Urinary incontinence is the involuntary, uncontrollable loss of urine. This condition is very common and up to 30% of women suffer from urinary incontinence, which can also occur at a young age. The symptoms often begin after pregnancy and childbirth, as the pelvic floor is under particular strain. Incontinence often increases with age and hormonal changes during the menopause.

We distinguish between two common forms of incontinence:

• Stress incontinence
  In stress incontinence, urine is lost during physical exertion, for example during sport, when lifting heavy objects or when coughing, sneezing or laughing. This type of incontinence is caused by a weakness in the closure of the urethra, so that urine is lost when the abdominal wall tightens. This closure weakness can be so pronounced that even small movements, such as normal walking or turning over in sleep, can lead to urine leakage.
• Overactive bladder
  This type of incontinence is also known as an "irritable bladder". Women suffer from a strong urge to urinate, which often occurs suddenly and forces them to go to the toilet immediately. In many cases, the urine cannot be held until the toilet. Frequent urination and night-time visits to the toilet are also signs of an overactive bladder.

Both forms of incontinence often occur together and are referred to as "mixed urinary incontinence". In addition to stress incontinence and overactive bladder, there are other rarer forms that need to be considered during the examination.

Talk to us about your symptoms

Incontinence is not a life-threatening condition, but it is very distressing for those affected. It can severely restrict everyday life. Nowadays, there are very good and effective therapies for all forms of incontinence, so it is worth talking to us about these symptoms!

In addition to urinary incontinence, chronic bladder infections are common complaints in the bladder area. In many cases, those affected have to take antibiotics several times a year and suffer from the symptoms of an irritable bladder. In the case of this disease, it is also important to have a detailed examination of the urine in a microbiological laboratory and an examination of the bladder using cystoscopy and ultrasound.

Sometimes these chronic infections are caused by bladder emptying disorders in which the bladder cannot be completely emptied during urination. Depending on the cause of such a bladder emptying disorder, there are various therapeutic options.

A prolapse of the bladder, uterus or rectum is a very common condition in women. Every tenth woman has a prolapse operation in the course of her life. The symptoms of genital prolapse vary greatly, but in many cases it causes no symptoms at all.

Possible symptoms of a prolapse:

• Foreign body sensation in the vagina
• Emptying disorders of the bladder
• Emptying disorders of the bowel
• Irritable bladder symptoms
• Pain in the pelvis
• Pain during sexual intercourse
• Pronounced prolapse of the vagina

The cause of a prolapse is a weakness of the pelvic floor, which can be favoured by pregnancy and childbirth, chronic physical strain, obesity, a congenital weakness of the connective tissue and a hormone deficiency due to the menopause.

We will find the right therapy for you

Genital prolapse can be diagnosed by means of a simple gynaecological examination and an ultrasound scan. We will be happy to advise you on the various therapeutic options and find the right treatment for your personal situation.

Women who suffer from chronic lower abdominal and pelvic pain are usually severely restricted in their quality of life and have already endured a long period of suffering. The causes of this often agonising pain vary greatly.

Possible causes of chronic lower abdominal and pelvic pain:

• Endometriosis
• Fibroids of the uterus
• Chronic inflammation of the pelvis
• Adhesions in the abdomen after surgery

In the search for the cause of the symptoms, we first carry out a detailed assessment of your medical history. In addition, we always carry out an ultrasound examination and a gynaecological examination with the taking of smears, which we have tested for specific germs in the microbiological laboratory. We can also perform a laparoscopy to take a closer look at the abdominal and pelvic organs. If necessary, an MRI scan by the radiology department can also provide helpful information.

The cause of the symptoms is not always found. In such situations in particular, it is important for us to continue on the path with you and utilise the various therapeutic options. Electrostimulation therapy often helps, using fine electrical impulses to positively regulate the pain and relax the internal muscles. Thanks to our close cooperation with specialised physiotherapists, relaxing pelvic floor exercises can help to alleviate your symptoms.

Temporary or permanent pain relief with pain medication can also improve your quality of life. To this end, we work closely with the pain outpatient clinic at the university hospital.

We take time for you

Sometimes it takes an open ear and some time to talk about everyday stresses and strains. In order to be able to respond professionally to your concerns, Dr Deniz has completed training in specialist psychotherapy and offers sufficient time in regular appointments.

Haemorrhoids and varicose veins are one of the most common diseases of the rectal area and often cause a great deal of discomfort to those affected. There are also prolapse problems in this area. Even more distressing and still a major taboo subject is faecal incontinence, from which many people suffer.

Interdisciplinary cooperation

In our consultation hours, we deal with this topic openly, as it is often caused by a weakness in the pelvic floor. If you suffer from faecal incontinence or other diseases of the rectum, we will arrange a prompt appointment with our proctology colleagues, who will look after you sensitively. Thanks to our many years of excellent cooperation, we will work hand in hand to treat your pelvic floor complaints.

Our society is becoming more and more open and topics that were previously not talked about are no longer taboo. Nevertheless, women and couples often find it difficult to talk about sexuality problems. These topics are avoided in the partnership and also in discussions with doctors. Surveys show that many women would like their gynaecologist to talk to them about their sexuality. Quite a few women and couples are dissatisfied with their sex life. There can be various reasons for this. Pain and a feeling of tension in the genital area as well as listlessness are the most common problems for women, while men often suffer from potency problems.

