Urinary incontinence - more than a medical problem. Episode 39

Monika Rachtan
I would like to extend a warm welcome to you to the next episode of the programme "Patient First". Did you know that up to 25 to 30% Polish women may have a problem with urinary incontinence? It might seem like just a medical problem. However, it is also a social problem, as many women experience stigma, both from society and from relatives. Most people think that incontinence is a problem of age and nothing can be done about it. But there are effective methods that can reduce the problem. I will talk about them today with my guest, Professor Vladimir Baranowski. Good morning, and a warm welcome, Professor.

Vladimir Baranowski
Good morning, and welcome very much.

Monika Rachtan
Professor, you are a urogynaecologist. What does this specialist do?

Vladimir Baranowski
Urogynaecology is a relatively new field, dealing mainly with problems of urinary incontinence and pelvic floor static disorders, i.e. lowering or prolapse of the genital organs, which is also partly associated with urinary incontinence.

Monika Rachtan
What are the worst words you have heard from a patient affected by incontinence and stigma?

Vladimir Baranowski
Patients in the practice often tell us that they are stigmatised by those around them who say they smell bad, which is related to chronic incontinence.

Monika Rachtan
Is this causing women to withdraw from social and professional life?

Vladimir Baranowski
Yes, it is quite common for women to limit their professional, social and family/personal activities.

Monika Rachtan
What is it about these ladies that makes them stop participating in family or social life?

Vladimir Baranowski
You could say that they become prisoners of their own room with a bathroom, because it is a place where they feel safe to use the toilet at any time because of an incontinence problem.

Monika Rachtan
And do these women experience mental health problems?

Vladimir Baranowski
Yes, depression is quite common, caused by isolation and reduced work activity, which leads to depressive behaviour.

Monika Rachtan
What scale are we talking about?

Vladimir Baranowski
The problem affects one in three, one in four women in our country. The differences between countries mainly concern the availability of treatment, but the problem is widespread worldwide.

Monika Rachtan
My understanding. I mentioned at the beginning that many ladies consider incontinence to be an age-related problem. But does it also apply to young women?

Vladimir Baranowski
Yes, it is also a problem for women much younger, of reproductive age, before menopause. It used to be thought that incontinence was a natural result of ageing. However, this is not a homogeneous group. There are different types of incontinence, such as urge urinary incontinence, which is a different functional disorder, compared to stress urinary incontinence, which is a more anatomical disorder. These types require different treatments.

Monika Rachtan
Is stress urinary incontinence associated with physical activity, such as climbing stairs?

Vladimir Baranowski
Yes, in more severe cases, even minor exertion can lead to uncontrollable urine leakage, for example when climbing or descending stairs, dancing, laughing, coughing, sneezing or lifting light weights like shopping.

Monika Rachtan
Do patients report that urinary incontinence also limits their sex life?

Vladimir Baranowski
Yes, especially those with the stress form of urinary incontinence. Functional disorders, such as overactive bladder, affect the sexual sphere to a lesser extent. It is possible to alleviate symptoms before intercourse, for example by taking bladder calming medication. However, in the case of stress urinary incontinence, the problem can be unexpected and stressful for the patient and their partner.

Monika Rachtan
Then it is not only the patient but also her partner who suffers the effects of incontinence. How would you describe the quality of life of female patients with this problem?

Vladimir Baranowski
It is important to distinguish between forms of incontinence. Dispositional incontinence significantly affects sexual, occupational and social life. Bladder overactivity causes the greatest discomfort, leading to frequent toilet use, which can result in depression and withdrawal from professional and social activities.

Monika Rachtan
What is the issue of stigma in the workplace? Do you know the story of a woman dismissed from her job because of incontinence?

Vladimir Baranowski
I have not encountered such a case directly, but patients come forward when the problem becomes unbearable. They know the topography of local bathrooms to deal with sudden urges.

Monika Rachtan
I ask about work because I read about a patient working as a cashier who lost her job because of her frequent visits to the toilet. It was very distressing for her.

