Incontinence is still a shamefully concealed problem - but there are also good treatment options for severe cases. Cornelia Betschart, Deputy Chairman Director of the Clinic for Gynecology and Co-Head of the Continence and Pelvic Floor Center at the USZ.
The subject of incontinence is dealt with more openly in advertising, special hygiene products are advertised and offered in supermarkets. Has the shame on the subject disappeared?
Above all, we can see from this that the problem is widespread. These products are of course helpful for those affected. However, they should not lead to the impression that there are no effective treatment options. The shame is still there. Those affected often try to cope on their own for far too long and only talk to their family doctor or gynecologist when the level of suffering has become too high.
How can shame be overcome?
Doctors can help by talking to their patients about bladder control and involuntary loss of urine of any size and not waiting for them to bring up the subject. We still see that older women in particular think that “a little incontinence” is normal with increasing age. However, the right treatment can not only alleviate the symptoms, but in many cases also restore complete control over bladder emptying.
Why are women affected in the vast majority of cases?
The female anatomy makes women susceptible to bladder weakness. Many people are aware that a weakening of the pelvic floor due to pregnancy and childbirth can be the cause of incontinence. But other changes around the bladder, in the bladder itself, heavy lifting or simply old age can also lead to incontinence.
Where does the therapy start?
When clarifying the cause. For targeted and effective therapy, it is essential to determine whether the cause is organ prolapse, pelvic floor weakness or problems with the bladder itself, for example with the sphincter. It is also important to know whether the loss of urine occurs under stress, e.g. through coughing or during sport, or whether there is a constant urge to urinate.
What treatment options are available?
The spectrum ranges from toilet training with a “bladder diary”, exercises to strengthen the pelvic floor and individual pelvic floor physiotherapy to various interventions. Depending on the cause, medication or hormone preparations can also help. However, some forms of urinary incontinence can only be corrected surgically.
Can you explain the surgical procedures performed at the USZ?
We most frequently restore the tightness of the urethra. This can be achieved with a band that is inserted around the urethra. To support the urethra, it can also be narrowed with filling agents known as gels. Stem cells from the body’s own muscles can also restore urinary closure; we are using these in a study. Extra-urethral incontinence is one of the rarer forms of incontinence. The urine is drained via fistulas. It is essential that they are corrected by doctors at specialized pelvic floor centers.
In the case of organ prolapse, it is possible to surgically lift the organs again and thus reduce the pressure on the urethral obstruction, which in these cases can suddenly make it difficult to empty the bladder. An overactive bladder, also known as an irritable bladder, can be calmed with a so-called bladder pacemaker. A bladder that no longer empties itself can also be reactivated by changing the settings of the pacemaker. Whenever possible, we perform all operations in a minimally invasive manner and without an abdominal incision. Some procedures can also be performed on an outpatient basis or only require local anesthesia.
At the USZ, patients with incontinence problems are treated by a specialized team. How is it put together?
Assessments and treatments are carried out in our urogynaecology specialist consultation at the Clinic for Gynaecology by experienced specialists in urogynaecology who also carry out research themselves and are familiar with the latest therapies. At the Pelvic Floor Center, we work closely with our colleagues from Visceral Surgery and Urology. Behind this is an interprofessional team of specialized urotherapists and doctors for the various therapies. We also advise patients who would like to obtain a second opinion before deciding on treatment. Patients can register for the consultation themselves or their family doctor or gynecologist can refer their patients to us.
