A study carried out by urologists from the Brazilian Society of Urology (SBU), based on the database of the Unified Health System (SUS), of the Ministry of Health, revealed that the covid-19 pandemic had a greater impact on surgeries for the treatment of incontinence. urinary effort 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%), Midwest (-61%), Southeast (-59%) and Northeast (-51%) regions. In 2019, 300 urinary incontinence surgeries were performed in the North Region, within the scope of the SUS, falling to 97 in 2020 and to 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 Northeast 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, against 6,735 in 2019, before the pandemic.
World Day
This Monday (14), when the World Urinary Incontinence Day is celebrated, the entity warns about the involuntary loss of urine, a problem that affects 45% of women and 15% of men over 40 years of age. The communication director of the Brazilian Society of Urology (SBU), Karin Anzolch, highlighted, in an interview with Brazil Agencythat covid-19 led hospitals and services to prioritize the care of the disease, postponing, or even canceling, elective surgeries.
Another factor for the reduction of hospitalizations for urinary incontinence surgeries was the fear of contamination, which led the population not to seek access to these procedures, which do not offer an immediate risk of death. With that, Karin admitted that she is now creating “a fairly large pent-up demand”.
types
The most common type of urinary incontinence is stress incontinence, which usually occurs when a person laughs, coughs, sneezes or makes some physical effort, such as lifting weights. In early stages, treatment can be complemented with pelvic physiotherapy, and surgery may even be avoided. In situations that become more serious, or that 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, avoiding the use of tobacco and repeated efforts that do not have a good strengthening of the pelvic floor are important measures that urologists consider in addressing 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 desire 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 fluid 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 last solution, involving botulinum toxin and implantation of a type of pacemaker to control the bladder. “But always in its early stages, treatment is easier, because we have less invasive measures to treat diseases”, observed the director of the SBU.
Factors
Karin Anzolch said that aging is one of the factors that can cause urinary incontinence, due to the loss of collagen that ends up making the support of the bladder and urethra more fragile, especially in women. The urologist warned that one should not think, however, that this is a natural event of old age. Other factors are births, family history. The greater the number of deliveries, especially vaginal deliveries, they can increase the chance of stress urinary incontinence, when they are accompanied by an exaggerated 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 get worse. Prostate problems and neurological problems such as Parkinson’s disease, multiple sclerosis, stroke are linked to urinary incontinence.
Some medications, such as diuretics, can contribute to these symptoms because they increase the feeling of urgency to urinate, in addition to people who do high-impact physical activities. In the case of women, Karin pondered that they have to work the pelvic floor to prevent this type of occurrence. “It’s not just working the external 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, stressed that these resources serve to treat or, at least, reduce the intensity of the loss, improving the quality of life of patients.
Awareness
Throughout March, the Brazilian Society of Urology will alert the population about the importance of identifying symptoms and treating urinary incontinence. On social media (@portaldaurologia), starting today (14), there will be posts, lives (live broadcasts) and videos with experts clarifying doubts on the subject.
On SBU Radio, there will also be special programs, with vocabulary accessible to the general public, including on urinary incontinence in children. According to Karin Anzolch, there is still a lot of ignorance and also prejudice in relation to the problem of urinary incontinence. Often, a person who suffers from this nuisance ends up living with it for many years, either because they ignore that there are treatment options or because they are ashamed to admit the issue to other people.
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 the loss of urine or feces occurs at night. From a certain age, however, one begins to suspect that incontinence needs some treatment. “Because urinary loss ends up being quite limiting for the social life of these children, who end up going through situations of embarrassment, not sleeping at a friend’s house”.
It is known that some children can have this problem because of genetics. “Urinary incontinence in children is closely linked to the family issue. If someone in the family already wets the bed, that child is more likely to have the problem as well,” Karin said. She also pointed out that, often, the antidiuretic hormone that should be produced at night does not work. However, this can be solved with simple medications, bladder training, physical therapy and alarms, for the child to learn to educate their bladder. Spinal cord problems or problems linked to the formation of the urinary tract will need specific treatments, for each age group and situation, she indicated.
“Urinary incontinence is not a situation that is always treated in the same way. It must be addressed by individualizing the types, by age groups, by the most common causes, so that this situation can be brought under control”, said the specialist.
Quality of life
Research published in Europe in 2021, involving almost 17,000 people between 40 and 74 years of age, revealed that many patients deal with the problem by reducing fluid intake and using sanitary pads; almost two-thirds of patients have had urinary incontinence for at least two years when they seek treatment; about 30% of patients who seek medical evaluation do not receive treatment; almost 80% are not even examined. “We need to change this game”, highlighted Ailton Fernandes, director of the Urinary Dysfunction Department of the Brazilian Society of Urology.
