Pelvic floor therapy and incontinence care in Munich

With stress incontinence, urine leaks when the pressure in the abdomen rises – when coughing, sneezing, laughing, jumping or lifting. The cause is usually a weakened pelvic floor or urethral closure. With urge incontinence, also called overactive bladder, a sudden strong urge to urinate comes on and the toilet is not always reached in time. Many women have a mixed form. Less common is overflow incontinence, in which the bladder does not empty completely. The distinction matters because treatment depends on it: with stress incontinence, pelvic floor training and, where appropriate, surgery take priority; with urge incontinence, bladder training and medication are more likely to be the focus. A drinking and bladder diary helps you recognise your own pattern.

The pelvic floor is a layer of muscle and connective tissue that supports the bladder, uterus and bowel and closes the outlets. Pregnancy and childbirth, the hormonal changes of the menopause, being overweight, chronic cough, constipation, heavy lifting and congenital weakness of the connective tissue can put it under strain. Even so, many women do not talk about it for a long time. That is why Prof. Schulte-Uebbing has repeatedly brought the subject into the open, for example in “Pelvic floor weakness – the secret taboo subject of many women” (Your Health magazine, 2013) and “Pelvic floor weakness and incontinence in women: a taboo subject and hidden widespread condition, holistic therapeutic approaches” (Your Health magazine, 2016). Our stance: you do not need to feel ashamed, and you do not have to put up with the symptoms. There are many options that we can discuss together.

Neocontrol is an extracorporeal magnetic field pelvic floor therapy. Extracorporeal means that the treatment is carried out from the outside, with no probe in the vagina. You sit fully clothed on a treatment chair, in the seat of which a coil produces a pulsating magnetic field. It is intended to stimulate the nerves of the pelvic floor so that the muscles repeatedly tense and relax – similar to a workout, only without any effort of your own. Our practice sees Neocontrol as a supportive option for prevention and treatment, together with hormonal treatment and targeted pelvic floor training. The evidence from studies is not consistent; we discuss openly whether the method is suitable for you. During pregnancy, with a pacemaker or with metal implants in the pelvis, the treatment is generally not suitable.

With the menopause, the oestrogen level falls. The lining of the vagina and urethra becomes thinner and the connective tissue loses firmness. This can encourage incontinence and worsen symptoms such as a frequent urge to urinate or recurrent bladder infections. Local hormone treatment of the vagina with low-dose oestrogen is a recognised option. Prof. Schulte-Uebbing has also studied the vaginal use of vitamin D for stress incontinence and presented it, among other places, at the International Vitamin D Congress at the Charité in Berlin (2013). One related publication is “Stage I and II Stress Incontinence (SIC): High dosed vitamin D may improve effects of local estriol” (Dermato-Endocrinology, 2016). This is a field of research; there is no guideline recommendation for it. Whether such a formulation is suitable for you, we discuss individually.

Incontinence prevention starts early. After childbirth, postnatal exercises support the pelvic floor; the costs are usually covered by statutory health insurance (GKV). In everyday life, you relieve the pelvic floor by lifting heavy loads correctly, avoiding constipation, keeping to a healthy weight and drinking enough. Pelvic floor training makes sense when it is properly guided and practised regularly, for example with a specialist physiotherapist. During the menopause it is worth raising symptoms early. As a complement, Neocontrol magnetic field therapy can be used for prevention, for example if you find training on your own difficult. We advise you on which steps suit your stage of life.

If stress incontinence remains distressing despite training and complementary treatment, surgery may be an option. Often a tension-free tape is placed under the urethra to support it when you cough or sneeze. For prolapse of the bladder, uterus or bowel there are various procedures that lift the organs back up. Such procedures are carried out in clinics specialising in urogynaecology. We explain the options, benefits and risks, recommend a urogynaecological assessment where needed, and support you before and after the procedure. Even after surgery, a well-trained pelvic floor remains important. Whether and when a procedure makes sense is your decision – well informed and without pressure.