The World Health Organization (WHO) declares that in different countries, 10-30% of people are exposed to urinary incontinence (incontinence). Patients. In Lithuania, there are no official statistics on the incidence of urinary incontinence, but doctors say that they encounter patients who are bothered by this problem on a daily basis. The good news is that cases of urinary incontinence – even at an advanced stage – can be contained.
Incontinence impairs the quality of life of people
According to Aivaras Grybas, a urologist at VUL Santaros Clinics , urinary incontinence has a completely negative effect on a person’s life – it interferes with physical activity, working capacity, opportunities to travel, play sports, participate in events. Women who are faced with urinary incontinence after childbirth often also experience discomfort in the area of intimate life. Urinary incontinence also affects men emotionally and physiologically – it is not uncommon for them to refuse full-fledged sexual intercourse.
Negatively, this problem affects not only the person himself, but also the partner next to him, who also has to give up certain activities.
“I had a patient who told me that due to urinary incontinence and an unpleasant smell, grandchildren do not come to him at home. How painful it is and important for a person. After solving such a problem, self-confidence returns and the quality of life improves,” says the urologist.
Causes of urinary incontinence
Aušra Černiauskienė, a urologist and associate professor at VUL Santaros Clinics, notes that urinary incontinence bothers women three times more often, but people who have reached a respectable age suffer equally often.
Although the causes of this ailment can be varied, in young and middle-aged people, urinary incontinence is most often caused by anatomical changes in the lower urinary tract or impaired activity of the bladder, urethral fold. In the elderly, this disorder can be caused by chronic diseases (for example, obesity, diabetes mellitus), excessive use of medications, a decrease in functional capacity. Other factors that can lead to urinary incontinence are also noted: decreased mobility, hormonal changes, spinal and head injuries, radiation therapy, heart failure, constipation, fecal incontinence and other causes. Most often they are complex.
According to A. Černiauskienė, in men, urinary incontinence most often occurs after operations to remove the prostate gland, and in women the risk of urinary incontinence grows with the number of natural births, especially in cases of complicated or large fetal births. Also, the risk increases after various gynecological diseases, for example, due to the appearance of descent of the pelvic organs, weakening of the muscles of the pelvic floor.
If you do not go to the doctors, time is lost
Darius Trumbeckas, a urologist and associate professor at Kaunas Clinics, says that women most often face urinary incontinence already after menopause. However, according to D. Trumbeck, there are also younger patients, about 35-40 years old, who are bothered by this unpleasant disease.
The urologist reassures those who fear that it will be late to go to doctors, but urges not to delay the decision to undergo treatment: “Urinary incontinence is not an oncological disease. A person will not be late for the doctor, but he will lose time. If urinary incontinence is significant, if you can’t cure it with physiotherapy or medication, there’s nothing to look forward to.”
D. Trumbeckas observes that men who are operated on for prostate cancer usually turn to incontinence at the age of 50-70 for urinary incontinence, but sometimes 80-year-olds also arrive – usually they have put up with urinary incontinence for 5 or even 10 years.
Urologist A. Grybas seconds that older people often delay the problem, believing that urinary incontinence is a consequence of old age. The smell of urine in the house could signal to loved ones that a person should be offered help.
“I advise you to encourage your elders to go to the doctors. It is always possible to at least inform them about possible hygiene and treatment measures,” advises A. Grybas.
According to him, nowadays the state provides lithuanian patients with support to solve the problem of urinary incontinence. Compensates both pads and diapers, as well as surgical and non-surgical means of treatment.
According to A. Grybas, urinary incontinence can be distinguished into three types: tension, urgency and mixed urinary incontinence. Also, urinary incontinence is divided into mild, medium and high degrees.
“Although it is difficult to accurately determine the degree, the expected indicators are observed: if less than 200 ml of urine per day is lost, then this is a mild degree of urinary incontinence. If 200-400 ml – medium, if more than 400 ml – high degree,” the doctor explains.
Also, doctors ask patients how many pads they consume per day. If 3-4 pads are needed, it is likely that a person has a moderate degree of urinary incontinence, if more than 4 – of a high degree. Of course, the amount of pads consumed also depends on the type of pads, the patient’s hygiene habits.
Minimally invasive treatments – extremely effective
According to A. Grybas, the treatment of urinary incontinence is divided into interventional and non-interventional (or conservative) methods of treatment. Conservative treatments include medications, physiotherapeutic measures, interventional (or minimally invasive) – implantation of the subscapular ligament or artificial sphincter.
According to A. Černiauskienė, in patients with mild and moderate degrees of urinary incontinence, since 2008, the implantation of subscapular ligaments in the Urology Center of Santara Clinics began to be implanted, in case of severe urinary incontinence – an artificial sphincter of the bladder. Since 2014, an innovative method of treatment has been introduced, replacing the sphincter of the bladder with a new ATOMS system. According to the literature, after the new implantations, good results are reported up to 84.2-92 percent. Cases.
D. Trumbeckas adds that in Kaunas clinics , patients suffering from urinary incontinence are treated with the same methods – by implanting the sublapsal ligaments, ATOMS systems or artificial sphincters.
Since 2018, these expensive means of treating urinary incontinence are included in the list of centrally purchased medical devices. This means that these medical aids are centrally purchased by the State Health Insurance Fund under the Ministry of Health (VLK) and are reimbursed from the budget of the Compulsory Health Insurance Fund. In this way, the means purchased by the VLK are delivered to medical institutions that apply these methods of treatment and are available free of charge to all patients suffering from urinary incontinence.
According to A. Grybas, the treatment is effective, and there are not many contraindications that would require the abandonment of these minimally invasive surgical treatments: they are usually not performed in cases where such concomitant diseases as coagulation disorders, significant heart failure, obesity of the highest degree predominate.
“However, each case is individual, it is decided together with the patient, for example, before the operation he is subjected to cardiological, dietetic or other preparation. Of course, patients who are faced with the problem of scarring of the urethra after radiation treatment for prostate cancer pose more challenges, but they can also be helped,” says the medic.
He emphasizes that patients dealing with urinary incontinence should first go to the family doctor and after receiving a referral to come to the urologist for a consultation – then after carrying out the necessary tests, the most appropriate treatment is selected.
Treatment results often exceed patients’ expectations
According to A. Grybas, there are many patients who are delighted with the good results of surgical treatment. Many of them were convinced that the changes caused by urinary incontinence were irreversible.
“We have a lot of testimony from patients who, after 10 or more years of such operations, enjoy a significant improvement in the quality of life,” he notes.
Urologist D. Trumbeck agrees that implants can significantly reduce urinary incontinence in men and women. According to him, the use of just one pad per day after the intervention is a good result of treatment, since absolute dryness is a thing created by nature, and not man.
Meanwhile, A. Černiauskienė remembers the story when a 62-year-old man was diagnosed with prostate carcinoma in 2018 and underwent a radical operation to remove the prostate gland. After the operation, the patient developed urinary incontinence during physical exertion, he consumed 3-4 pads per day.
The man was prescribed conservative treatment, which, if not justified, the patient in 2020. an adjustable sub-wet ligament was implanted. In the absence of the desired results, in 2023. the patient was implanted with the ATOMS system, after which he wore one pad per day. It was decided to carry out the replenishment of the ATOMS system.
“Six months after the replenishment of atoms, the patient began to hold urine well, urinated normally, he no longer needed pads. Now he lives a full life, he is satisfied with the results of the operation,” says the doctor.
D. Trumbeckas is pleased that in a decade the treatment options for urinary incontinence in Lithuania have improved and are not inferior in anything to the treatment methods used in Western countries.
