Birgit Bulla thought for a long time that she was alone with her suffering. When it began, she sat down in the cinema, beer garden or café as close as possible to the toilets, always had a change of underwear with her, at meetings she warned people: "Don't blame me if I have to go to the toilet every ten minutes." But little by little, friends and acquaintances told the non-fiction author about very similar problems.
This is not surprising for urologist and professor Ricarda Bauer from Munich: "Urinary incontinence in women is a widespread disease." It is difficult to say how many are really affected due to the number of unreported cases. While international studies indicate an incidence of 13 percent, a German-Danish study in 2017 showed that 48 percent of people over the age of 18 lose urine involuntarily - that is, every second adult. This is what the first standardised guideline on female urinary incontinence, which doctors in Germany, Austria and Switzerland have been following since the beginning of 2022, states. The weakness of the bladder can have far-reaching consequences: sleep problems, urinary tract infections and severe restrictions in everyday life. This can also lead to depression. The disease can be treated well with physiotherapy, medication or even Botox.
A "very complicated process"
Birgit Bulla realized for the first time during a stay in the USA that something was wrong: the then 27-year-old was driving across the country with her twin sister, visiting San Francisco and getting to know a group of "Austrian guys". But just when her sister wanted to take a picture of everyone, it suddenly started: "I had to go to the toilet from zero to a hundred, " Bulla says: "It felt like I hadn't gone for two days." She knelt down, pressed her heel into the pelvic floor and when the photo was taken, she ran to the toilet. But the bladder was not nearly full, she could only pass a little urine. From then on, however, she had to go to the bathroom every quarter of an hour.
At that time, Bulla developed an irritable bladder - a symptom complex that can go hand in hand with urge incontinence. The women with urge incontinence then often feel a robbery -like urge to urinate or feel that they can no longer hold the urine. The bladder locking muscle is generally intact here, but reacts hypersensively: it contracts even with low filling and an involuntary urinary exit occurs. In addition to the stress incontinence (formerly: stress incontinence), urge incontinence is one of the most common types of unwanted loss of urine. In the latter, people lose fluid uncontrolled when lifting, carrying, sneezing or laughter.
In the case of urge incontinence, one does not yet know the exact causes that the stress incontinence "develops through all the stresses that the pelvic floor is exposed to in a woman," says Professor Christl Reisenauer, senior doctor of the UrogyNecology section at the University Women's Clinic Tübingen. This could be especially due to births or pregnancies. That is why women are more often affected by urinary incontinence than men.
In addition, the risk increases with age due to hormonal changes or aging processes in the tissues. According to urologist Bauer, urination and retention is a "highly complex process" that is becoming increasingly difficult to control over the course of life. While older people may still be able to walk perfectly, continence is already causing them problems. Bladder weakness can also have other, diverse causes: According to Ricarda Bauer, overweight is an important factor, but diet can also play a decisive role. Thus, even half a liter of coffee a day increases the risk of suffering from urge incontinence by 20 percent.
Urinary incontinence daily advice:
Get warm in the cold season. In the case of cold, the muscles contract and there may be an unwanted loss of urine.
Keep yourself busy. "When some of my patients come home by car, suddenly the urge to urinate is insanely strong," says Christl Reisenauer: "One trick is to park backwards to be distracted.«
Sounds banal, but: clear the way. If you rush to the toilet quickly at night, you can get stuck or slip on something. Because urinary incontinence increases the risk of broken bones.
Drinking less does not help. This is more likely to weaken the body.
Get the causes to the bottom: asparagus can promote urge to urinate. Saurer orange juice, pineapple juice or sharp spices can also lead to having to go to the toilet more often.
Birgit Bulla also tried to find reasons for the constantly recurring urine loss after her trip. The first doctor did not even examine her, she says, put the problems down to cystitis and prescribed antibiotics. When these did not help, an "odyssey" began for the author: many doctors sent her home again, as they had specialized more in the prostate. Very few people knew about an irritable bladder. Bulla was examined on an MRI, began to take various medications, tried psychotherapy, even tried hypnosis. Nothing helped. But then a doctor suggested a treatment with Botox.
