A study by urologists from the Brazilian Society of Urology (SBU), based on the Unified Health System (SUS) database, of the Ministry of Health, found that the covid-19 pandemic had an impact more important on surgeries for the treatment of urinary stress incontinence in states with the lowest human development index (HDI).
The North region was the most impacted, with a 72% reduction in hospitalizations, followed by the South (-69%), Center-West (-61%), South-East (-59%) and Northeast (-51%). In 2019, 300 urinary incontinence surgeries were performed in the North Region, within the scope of the SUS, rising to 97 in 2020 and 85 in 2021, in preliminary data.
In the other regions, the numbers are, in the same comparison, of the order of 888, 428 and 436, in the North-East Region; 3,220, 1,374 and 1,332, in the Southeast region; 1,736, 658 and 545, in the South Region; and 591, 235, and 233, in the Midwest. The average reduction was 61% in the number of hospitalizations for surgical treatment of urinary incontinence in 2021, compared to 2019: there were 2,631 hospitalizations in Brazil for this purpose last year, compared to 6,735 in 2019, before the pandemic.
This Monday (14), during the celebration of World Urinary Incontinence Day, the entity warns of the involuntary loss of urine, a problem that affects 45% of women and 15% of men over the age of 40 years. The communications director of the Brazilian Society of Urology (SBU), Karin Anzolch, pointed out, in an interview with Agência Brasil, that covid-19 has led hospitals and services to prioritize the care of the disease , postponing or even canceling elective surgeries.
Another factor reducing hospitalizations for urinary incontinence surgeries has been the fear of contamination, which has led people not to seek access to these procedures which do not offer an immediate risk of death. As a result, Karin admitted that “a very large pent-up demand is now being created”.
The most common type of urinary incontinence is stress incontinence, which usually occurs when a person laughs, coughs, sneezes, or exerts physical effort, such as lifting weights. In the early stages, treatment can be supplemented with pelvic physiotherapy, and surgery can even be avoided. In situations that worsen or persist after the first treatment, surgery is offered with excellent results.
“Today, more and more minimally invasive surgeries are being performed.” The doctor recalled that attitudes such as weight loss, adequate assistance during labor, avoidance of tobacco use and repeated efforts that do not have a good strengthening of the pelvic floor are important measures that urologists are considering to solve this type of problem.
Another type of urinary incontinence is urge incontinence. The person wants to urinate, but the bladder gives no warning. “The first warning is already accompanied by a strong urge to urinate and the person often ends up losing urine before reaching the bathroom.” In this case, the treatment is usually clinical, including taking care of the type and amount of liquid the person takes, avoiding caffeine, which also worsens this type of symptom, and physical therapy can be included in the treatment. . There are also oral medications that regulate the bladder. Surgical procedures are the latest option, involving botulinum toxin and the implantation of a type of pacemaker to control the bladder. “But still in its initial stages, the treatment is easier, because we have less invasive measures to treat the diseases,” observed the director of the SBU.
Karin Anzolch said that aging is one of the factors that can cause urinary incontinence, due to the loss of collagen which eventually weakens the support of the bladder and urethra, especially in women. The urologist cautioned that this should not, however, be thought of as a natural occurrence of old age. Other factors are births, family history. The more deliveries there are, especially vaginal deliveries, the more they can increase the risk of stress urinary incontinence, when accompanied by excessive weight gain.
“That’s why prenatal care is important.” In terms of family history, Karin recalled that there are women who suffer from this problem, that menopause can worsen. Prostate problems and neurological problems such as Parkinson’s disease, multiple sclerosis, strokes are linked to urinary incontinence.
Certain medications, such as diuretics, can contribute to these symptoms because they increase the sense of urgency to urinate, in addition to people who engage in high-impact physical activities. In the case of women, Karin reflected on the fact that they must work the pelvic floor to prevent this type of event. “It’s not just about working the outer muscles, but learning to work the muscles that close the pelvic floor below, which supports the bladder and urethra.” The president of the SBU, Alfredo Canalini, pointed out that these resources serve to treat or, at least, to reduce the intensity of the loss, thus improving the quality of life of the patients.
Throughout March, the Brazilian Society of Urology will alert the public to the importance of identifying symptoms and treating urinary incontinence. On social networks (@portaldaurologia), from today (14) there will be publications, Lives (live broadcasts) and videos with experts clarifying doubts on the subject.
On SBU Radio, there will also be special broadcasts, with a vocabulary accessible to the general public, in particular on urinary incontinence in children. According to Karin Anzolch, there is still a lot of ignorance and prejudice regarding the problem of urinary incontinence. Often a person who suffers from this nuisance ends up living with it for many years, either because they are unaware that there are treatment options or because they are ashamed to admit the problem to others.
The director of the entity clarified that, for children, the treatment is not the same as for adults. For a time, the child’s lack of control is accepted as normal, linked to the maturation of the neurological system, especially when loss of urine or stool occurs at night. From a certain age, however, one begins to suspect that incontinence requires treatment. “Because the urinary losses end up being quite limiting for the social life of these children, who end up experiencing situations of embarrassment, not sleeping with friends”.
It is known that some children may have this problem due to genetics. “Urinary incontinence in children is closely linked to family problems. If someone in the family already wets the bed, that child is more likely to have the problem as well,” Karin said. He also pointed out that, on several occasions, the antidiuretic hormone which should be produced at night does not work. However, this can be solved with simple medications, bladder training, physical therapy and alarms, so that the child learns to educate his bladder. Problems in the spinal cord or related to the formation of the urinary tract will require specific treatments, for each age group and situation, he indicated.
“Urinary incontinence is not a situation that is always treated in the same way. This must be remedied by individualizing the types, by age groups, by the most frequent causes, so that this situation can be controlled,” said the specialist.
Research published in Europe in 2021, involving nearly 17,000 people aged 40-74, found that many patients deal with the problem by reducing their fluid intake and using sanitary napkins; nearly two-thirds of patients have suffered from urinary incontinence for at least two years when they seek treatment; approximately 30% of patients who request a medical evaluation do not receive treatment; almost 80% are not even examined. “We have to change this game,” said Ailton Fernandes, director of the department of urinary dysfunction at the Brazilian Society of Urology.