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Urinary leaks in women: behind the taboo, effective treatments in 95% of cases

2023-03-15T16:49:52.009Z


HEALTH ADVICE - Provided you consult a urologist, the vast majority of incontinence is treatable and allows you to do without protection.


Leaking urine is a scourge for many women.

About a third of them are affected after the age of 65 and the frequency continues to increase with age.

This represents 1.5 million women in France.

Linked to effort or an urge to urinate, these leaks are almost always a taboo, affecting self-esteem and often requiring people to reduce their social activities for fear of accidents.

However, most of the time there is no fatality behind these incontinences since more than 95% of them can be treated effectively.

We'll see how.

To discover

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In the preamble, some small anatomical explanations.

Two muscles hold urine in the bladder.

The perineum, which forms a kind of hammock of support under the bladder, and the sphincter, which encircles the urethra through which the liquid flows.

If either of these muscles is no longer able to contract properly due to weakness or injury, and pressure is exerted on the stomach, loss of urine may occur.

This is stress incontinence, the most common form.

"Any strong abdominal pressure linked to physical activity, coughing or even giggling can trigger a leak", summarizes Dr Jacques Bron, urological surgeon in Loiret.

A number of these incontinences are linked to the loss of muscle tone which increases with age, especially after menopause due to the drop in estrogen levels, so any woman can be affected.

However, there are risk factors which, if corrected, can limit the risk: losing excess weight, rehabilitating the perineum after pregnancies, especially if the birth was difficult, reducing the risk of chronic cough by quitting smoking for example, treating chronic constipation which forces you to push and ends up stretching the perineum, choosing sports that do not force the abdominals too much (swimming or cycling rather than trampoline or gymnastics).

Overactive bladder

The other form of incontinence called urgency or "urge" is quite different.

It is linked to an overactive bladder and can occur at any time of the day or night, with no triggering factor.

The person suddenly feels an urge to go to the toilet and cannot hold back.

“This hyperactivity may be linked to inflammation or irritation of the bladder wall which contracts and forces the evacuation of urine.

It can be due to significant stress, hormonal imbalances, an infection, a neurological disease such as Parkinson's or multiple sclerosis, or even cancer,” explains Jacques Bron.

After making his diagnosis, a urologist has several strings to his bow to treat the women concerned.

"There is a wide range of therapeutic options to deal with the different scenarios that arise," explains Professor Jean-Nicolas Cornu, urological surgeon at the Rouen University Hospital.

“We can truly speak of personalized medicine.

The only difficulty is finally to find the right treatment from the outset.

There is therefore no reason to be satisfied with protections if this palliative solution is not satisfactory and is not well experienced.

"These treatments are effective insofar as they make it possible to significantly reduce the frequency and intensity of leaks, or even completely eliminate incontinence in a certain number of patients", adds Dr Marie-Aimée Perrouin-Verbe, urologist at the Nantes University Hospital.

“The failures mainly concern women with serious comorbidities and very complex situations.

Cases of incontinence refractory to any treatment are rare.

perineal rehabilitation

The most common therapeutic option is perineal rehabilitation.

It consists of carrying out several sessions to strengthen the perineum at the physiotherapist's through exercises and/or the use of a probe inserted through the vagina sending electrical impulses.

The exercises can be continued at home.

"The woman learns to lock her perineum before an effort", explains Jacques Bron.

“This rehabilitation is effective in more than half of cases on stress incontinence and can relieve certain emergencies.

However, the benefit may eventually fade.

» Combining topical application of estrogen for postmenopausal women with behavior modification to reduce the risk factors listed above may enhance its effectiveness.

For a more durable solution in case of stress incontinence, a surgical treatment can be proposed.

The most common is the placement of strips to support the perineum.

“This intervention has revolutionized care with more than 80% efficiency at 5 years”, assures Jacques Bron.

“Women who had stopped sport or limited their activities can resume a normal life.

»

Great progress has also been made in cases of sphincter deficiency.

It is possible to inject gel-type fillers or place small balloons in this muscle to improve the closure of the urethra.

There is also an artificial silicone urinary sphincter that can be implanted if the sphincter is too deficient.

Neurostimulation

For urgency, the most common approach is to “re-educate” the bladder by limiting its activity.

This can be done via special medications, which may nevertheless have side effects.

Botulinum toxin can be injected in low doses into the bladder wall to reduce contractions for several months.

Neurostimulation is also an option to regulate the activity of contractions (and reduce them) and restore its normal functioning.

This can be done via the tibial nerve which runs behind the ankle and is connected to the bladder.

It is also possible to implant an electrode near the nerves controlling the bladder, connected to a pacemaker placed under the skin in the lower back.

The latter regularly sends painless stimulations.

If this seems impressive, “we are talking about an intervention of a few tens of minutes which is minimally invasive to introduce the device”, specifies Jean-Nicolas Cornu.

And do not think that these interventions are reserved for extreme cases: they concern all people sufficiently embarrassed by their incontinence to come for consultation.

The only condition for having a free and informed choice: “to go to urology departments offering all the therapeutic options.

There is no label strictly speaking, but the French Association of Urology can provide information to patients”, suggests Jean-Nicolas Cornu.

Source: lefigaro

All tech articles on 2023-03-15

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