In 2006 a new life began for me. And I owe that to the bladder pacemaker,” says Gertraud Schlechter from near Heilbronn. “The incontinence isolated me completely.” In the last two years before the operation, she hardly dared to leave the house. It is not easy for the 52-year-old to tell her story. But she wants to inform, to prevent other women from suffering as much as she does. In Germany, 2.6 million people under the age of 65 are affected by bladder weakness. In addition, there are another 14.7 million older people. A much-hidden affliction. As a result, many patients do not receive the therapies that could help them.
For Gertraud Schlechter it all started with a routine operation. At the age of 39 she had to have her uterus removed. In order to prevent sagging and thus bladder weakness, the bladder was “hung up” again in the same operation. The effect was not as desired. A slight incontinence set in. “I went to a urologist, but he was no help and not very sensitive. So I tried to get the problem under control with insoles,” she recalls. At first it worked, but then the complaints increased. “I didn’t want to accept this situation so easily. But of course I had no way of knowing that it would be so difficult to find a suitable treatment.” What followed was an odyssey of years between clinics and doctors. All therapies failed. Sometimes a drug dried out the mouth so much that it had to be stopped. Gertraud Schlechter reacted allergically to other remedies. Months of physiotherapy brought only short-term success. And in between operations again and again – a total of ten times.
“I felt completely alone”
Some treatments gave her relief for a short time. “But then it got worse every time,” says the current pacemaker patient. When the bladder was fixed in a kind of hammock in a so-called “rein plastic”, the mesh material used did not tolerate it. It came to a severe inflammation in the abdominal cavity, the encapsulated foci of which are still bothering her to this day.
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Hide and seek
But at least as stressful as the pain and scars was the fear. The fear that others might notice something about the bladder weakness, which at some point could hardly be hidden. “I worked until 2001. In the production. Soldering fine electronics.” Gertraud Schlechter does not like to think back to that time. “I always had a change of clothes with me. Because deposits were no longer enough. And the constant fear of not making it to the toilet in time, the fear of knowing looks from colleagues. Working life was an abomination.” Private life was also reduced to a minimum. She only left the house in emergencies. Every route was carefully planned. She knew all the public toilets in the city and in the neighboring towns. Hardly dared to drink a glass of water to avoid the inevitable urge to urinate. “But the worst thing was the loneliness,” she says in retrospect. “I couldn’t talk to anyone about what was going on inside me and with my body.” Her husband was overwhelmed by the situation. She didn’t want to confide in friends. And none of her doctors told her that there were self-help groups for her problem.
“It was the last try”
Then came the turning point. After various unsuccessful operations, she referred her clinic to the Klinikum am Plattenwald in Bad Friedrichshall and thus to Prof. Burkhard von Heyden. If other therapies are unsuccessful, the chief physician in urology uses a special bladder pacemaker. “The device uses weak and harmless electrical impulses to control the nerve fibers that send commands from the brain through the spinal cord to the bladder as electrical signals. In this way, it prevents uncontrolled loss of urine,” explains the expert. He has been working with this technique since 1994. However, to this day the process is not well known. Although the operation is not risky, it is complicated. Only about 200 patients in Germany receive such a pacemaker every year. But the need, the expert estimates,
The fear is gone
“Actually, after all the bad experiences, I decided not to have the surgery anymore. It was absolutely the last attempt,” says Gertraud Schlechter. “A lot of interested doctors wanted to watch the operation, the hall was really full. But after so many surgeries, I didn’t care at all.” Since that day, she has worn a small electrode over her tailbone, which is connected to the pacemaker in the lower abdomen via a fine wire. Both cannot be seen from the outside and also not an unpleasant foreign body, as she assures. She got along well with the pacemaker from the start. It is switched on and off as required via an external switch. “I am so glad I dared to have this surgery. The device means so much more quality of life and freedom for me.”
