Unintended loss of urine restricts many women in their daily activities. In the summer, they suffer even more than usual from not having control over their bladder. This would not be necessary as there are therapies available even for severe cases of incontinence. Cornelia Betschart is a senior attending physician at the Department of Gynecology and a specialist in urogynecology at the University Hospital Zurich (USZ), and she is familiar with the treatment options.
Ms. Betschart, advertising addresses nowadays incontinence more openly, with special hygiene products being promoted and offered in supermarkets. Did the stigma around this topic disappear?
Above all, this shows that the problem is widespread. These products are certainly helpful for those affected. However, they should not lead to the impression that there are no effective treatment options available. And: the stigma is still present. Those affected often try to manage the problem on their own for far too long and only discuss it with their general practitioner or gynecologist when they are already suffering a lot. The right treatment can not only alleviate the symptoms but also, in some cases, restore complete control over bladder emptying.
When do we call it incontinence?
People affected of incontinence can no longer control the emptying of their bladder. This results in an involuntary loss of urine. The extent of the problem can vary greatly, but it significantly impairs the quality of life for all people affected. Depending on the cause, incontinence is also associated with other symptoms.
Why are the majority of those affected women?
Female anatomy makes women more prone to bladder weakness. Many are aware of the fact that the weakening of the pelvic floor due to pregnancy and childbirth can be the cause of incontinence. However, other changes around the bladder, in the bladder itself, heavy lifting or simply aging can also lead to incontinence.
So the first step is to determine the exact cause?
For a targeted and effective therapy, it is fundamental to know whether the cause is an organ prolapse, a pelvic floor weakness or problems with the bladder itself, for example with the sphincter muscle. We also distinguish between different forms of incontinence, depending on whether urine loss occurs during stress, e.g. due to coughing or exercise, or whether there is a constant urge to urinate. The first person to talk to for examination is the general practitioner or gynecologist.
Which treatment options are available?
The spectrum of treatments ranges from toilet training with a “bladder diary”, exercises to strengthen the pelvic floor and personalized pelvic floor physiotherapy to various surgical procedures. Depending on the cause, medication or hormone treatments can also help. However, some forms of urinary incontinence can only be corrected through surgery.
Could you explain the surgical procedures performed at the USZ?
Most often, we restore the tightness of the urethra. This can be achieved by placing a sling around the urethra. To support the urethra, it can also be narrowed with fillers, known as gels. One of the rarer forms of incontinence is extraurethral incontinence, where urine exits through incorrect pathways, i.e. fistulas. Such corrections must be done by physicians working at a specialized pelvic floor center. In the case of an organ prolapse, it is possible to lift it surgically back up to reduce the pressure on the urethral obstruction, which leads to urine loss. An overactive bladder can be calmed with a so-called bladder pacemaker. Adjusting the pacemaker also allows reactivating a bladder that no longer empties itself. Whenever possible, all surgeries should be minimally invasive and without abdominal incision. Some procedures can also be performed on an outpatient basis or require only local anesthesia.
At the USZ, a specialized team treats patients with incontinence problems. Who is part of this team?
The examinations and treatments take place in our urogynecological consultation hour of the Department of Gynecology and are done by experienced specialists in urogynecology who themselves also conduct research and are familiar with the latest therapies. They work with an interprofessional team of specialized urotherapists and physicians for the different therapies. We also have patients who seek a second opinion before deciding on treatment.
What can I do to prevent incontinence?
A strong pelvic floor can not only prevent incontinence but also contribute to avoiding back problems and tensions in the neck/shoulder area. Exercising regularly leads to controlled release of urine, gas, or stool, and pays off in various ways. Excess weight can also weaken the pelvic floor and worsen existing incontinence. To reduce stress on the pelvic floor, it is advisable to try to lose excess weight.