Vladimir Baranowski
Awareness of this condition is low, not only among patients, but also among those around them. This is not only a problem in Poland, but also in developed countries. There is a lack of social acceptance and understanding.

Monika Rachtan
Only 50% people affected by incontinence discuss it with their doctor. Are patients ashamed to raise the subject?

Vladimir Baranowski
Yes, often patients do not mention it, especially if they come with another problem. However, increasingly patients are open to talking about incontinence. It is worthwhile for doctors, especially gynaecologists and urologists, to ask targeted questions, especially when they see a risk, such as in patients after multiple births or with genital static disorders.

Monika Rachtan
You said that primary care doctors, family doctors, should also ask about this problem. Is there any special test needed to diagnose urinary incontinence that is not available in the GP's office?

Vladimir Baranowski
It has been known for about 20 years now that a very simple test to determine incontinence is to ask the patient three questions about problems with continence, the circumstances of leakage and the frequency of events. This test, with a high degree of precision, allows a preliminary diagnosis. If the answers are inconclusive, then a urodynamic study is recommended, which is more specialised and may require referral to a urologist.

Monika Rachtan
What does this urodynamic study consist of? Is it an invasive examination?

Vladimir Baranowski
Urodynamic testing is quasi-invasive, involving the placement of sensors in the bladder and rectum. It is a longer test, requires preparation of the patient and may involve a risk of urinary tract infection after the test.

Monika Rachtan
I would like to convince our viewers that a GP can be a great first step to solving incontinence. It is not always necessary to see a specialist.

Vladimir Baranowski
The GP, knowing the basics of the diagnosis, can provide initial treatment, e.g. for overactive bladder. It is important to educate and make GPs aware of the prevalence of the problem and the diagnostic methods and treatment available, which can help patients at an early stage.

Monika Rachtan
What characteristics may predispose a woman to develop urinary incontinence? What can I do to apply prevention?

Vladimir Baranowski
There are modifiable risk factors such as smoking, excessive coffee consumption, chronic cough associated with lung disease, heavy physical work and obesity. Controlling these factors, such as smoking cessation and weight reduction, can reduce risk. Health-promoting behaviours such as physical activity and pelvic floor muscle training are also important and can act as a preventive measure.

Monika Rachtan
We talked about the fact that a diagnosis of incontinence does not mean that the patient has to suffer for the rest of her life. What treatment methods does the professor suggest to his patients to get rid of this problem?

Vladimir Baranowski
A correct diagnosis is crucial, because based on this, we select the appropriate treatment method. For urge incontinence, we recommend pharmacological treatment, based on the use of medications. There are two main groups of preparations available in Poland, including some that are reimbursed, although they have slightly more side effects, and newer, more effective, but not reimbursed and more expensive.

Monika Rachtan
Do patients have to use the treatment for the rest of their lives?

Vladimir Baranowski
Treatment is usually empirical, with several months of medication recommended, followed by a break and assessment of the condition. If the condition returns, therapy is resumed. Some patients may need to take medication intermittently for the rest of their lives and others do not respond to drug treatment, requiring other methods, such as Botox.

Monika Rachtan
What other treatment options are available?

Włodzimierz BaranowskiFor patients with stress urinary incontinence who do not respond to conservative treatment, surgical treatment is an option. This is a minimally invasive method involving the placement of a special tape under the urethra, which is very effective and with minimal risk of complications.

Monika Rachtan
How do you prepare for such a procedure and how long does the hospital stay last?

Vladimir BaranowskiPatients usually stay in hospital for a day or two. The healing process after surgery takes about 4-6 weeks, during which it is advisable to limit physical activity. After this period, patients are usually fully healed and can return to normal activity.

Monika Rachtan
Are there preparations, ointments, gels that help these to heal better? Is it worth telling your gynaecologist, for example, or is it necessary to see a dermatologist?

Vladimir Baranowski
Particularly if the problem is chronic and the lesions are advanced, it is worth consulting a dermatologist. However, it is possible to alleviate the discomfort with protective preparations such as moisturisers, including Vaseline, and others containing fatty acids that regenerate the skin.