“The fear is gone”
Today, the 52-year-old likes to be on the road again, meets up with friends and has become much more open overall: “When I told my friends about the incontinence, they showed a lot of understanding. But I just wouldn’t have been able to get that word out of my mouth before.” Meanwhile, it’s no longer a problem for her to drink enough. She has to go to the toilet relatively often, but that is not a major limitation: “I can live well with a rhythm of one and a half to two hours. That doesn’t limit my activities. And taking a deposit isn’t a bad thing for me either. I know that no real ‘catastrophe’ happens anymore. I am so thankful that I no longer have to live in constant fear.”
Info-Addresses
Gertraud Schlechter advises other people affected not to hide, but to seek contact: “Now that I know that there are millions of people affected, I would go straight to a self-help group and get much better information.”
Interview
“The pacemaker inhibits the voiding reflex”
Prof. Burkhard von Heyden, Head of Urology at the Klinikum am Plattenwald in Bad Friedrichshall, explains the procedure
Does the bladder pacemaker help with any form of urinary incontinence? In the case of stress incontinence – i.e. when urine is lost when coughing, sneezing or laughing – it does not work. It is suitable for people with a motor urge bladder for whom medication does not help. If only a few drops are lost, treatment with medication is usually successful.
What Causes a Severe Urge Bladder? The symptoms are usually preceded by operations in the small pelvis, such as a hysterectomy. But bad bladder operations that have been repeatedly re-operated also lead to such complaints. As a result of the scarring, the nerves responsible for normal emptying are completely disrupted. This can then lead to a child’s reflex bladder that empties uncontrollably. But urinary retention is also possible. A pacemaker can also be used successfully in these cases.
What does it do? An electrode on the sacral nerve, on the lower back, stimulates the nerve that controls the bladder and bladder sphincter at 12 on/off pulses per second. The stimulator, which is inserted under the skin on the stomach together with the battery, supplies the necessary electricity. This constant stimulation disturbs the foreign reflex, which in reflex incontinence triggers a complete emptying that cannot be suppressed as soon as a certain filling of the bladder is reached.
And if the bladder needs to be emptied? The stimulator is switched off for urination. This is done with an external switch that is about the size of a cell phone. It is simply placed over the stimulator and switched off. After urinating, turn the stimulator back on in the same way.
What do you feel from the stimulation? There is always a slight tingling sensation when switching on, but this disappears after a few seconds.
And the success rate? In a test stimulation, an external device is used to test how the body reacts over several days. In 50 percent of cases, the stimulator can reduce bladder weakness so significantly that an internal device is then used.
Tips
Sensitive Bladder? You can do something about it
It’s such a thing with taboo topics: you’d rather not ask and you’ll only hurt yourself by doing so. Stop it!
Every fourth woman in Germany knows the problem of a sensitive bladder. Childbirth, menopause and obesity are common causes, but bladder infections or congenital weakness of the connective tissue can also be responsible. Usually only a few droplets are lost every now and then. Not really bad, but not great either. And something that in most cases can be changed. Here are a few tips:
- Pelvic floor training Most people only notice their pelvic floor when it causes problems. It’s a pity really, because whoever strengthens this muscle not only strengthens his bladder. Posture also improves, which prevents back pain. And many women experience sex more intensely with a trained pelvic floor. There are courses at adult education centres, with physiotherapists and at pelvic floor centres. Health insurance companies also often pay subsidies as part of prevention.
- CoreWellness DVD The alternative for at home: Together with the Norwegian sports scientist and physiotherapist Kari Bø, an international expert, Tena has developed a training DVD for the pelvic floor. The effectiveness of the concept has been scientifically proven. The program lasts about 20 minutes for beginners, the short version for experienced users only 10 minutes.
- Hygiene products Many women who discover bladder weakness spontaneously reach for panty liners and pads that were developed for menstrual hygiene. However, since urine and menstrual blood differ in composition and pH values, the result is often unsatisfactory. Much more effective and comfortable to wear are special products for the sensitive bladder from the medical supply store or supermarket.
