It affects 19% of women between 18 and 85 years old. THE’urinary incontinence effort consists of urine leaks uncontrollable, which occurs during physical exertion such as exercising, dancing or carrying a weight. Even if three million women are concerned in France, only one million of them see a doctor. And when they do, they talk more about leaks than incontinence. “The word incontinence itself poses a problem, it is still taboo because it remains associated with old age.“, deplores Professor François Haab, urological surgeon at the Hospital des Diaconesses (Paris). However, this disease concerns young, active, often athletic women and will then be a source of shame, embarrassment,anxiety or even of depression.
“Incontinent women often lose their self-esteem and their femininity. Embarrassment is pervasive, even in their sexuality, for fear of leaking during sex“develops Laure Mourichon, physiotherapist and sex therapist in Vincennes.
Weak perineum or urinary sphincter
Physically, stress urinary incontinence results from a relaxation of the urinary sphincter, the muscle that encloses the urethra and closes the bladder, or from an alteration of the tissues of the urethra. perineum. “The perineum is an intimate muscle, often taboo, the size of a hand. It extends from the pubis to the coccyx and the ischia, and is pierced with three orifices (the urinary meatus, the vagina and the anus)“describes Laure Mourichon.”In addition to its role in sexuality, it also ensures urinary and fecal continence and the maintenance of the genitals by preventing the prolapse(or organ descent)“She adds. If it loses elasticity or firmness, it will no longer be able to fully fulfill its missions. Several factors affect its integrity and therefore increase the risk of urinary leakage.
To identify urinary incontinence with certainty, the doctor or physiotherapist asks questions about back problems, sexuality, the number of urinations per day and the number of pregnancies. He will ask the woman to cough to check for leaks, to push to check for organ descent, and to contract the perineum to measure her muscle strength.
Pregnancy, tobacco and chronic constipation: risk factors for urinary leakage
The pregnancy is one of the leading causes of incontinence: “being pregnant is a risk factor in itself, because of being overweight“, explains Laure Mourichon. vaginal birth further increases the risk because it puts a lot of strain on the perineum. “And the more difficult the birth, the more lesions there will be in the muscles of the perineum and the urinary sphincter.“explains Professor Haab. The cough, the chronic bronchitis, the menopause and the constipation chronic are also risk factors because they reduce the effectiveness of the urinary sphincter. the tobacco also plays a negative role on incontinence since it promotes coughing and decreases the quality of muscle tissue. Finally, some professions harm the condition of the perineum and are therefore favorable to urinary leakage. For example, “women who work in professions where they lift weights daily (nurses, housekeepers, handling professions, etc.) or professional sportswomen are more likely to report stress urinary incontinence“, warns Laure Mourichon.
Physiotherapy, operation, vaginal device … what solutions against urinary leakage?
“The first solution that comes to mind when talking about urinary incontinence is the use of protections. It’s a shame, because it’s not inevitable and other less uncomfortable answers exist“, underlines Professor Haab. To treat incontinence, it will be necessary to act on the perineum or on the urethra to prevent the occurrence of leaks.
The first recourse consists of a perineal rehabilitation at a physiotherapist. In addition to the weekly sessions, it will be important to do exercises alone at home to ensure the success of the rehabilitation. This will include three types of work, according to Laure Mourichon:
– manual work with a contraction of the perineum to become aware of the existence of the perineal muscle and control the locking of the perineum before and during the effort
– work by intravaginal probe connected to a computer (or biofeedback) to visualize the contractions of the perineum
– work by electrostimulation which helps to feel the perineum, to strengthen the urinary sphincter and therefore to improve continence on an ad hoc basis.
The strips, a surgical solution
Although rehabilitation teaches you to control the perineum, it is not always easy to contract this muscle permanently. Physical solutions can then lend a hand to women suffering from stress incontinence. First, a surgical operation involves placing a synthetic sling in support of the urethra, to help control the leakage. Another solution: a silicone vaginal device that complements rehabilitation to increase the woman’s urinary autonomy. This tool called Diveen® and marketed by the medical group B. Braun, is placed in the vagina, like a tampon, using an applicator. “When exerted, the urethral canal becomes blocked on the device located behind, in the vagina. It is therefore locked thanks to the contact of a solid floor“describes Professor Haab.
Its effectiveness has been estimated at 69% by a scientific study * involving 29 women. It generates little or no discomfort, women can keep it on for a whole day, even when going to the bathroom. As an additional advantage, it is used by physicians as a diagnostic tool because the patient’s assessment and feelings constitute invaluable information in order to best adapt care to her personal situation.
Each woman can choose the solution that suits her best, by talking to a doctor or physiotherapist. In all cases, the first step is therefore to break the taboo of urinary incontinence for regain self-confidenceand no longer fear the sudden coughing fit or the irresistible urge to dance.
* Cornu, JL., Mouly, S., Amarenco, G., Jacquetin, B., Ciofu, C. Haab, F. 75NC007 device for noninvasive stress urinary incontinence management in women: a randomized controlled trial. International Urogynecology Journal. December 2012, Volume 23, Issue 12, pp 1727-1734 DOI 10.1007 / s00192-012-1814-z (http://www.ncbi.nlm.nih.gov/pubmed/22588140)
Source : Diveen® launch press conference, organized by B. Braun on June 3, 2016. Interventions by Professor François Haab, urological surgeon at the Hospital des Diaconesses (Paris) and Laure Laure Mourichon, physiotherapist and sexologist in Vincennes.
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