Everyone has that one friend who still “has to go to the toilet quickly”. At a young age this is usually not a problem as long as a toilet is in sight. The older you get, after childbirth or after bladder infections, the "constant-running-to-the-toilet" can become a burden. Although many women suffer from bladder weakness, the subject is often still taboo.
Important note: This text cannot replace a doctor's visit or personal medical advice. Please always contact your doctor if you have any questions, problems or anything is unclear. Our medical texts are written by specialists (e.g. medical journalists, doctors, medical students shortly before the end of their studies, doctoral students in medical fields); however, we cannot guarantee the correctness or liability for the content.
While the "weak bladder" is not a clearly defined term, there is a term used in medicine as "incontinence". This is an involuntary loss of urine. This can be a "minor mishap", e.g. when coughing or doing sports. However, incontinence can also have more drastic causes, such as constantly feeling the urge to go to the toilet. The proportion of people in Germany who suffer from uncontrolled loss of urine increases with the age. But even in the age range of 18 to 40 year olds, 6% are already affected. Between the ages of 41 and 60, the proportion rises to around 9%, and around 23% of those over the age of 60 suffer from incontinence. Women are affected significantly more often than men (Beutel et al. 2005).
According to a survey among people with incontinence, many sufferers feel high levels of suffering (Beutel et al. 2005). It is mainly young people who feel restricted in their everyday life. The burden even goes so far that in all age groups the quality of life is worse for those affected than for those without bladder weakness. Many people with incontinence also complained about other symptoms such as pain in the lower abdomen, fatigue and restricted sexual life (Beutel et al. 2005).
Another study also found that many doctors underestimate the psychological stress on patients (Rodríguez et al. 2003). This can mean that therapy steps are only started later.
The involuntary leakage of urine is a symptom behind various underlying diseases. It is important to know what type of incontinence a patient has in order to enable an optimal therapy. But there are also tips and strategies that can make life easier for all patients.
In stress incontinence, an unwanted leakage of urine occurs when the pressure on the bladder is increased. Light incontinence often involves urine in droplets when sneezing, laughing or tensing the abdominal wall. This increases the pressure in the abdomen and thus also on the bladder. The higher the incontinence, the lower the exposure must be to lead to urine leakage. Under certain circumstances, urine leakage can occur while lying down (Gätje et al. 2015). The reason for this is an inadequate closing mechanism of the urethra (Beutel et al. 2005).
The lack of occlusion of the urethra can be triggered by various factors. These include, for example, injuries and overstretching of the pelvic floor, some women simply have weak connective tissue. A common reason for overstretching the pelvic floor is childbirth. Especially multiple births or a rupture of the perineum during childbirth can lead to incontinence (Gätje et al. 2015).
But increased pressure from the abdominal cavity in the case of severe obesity or, rarely, tumors, can lead to overload. Correspondingly, an improvement in healing the incontinence could often already be determined through weight loss.
In old age, the weakness of the supporting apparatus and the pelvic floor can lead to a sagging of the pelvic organs in women. Often the vagina and uterus are affected. The bladder and rectum can be dragged along with them. In the case of a decrease, doctors speak of a descensus, in the case of a incident of a prolapse. In women around the age of 80, up to 10% are affected. The symptoms correspond to stress incontinence. In addition, there may be pain and constipation. The gynecologist can detect the sagging or the incident during the gynecological examination by the women tensing their stomach (Gätje et al. 2015).
In addition to stress incontinence, another common form is urge incontinence. Affected people feel a lot of pressure to go to the toilet. They have the feeling of "peeing their pants". Failure to get to the toilet quickly enough (but sometimes this is only seconds) will result in an incapacity to hold urine and a loss of urine. This is caused by increased activity of the bladder muscle. The symptoms can also persist at night (Beutel et al. 2005).
Not so rarely, there is a mixed form between stress and urge incontinence. Patients then suffer from a strong and persistent urge to urinate and have a loss of urine, e.g. when coughing (Beutel et al. 2005).
In addition to the frequent types of urine leakage mentioned, special forms can also occur in the context of illnesses. In older men, when the prostate becomes enlarged, urine may build up in the bladder. If the bladder becomes too full, there may be an involuntary loss of urine. Diseases of the nerves or the brain can also lead to incontinence. Special therapies are necessary here.
Chronic cystitis is a special clinical picture. Often it is women who suffer from frequent urination and painful urination. The symptoms are caused by constant irritation of the bladder, e.g. by bacteria. But there can also be other causes. For many women, the constant need to urinate creates a great fear that there will be a sudden loss of urine, which can lead to major restrictions in everyday life.
The first step towards diagnosis is to find the right contact person. Gynecologists and urologists specialize in issues of bladder continence. You will already receive a lot of clues about the correct diagnosis from the anamnesis. Furthermore, a diary about the urine loss and going to the toilet can be useful. It is important to check with the ultrasound whether there is still urine in the bladder after urination. In the so-called pad test, the weight of a hygienic pad is used to determine how much urine escapes unintentionally. If there are indications of a bladder infection, the urine can also be examined. The doctor should of course look at the genitals to identify any abnormalities. In some cases, further diagnostics are necessary, e.g. a pressure measurement in the bladder and an analysis of the urination dynamics (Reisenauer et al. 2013).
