ENPeople stay silent about incontinence for years: pads, giving up sport and travel, embarrassment in front of family. Urinary incontinence treatment in Germany starts with a conversation without awkwardness and with finding out which type the patient has.
It is common in women after childbirth and menopause, in men after prostate surgery and in people with neurological diseases, and in many cases it can be reduced considerably, as the German federal health portal also notes. Below: types, diagnosis, treatment without surgery, operations, specialists and arrangements.
Types of urinary incontinence
The main types are stress, urge and mixed incontinence. In stress incontinence, urine leaks when coughing, laughing or lifting because the pelvic floor or the sphincter, the muscle that closes the urethra, is weak. Urge incontinence means a sudden strong urge – «I can’t make it in time» – often with an overactive bladder that contracts on its own. Mixed forms combine both.
Special cases: leakage after prostate removal, for example as part of prostate cancer treatment in Germany, is mainly due to a weak sphincter. Neurogenic incontinence, caused by a disease of the nervous system, occurs after spinal cord injury, in multiple sclerosis and after stroke. In overflow incontinence, the bladder does not empty fully and the overfilled bladder leaks. Pelvic organ prolapse in women is a matter for gynaecologist and urologist together; see also urology in Germany.
Diagnosis: from bladder diary to urodynamics
Diagnosis starts with simple tests, and urodynamics is added only when needed. For several days the patient keeps a bladder diary: fluid intake, how often and how much they pass urine, leakage episodes. Then come a urine test and ultrasound measuring residual urine, the urine left in the bladder after voiding; in women, the doctor also examines the pelvic floor.
Urodynamic testing shows how the bladder works: thin sensors measure bladder pressure during filling and emptying. It is needed before surgery when the result affects the choice of operation, and when the picture is unclear. Cystoscopy, a look inside the bladder with a thin instrument, is done where indicated. Bring your reports and a list of your medication.
Treatment without surgery
Treatment usually starts without surgery; a key part is pelvic floor muscle training with a physiotherapist, including biofeedback: a device shows whether the muscles work correctly. Weight loss, if needed, and a sensible drinking routine are added.
Urge incontinence is treated with bladder training, gradually lengthening the intervals between toilet visits, and medication that reduces involuntary bladder contractions. If this fails, botulinum toxin is injected into the bladder wall via a cystoscope; the effect is temporary, so the injections are repeated.
Aids include pessaries for women, vaginal inserts that support the urethra and pelvic organs, and electrical stimulation for some patients. To be honest, finding the right approach takes time.
Operations for urinary incontinence
The operation depends on the type of incontinence and on whether the patient is a woman or a man. For women with stress incontinence, a synthetic sling or one made from their own tissue is placed under the mid-urethra as a support: when the woman coughs or strains, the urethra is pressed against it and closes. Prolapse is treated with pelvic floor reconstruction. These operations carry risks, such as difficulty passing urine, pain or, with synthetic tape, the tape wearing through the vaginal lining; the doctor discusses them in advance.
Men with incontinence after prostate surgery are offered a male sling or an artificial urinary sphincter: a cuff around the urethra that keeps it closed until the patient opens it with a small pump to pass urine. For urge incontinence that has not responded to medication, and for some neurogenic disorders, there is sacral neuromodulation: a small stimulator with an electrode near the sacral nerves regulates the bladder’s nerve signals. The choice of operation follows urodynamics.
Frequently asked questions
Can urinary incontinence be treated without surgery?
Often the symptoms can be reduced considerably without surgery, but a complete cure cannot be promised. Stress and mixed incontinence are treated mainly with regular pelvic floor training with a physiotherapist, urge incontinence with bladder training and medication. Losing excess weight and a drinking routine also help. If this is not enough, the doctor discusses botulinum toxin or an operation.
Is urodynamic testing needed for urinary incontinence?
Not always. Treatment without surgery usually starts on the basis of the bladder diary, a urine test and ultrasound. Urodynamic testing is needed when the picture is unclear or when its result affects the choice of operation: thin sensors measure bladder pressure during filling and emptying, showing the doctor why urine leaks.
What can be done about urinary incontinence after prostate removal?
The first step is pelvic floor muscle training, if needed with biofeedback or electrical stimulation. If leakage persists, the urologist discusses surgery: as a rule, a male sling for mild to moderate incontinence and an artificial sphincter for more severe cases. Urodynamic testing is carried out before the operation.
How AlenMed arranges urinary incontinence treatment
AlenMed sends your documents to a urologist experienced in your type of incontinence. Specialists include Prof. Dr. med. Ricarda M. Bauer, chief physician at Urologische Klinik München-Planegg and formerly head of the continence centre of the LMU urology department; she runs a counselling office of the German Continence Society and is chair of Forum Urodynamicum. Dr. med. Bernhard Liedl is chief physician at the same clinic and head of the centre for reconstructive urogenital surgery; his work includes sphincter implantation and incontinence treatment, and he is a former president of the International Society for Pelviperineology. Dr. med. Marcus Nehiba, chief physician of the centre for spinal cord injury and neuro-urology at Werner Wicker Klinik (Bad Wildungen), specialises in neurogenic bladder dysfunction.
Before the trip, we translate your reports and bladder diary and send them to a urologist, who says whether urodynamics are needed and which options make sense. We then book the appointment, obtain the hospital estimate and visa invitation letter, and arrange the transfer and an interpreter, where possible of the same sex. The AlenMed office is in Munich; see also arranging treatment in Germany.
After you return home, you keep the exercise programme and a report in your language, and we help you stay in contact with the doctor.
This material is for information only and is not an offer. The treatment plan is decided by a doctor at an in-person consultation.
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