Monika Rachtan
I saw on the website that, in addition to absorbent pads, special underwear is also available. Is it dedicated to a different problem or is it only used when the problem is very high?

Vladimir Baranowski
Special underwear is designed for people who do not qualify for other forms of treatment or who have very intense symptoms. The problem affects both men and women.

Monika Rachtan
Are these devices reimbursed?

Vladimir Baranowski
They are partially reimbursed. In milder cases, reimbursement may be enough, but in severe cases, reimbursement usually only covers part of the cost.

Monika Rachtan
Do you need a special procedure to benefit from a refund? Is it complicated?

Vladimir Baranowski
The procedure requires a certain amount of paperwork for reimbursement, but is not so complicated as to discourage its use. It is well worth taking advantage of the refund option.

Monika Rachtan
How do you convince relatives who have an incontinence problem to see a doctor?

Vladimir Baranowski
It is important to raise awareness that the problem of incontinence is not an inevitable part of ageing and there are effective, minimally invasive treatments available, including drug treatment. Highlighting the availability of effective methods may encourage people to seek treatment.

Monika Rachtan
It is often the case that people affected by a condition such as incontinence are embarrassed when they have to go to the pharmacy or shop for hygiene products. How can this situation be dealt with? How do you tell the pharmacist that you have come for such a product?

Vladimir Baranowski
A discreet form can be used, for example, writing on a piece of paper what we need. The pharmacist is aware of this issue and will be sure to issue the needed dressing without arousing unnecessary attention.

Monika Rachtan
The card is a great idea. More recently, special pharmaceutical care rooms have also been available in pharmacies. Patients can request a consultation there in private. How do you assess this solution?

Vladimir Baranowski
This is a very good idea. I wasn't aware of the possibility, but I'm convinced that as public awareness grows, attitudes to incontinence will change to a more forgiving one.

Monika Rachtan
What advice would you have for young people who may not understand incontinence and laugh about it?

Vladimir Baranowski
First of all, it is worth remembering that incontinence can affect anyone. Education and understanding are key.

Monika Rachtan
What are the three most important lessons from today's programme that every one of our viewers should remember?

Vladimir Baranowski
Awareness that incontinence is a common condition, there are effective treatments, and the need to minimise risk factors such as obesity and smoking.

Monika Rachtan
We have mainly talked about women, but urinary incontinence also affects men. How common is this problem in men?

Vladimir Baranowski
As a gynaecologist, I see women more often, but urinary incontinence is also a significant problem in men, often associated with prostatic hyperplasia.

Monika Rachtan
What support do women struggling with incontinence expect from their partners?

Vladimir Baranowski
Support is very individual and depends on the harmony in the relationship. The presence of the partner during counselling visits can be an expression of this bond and support.

Monika Rachtan
What does the humanisation of medicine mean to you?

Vladimir Baranowski
Humanising medicine is about individualising the patient and tailoring treatment to their unique needs and situation, rather than treating them in a template.

Monika Rachtan
It is very important that patients have access to such a personalised approach. Thank you for talking to us and for highlighting the importance of education and support in the context of incontinence.

Vladimir Baranowski
In summary, education and proper communication are key to ensure that patients know they are not alone and have access to effective treatments.

Monika Rachtan
What more can we journalists do to better educate this public? Is this such a systemic problem that exists in our country? Are there any simple methods we can use to deal with it sooner?

Vladimir Baranowski
The main thing is what attractive form this necessary information and information is given in. First of all, honestly, realistically assessing the situation, and this is probably the best moment for such a patient to take advantage of such a proposal, Be aware that there is such a thing and be able to use it.

Monika Rachtan
Awareness is very much needed. I hope that our format was attractive to you today, that you gained a lot of information and that we convinced people who have a problem with incontinence to see a doctor and deal with this problem effectively. Professor, thank you again for talking to us. Thank you for your attention.