Although incontinence can have very different causes, there are general recommendations that can help patients. Adequate hydration prevents cystitis. Pelvic floor training can even be preventative. The right hygiene products to cope with everyday life safely and the right personal hygiene can reduce the level of suffering.
In order to become more aware of one's own body, a drinking and urination diary is kept. This means that you make a note of when you have to urinate, when you have been to the toilet or when you have accidentally leaked urine. Urination after the clock can also train the bladder and relieve symptoms (Kretschmer and Bauer 2018).
Training the muscles in the pelvis can help, especially with the frequent form of stress incontinence, but also with urge incontinence. The pelvic floor muscles support the bladder's closing apparatus and can be trained through exercises. These exercises should best be learned under supervision in individual or group training. Pregnant women are advised to exercise their pelvic floor during pregnancy. But older patients shouldn't shy away from training either. There are now various methods of adapting to individual needs and abilities (Reisenauer et al. 2013).
Products that can safely collect urine help to take on everyday life in a relaxed manner. It is important to use products with a high absorption capacity. There are numerous products specially designed for urine loss, which are particularly recommended for large amounts of urine. They absorb the fluid better than, for example, period products and are therefore gentle on the skin (Gray et al. 2002). There are now a large number of products on the market, from special sanitary towels and classic inserts to concealing panties that have nothing to do with adult diapers. If there is a high volume of urine, material costs can also be covered by the health insurance company.
Our ALMO products - especially those with strong absorption capacity - are suitable for incontinence. For postpartum women with mild urinary incontinence and heavy physical exertion, sanitary towels are often sufficient. If you use this on a daily basis, this can of course be expensive. Washable sanitary towels made of cotton are a sustainable and economical alternative. At the same time, they do not contain any chemicals that could additionally irritate the skin.
Period panties can be a good alternative, especially for young women who suffer from bladder weakness. They are discreet, do not bulge, and have a good absorption capacity. You don't feel like you're wearing a diaper and still have the feeling of security.
Especially with providers of sustainable period products, some products can be converted well for bladder weakness. So-called wetbags are coated cotton bags in which wet pads, diapers (also for children) and period briefs can be safely transported and not attract attention due to the beautiful fabrics.
If a woman “only” suffers from frequent urination, astanding pee helper can be useful. This means that you can urinate at any time, similar to a man, while standing. Useful for long car journeys or other activities where a toilet is not always available.
If the skin is in frequent contact with urine, this can upset the balance of the skin on various levels. On the one hand, the pH changes, on the other hand, the skin can be stressed by constant moisture and friction. In the worst case, it can lead to a skin infection in the genital area. However, this can be prevented through appropriate care. Regular cleaning of the genital area is important. The aim is to keep the skin as dry and clean as possible. Soft, moist towels are recommended. Wipe gently and do not rub vigorously. Folds of skin should be gently pulled apart to clean all areas. Special cleansing lotions are controversial because they can irritate the skin even more. Likewise, products with fragrances should be avoided. Creams or lotions that help maintain the skin's natural barrier function should be applied at regular intervals (Gray et al. 2002).
It is particularly important to know what type of incontinence it is when it comes to drug treatment. The therapeutic approaches are then very different. In menopausal women, topical application of estrogens to the genital area can reduce symptoms. Other drugs include duloxetine and drugs that inhibit the parasympathetic nervous system. However, these drugs do not cure incontinence and can only relieve symptoms. Of course, they also have side effects, which often lead to discontinuation of therapy (Kretschmer and Bauer 2018; Reisenauer et al. 2013).
Surgery can be considered as a final step. For stress incontinence, ligaments are often placed around the urethra, which seal the urethra when the pressure on the bladder is increased (Reisenauer et al. 2013). Women with a depression or an incident can be offered an operation in which the supporting structures are tightened or nets are inserted that strengthen the supporting apparatus. In older women and with severe symptoms, removal of the uterus may be considered. The decision as to which therapy is suitable must be discussed individually with the doctor for each woman (Gätje et al. 2015).
The most important thing is not to be ashamed of your weak bladder! Since so many women and men suffer from it, it is worthwhile to discuss the topic openly with friends. You should also explain the symptoms honestly to doctors. Because the topic should not be a taboo, but is a symptom of various diseases for which there are many solutions.
Beutel, ME, et al. (2005), 'Prävalenz der Urininkontinenz in der deutschen Bevölkerung', Der Urologe, Ausgabe A, 44 (3), 232-38.
Gätje, Regine, et al. (2015), Kurzlehrbuch Gynäkologie und Geburtshilfe (Georg Thieme Verlag).
Gray, M., Ratliff, C., and Donovan, A. (2002), 'Tender mercies: providing skin care for an incontinent patient', Nursing, 32 (7), 51-4.
Kretschmer, Alexander and Bauer, Ricarda M. (2018), 'Konservative Therapiemöglichkeiten der weiblichen Inkontinenz', Aktuelle Urol, 49 (01), 73-77.
Reisenauer, Christl, et al. (2013), 'Interdisziplinäre S2e-Leitlinie für die Diagnostik und Therapie der Belastungsinkontinenz der Frau', Geburtsh Frauenheilk, 73, 1-5.
Rodríguez, L. V., et al. (2003), 'Discrepancy in patient and physician perception of patient's quality of life related to urinary symptoms', Urology, 62 (1), 49-53.
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