incidence of mixed incontinence particularly rises as age increases. Especially women as of the age of 50 are affected by this type of incontinence. After stress incontinence it is the second most common type of incontinence in women.

Faecal incontinence
Faecal incontinence is the inability to voluntarily hold back bowel contents, i.e. liquid or solid stool, flatus and intestinal mucus. An uncontrolled discharge of small or large quantities of stool may occur, or the urge to defecate is perceived too late or not at all so the person either reaches the toilet too late or does not go to the toilet at all. There are three different degrees of severity, which range from faecal staining under stress to total loss of control over defecation.