Continence promotion & incontinence in the Kenntnisprüfung

Mrs S., 58, loses small amounts of urine when laughing, coughing and climbing stairs — she does not feel an urge to urinate at those moments. Which type of incontinence is most likely?

• Urge incontinence (Dranginkontinenz)
• Stress incontinence (Belastungsinkontinenz)
• Overflow incontinence (Überlaufinkontinenz)
• Functional incontinence (funktionale Inkontinenz)

Explanation: Loss of urine during physical strain (coughing, laughing, lifting) without a preceding urge is the classic picture of stress incontinence: the pelvic floor cannot withstand the increased pressure in the abdomen — typical after childbirth and in the menopause.

Mr P., 81, with a known enlarged prostate, constantly dribbles urine; the urine stream is weak and the lower abdomen is distended. Why is this type particularly dangerous?

• Because the constant loss of urine leads to dehydration, which can be prevented by strictly increasing fluid intake
• Because the dribbling indicates an overactive bladder, which turns into a contracted bladder without consistent bladder training
• Because the overfull bladder with residual urine can lead to urinary tract infections and backflow up into the kidneys
• Because the bladder is completely empty and the bladder muscle wastes away due to lack of filling

Explanation: The picture points to overflow incontinence: because of the outflow obstruction, the bladder never empties completely. The constant residual urine is a source of infection, and the backflow can damage the kidneys — so a medical work-up with measurement of residual urine, not bladder training.