We provide you with professional advice

In our urogynaecological consultation hours, we actively address the topic of sexuality. We are specially trained in the field of sexual medicine so that we can respond professionally to questions or concerns about your sexuality. We are also happy to offer counselling sessions for couples in the protected setting of our consultation hours, as talking about the problem is often the first important hurdle to improvement.

Detailed consultation

During your visit, we will first of all take the time to talk to you in detail about your symptoms and medical history. It is most important to us what is bothering you personally and what your wishes are with regard to treatment. We enquire about your bladder and bowel function, prolapse problems and your sexuality. In addition, any other illnesses, such as diabetes or heart disease, and previous operations are of course also important to us. Please bring a list of the medication you are currently taking with you.

Comprehensive examination

After the consultation, we will carry out our routine examinations: a gynaecological examination, an ultrasound examination and urine diagnostics. In special cases, further examinations will be carried out, such as a bladder pressure measurement, to give us a precise picture of your symptoms.

Bladder infections are often partly responsible for the symptoms, even if they do not necessarily manifest themselves with the classic symptoms. We therefore analyse a urine sample from almost every patient in our consultation. A special test strip is used for this and the midstream urine is analysed. If a bladder infection is suspected, we have the option of having the urine tested for germs and the appropriate antibiotic in our microbiological laboratory.

Using ultrasound, we can assess the female genital organs (uterus and ovaries) from the vagina, as well as the bladder, urethra and the function of the pelvic floor. Among other things, we check the bladder volume and the possible presence of a prolapse.

During our consultation, we carry out a gynaecological examination on every patient, as you would expect from your gynaecologist. This enables us to assess a possible prolapse. We can confirm the diagnosis of stress incontinence with the so-called cough test. We also pay particular attention to signs of vaginal dryness, which often occur after the menopause and can exacerbate symptoms in the bladder area.

For further diagnosis of urinary incontinence and complaints in the bladder area, we can measure bladder pressure and perform cystoscopy.

Bladder pressure measurement

We carry out a bladder pressure measurement primarily for stress incontinence, as this is a good way of assessing the urethral closure function. A bladder pressure measurement can also be helpful in making the correct diagnosis in cases of incontinence with an unclear cause. In the case of urinary bladder emptying disorders, we obtain information about the function of the bladder emptying system.

Cystoscopy

In the case of recurring bladder infections or an unclear irritable bladder, a cystoscopy may be necessary to assess the bladder mucosa inside the bladder. This is a short, outpatient examination that we perform under local anaesthetic.

Once a month, we meet as cooperation partners of the interdisciplinary pelvic floor centre as part of a pelvic floor conference and discuss patients with complaints that require interdisciplinary care beyond the individual specialist areas. This primarily includes patients with urinary and faecal incontinence, but also cases with a long and complex medical history.

In these conferences, we benefit greatly from the specialist knowledge of the respective colleagues and can therefore offer optimal and individualised treatment.

Drug therapy

Effective medication is available for the treatment of both overactive bladder and stress incontinence. We will discuss these treatment options with you in detail and inform you about their effects and side effects. It is important that you take the prescribed tablets regularly, as an effect is usually only recognisable after two to three weeks. Do not hesitate to contact us if you experience any undesirable side effects, such as sluggishness in the bowel or dry mouth. These often pass after a while and the positive effect of the medication sets in.

We often advise you to apply oestrogen directly to the vagina if you have pelvic floor problems. This can treat both the bladder and vaginal dryness very effectively. Due to the topical application, the active ingredient only reaches the body's circulation in negligible quantities, meaning that there are virtually no side effects.

Acupuncture

In addition to traditional drug therapies, particularly for irritable bladder symptoms and chronic pain, we also offer professional acupuncture treatment. This comprises ten 20-minute sessions, once a week. With acupuncture, we have already been able to help many women with their complaints in an extremely gentle way.

Pessary therapy

Genital prolapse and stress incontinence are usually treated by surgery. The use of pessaries is one way of alleviating the symptoms without surgery. Pessaries are made of soft silicone or plastic and are inserted into the vagina in a similar way to a tampon. This pushes the prolapse back into the vagina. Pessaries are available in a wide variety of shapes. In our consultation, we always offer you this treatment option as an alternative to surgery. If you require this therapy, we will customise the pessary to suit your individual needs.

Electrostimulation

In addition to traditional pelvic floor exercises, electrostimulation therapy has proven particularly effective for urinary and faecal incontinence and chronic pelvic pain. This involves inserting a probe into the vagina or rectum, which emits fine electrical impulses to the surrounding tissue. The bladder and rectal function is positively regulated and tension in the pelvis can be relieved.

At our pelvic floor centre, we work together with specialised professionals who will instruct you in the function of the devices and set the appropriate programme for you. You will receive the devices on prescription for a period of usually three months and can carry out the therapy in the comfort of your own home.

Various surgical techniques can be used for the surgical treatment of stress incontinence in women. The most commonly used is the so-called "tension-free vaginal sling". A fine mesh is inserted under the urethra through a small incision in the vagina to support it. This minor operation, which can also be performed under local anaesthetic, results in a high level of patient satisfaction. Alternatively, in special situations, stress incontinence can also be treated by injecting the urethra or surgically lifting the neck of the bladder via laparoscopy.

If the bladder is overactive and difficult to treat, but also in the case of bladder emptying disorders, we also offer the option of implanting a bladder pacemaker. Similar to a pacemaker, the bladder is modulated and its function significantly improved via fine electrical probes implanted via the sacrum. This procedure is called "sacral neuromodulation".

We are happy to take plenty of time to discuss the advantages and disadvantages of each operation with you before we plan the procedure.