Between 3 and 5 million women would be affected by urinary incontinence.

Still taboo, this disorder can prove to be very disabling in daily life, disrupting the professional, private and social life of patients.

Yannick Rouach, urologist surgeon, takes stock in Sans rendez-vous, on Europe 1, to deconstruct received ideas.

DECRYPTION

Urinary incontinence is a common problem, which affects around 3 to 5 million women, according to the various studies available.

Yet it is still taboo for many patients, of all ages.

To better understand the origin of these leaks, which can be very disabling, but also how to fight them, Yannick Rouach, doctor at the Private Hospital of Antony, in Hauts-de-Seine, takes stock of the symptoms. , treatments and received ideas around urinary incontinence.

What are the different types of urinary incontinence?

There are generally two types of urinary incontinence: stress or urgency.

The first is more common in young women.

"It is not uncommon to see women in consultation who are between 30 and 40 years old", explains doctor Yannick Rouach.

This category designates the fact of losing urine during an effort: brisk walking, sport, coughing, sneezing.

These leaks, which correspond to approximately half of the consultations, are linked to "fatigue of the perineum": "the muscles of the perineum which are supposed to support the bladder and the urethral canal are a little relaxed", specifies the doctor.

"During the effort, instead of being supported by these muscles, the bladder and urethra are loose."

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Urinary incontinence due to urgency corresponds to urgent and irrepressible cravings that cause some leaks.

The bladder is unstable.

"Urgency is rather linked to aging phenomena, because the neurological mechanism of the bladder ages with age", explains Yannick Rouach.

"And to hormonal phenomena: when you are peri-menopausal or menopausal, you have fewer hormones, the bladder becomes disordered. The cravings are a little chaotic and sometimes irrepressible."

Incontinence can also be mixed, that is to say, combine the two types of urinary leakage mentioned above. 

From when should we talk about it?

If everyone can occasionally have urinary leaks, it is important to talk about it when the problem becomes recurrent, underlines urologist Yannick Rouach.

"If we start to adapt our pace of life, no longer want to go out, run, have to wear protection, we must talk about it," he says. 

"The earlier we consult, the better. Urinary leaks when they are beginners, occasional and not too impacting in everyday life, we have time to treat them and we can do it with 'small means' ", he adds.

How is the diagnosis made? 

"The first contact is always the attending physician", explains Yannick Rouach.

The general practitioner will thus be able to carry out the first examinations and eliminate certain hypotheses such as urinary tract infection, which sometimes leads to leaks.

He then refers to a consultation with a urologist.

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The consultation is a consultation of the gynecological type.

The doctor observes the trophicity of the vagina, or all the mechanisms that allow the nutrition and growth of an organ.

He thus checks the hydration, the presence of hormones etc, but also that the patient does not present the symptoms of a prolapse, a descent of organs, which can also lead to urinary leaks.

This consultation allows the urologist to differentiate the type of incontinence: urgency or effort.

Stabilizing the bladder is the first concern. 

Why is the subject still taboo?

If this disorder concerns millions of people, of all ages, the subject is still delicate to tackle.

Many women think that urinary incontinence is still "a must."

"There are women who will never have problems, it depends on the individual characteristics, more or less toned perineum", answers Yannick Roach.

"It is very common but it is not 'normal'."

You should therefore not hesitate to consult to resolve these disorders which can upset daily life: professional, social or even sexual.

"It's taboo because it reminds us of aging, these are excretory functions: stool, urine, it's not sexy," laments the urologist.

"It's also taboo because we see advertisements everywhere or even on shelves in protective supermarkets, so we don't have the impression that this is normal."

What are the effective treatments? 

For urinary leakage during exertion, the problem is muscular.

The first effective treatment for 60% of cases is therefore rehabilitation of the perineum, with a physiotherapist or with exercises to be performed at home.

"There are dietetic and hygienic rules that can apply, but if physiotherapy is not effective then there is no medical treatment", explains Yannick Roach.

In this case, it is necessary to go through a surgical operation, minimally invasive, practiced for twenty years and supported by health insurance.

"The principle is to support the urethral canal: we put in place a suburethral strip, made of fabric, under general anesthesia or spinal anesthesia [the lower body, note]", explains the surgeon-urologist.

"We make a small incision in the vagina, we slip the strip. The woman wakes up, urinates and goes home. It's an outpatient procedure."

Daily life can resume the next day and it takes three weeks before resuming physical and sports activity.

The success rate of this intervention, when the patients are well selected because they will not all be eligible for the operation, is about 95%. 

In cases of urinary incontinence due to urgency, local hormone-based treatments stabilize the bladder and thus limit leaks.