This is not an unusual way for Bauer and Reisenauer: some of their patients have already gone through many practices before they came to them. According to the current guideline, targeted and standardized questions could already be categorized as a stress, urge or an mixing harness incontinence in up to 80 percent of women. According to certain studies that are similar to the gynecologist, the treatment can then begin.
Male urinary incontinence
Most of the urge incontinence are most often affected, which arises from the aging process, changes in prostate or overweight, for example.
Stress incontinence, on the other hand, occurs mainly after surgery on the prostate.
Physiotherapy in particular has a high priority in treatment: Here, it is first important to raise awareness of your own pelvic floor. After that, the patient practices the targeted contraction of the pelvic floor with the therapist.
First of all, you try to avoid surgery, explains Reisenauer. With physiotherapy, women can learn how to relax and relax the pelvic floor in a targeted manner, which is helpful for both urge and stress incontinence. It is important that someone with appropriate training guides the patients. Special vaginal tampons made of soft, sponge-like plastic could support the urethra and strengthen the bladder closure in case of stress incontinence, especially during sports, dancing or coughing attacks. If women lose urine unplanned during sex due to urge incontinence, this may be due to an involuntary contraction of the bladder muscle. In this case, medications prescribed by the doctor would help.
Dance in your wedding dress without diapers.
However, if neither physiotherapy is of any use, nor pills help, or if women no longer want to rely on aids such as tampons, specialists such as Christl Reisenauer advise surgery: for example, she treated a young patient who absolutely wanted to dance in a wedding dress without a diaper. After an operation, she did not even need any more deposits. The possibilities are many: in some therapies, a sling is placed under the urethra in order to stabilize it better in the pelvic floor again.
A laser is used for others. Introduced into the vagina, he stimulates blood circulation and the formation of collagen, which in turn strengthens the vaginal wall. This better supports bladder and urethra. "This is just very vogue to treat urinary incontinence," says Bauer. "But if you look at the study situation, it is not as convincing as it is shown by some colleagues or industry." According to the updated guideline, laser therapy can at least be recommended for a selected group of women with stress incontinence ".
Birgit Bulla was finally helped by a Botox procedure: "When my doctor suggested that I inject Botox, I first thought, 'Oh God, absolutely not,'" says the 37-year-old. According to the guideline, injecting the neurotoxin into the urethral wall is effective in the case of an overactive bladder – and is then recommended if other therapies fail. The active ingredient temporarily blocks the nerves and thus ensures that the bladder muscles relax and are less irritable. About 30 percent of patients are completely cured and 60 percent show a decrease in symptoms by half. Side effects can be inflammation. Bulla was insanely afraid: even a urethral smear had been extremely painful for her – "how should that be then, if they inject something into me?", she says.
But after the procedure she was able to follow live over a monitor, and after dozens of stitches in the urethra, she was relieved: "It burned a little, but I was much more afraid than was necessary." Some things change: Now she has to go to the toilet less frequently and can wait half an hour. The author can usually go through interviews with prominent people and does not have to go to the toilet immediately afterwards. Bulla helped the procedure a lot, but above all it is important to her "that you spoke openly about it, entrust yourself with people and get help." Then you can find out the exact treatment method together with the doctor.
Who can I speak with?
The first point of contact for urinary incontinence are gynecologists or urologists. Alternatively, you can also contact a continence and pelvic floor center. Corresponding advice can be found through the website of the German continence society.
Bulla is now openly dealing with her illness, has created a blog about urinary incontinence ( /), a book with the title "Noch ganz dicht? Everything worth knowing about the bladder" and even had her Botox treatment filmed on public radio. "I want people to realize: you are not alone in the world," she says: "There are so many who are affected." For her, a treatment means one thing above all: a better quality of life. Thus, the bladder may not be the most important thing in life, but it is a much more important aspect than many people realize.
