Česky
Incontinence is manifested by leakage of urine or stool or, conversely, the inability to defecate. It is associated with an almost constant urge to go to the toilet, as well as frequent abdominal pain. Urinary incontinence affects up to 2,000,000 people in the Czech Republic and affects everyone, especially women, often even women after childbirth. Most of the time, it is a problem with an overactive bladder, where the patient feels a constant need to urinate, or, on the contrary, with urinary retention (urinary retention). Stool incontinence is less common, but it is burdened with an even greater stigma. It affects about 3.5% of people under 60 and up to 15% of people over 70. It is manifested by spontaneous leakage of faeces (even if only to a small extent in the form of 'spotting') or by retention of faeces and inability to defecate. Urinary and faecal incontinence does not affect only the elderly; young people also have problems with both types.
What is to blame?
There are several causes, not always fully known. Urinary incontinence most often occurs after nerve disruption in the pelvic floor area (often the result of surgery), also as a result of complicated childbirth and associated postpartum injuries. Furthermore, after accidents that injured the spinal cord or brain, but stress can also be to blame. However, incontinence can also accompany a stroke, multiple sclerosis or diabetes.
Incontinence as a major social problem
Incontinence limits people in every way and in all activities. And it's not just about holidays, hobbies or sports, but also very ordinary activities such as going shopping, taking public transport or going out for coffee with friends. Some patients overlook the symptoms because they are not "life-threatening", but the disease usually gets progressively worse, and they get used to it. In addition, shame often prevents them from solving problems and they very often shut themselves in their homes. Patients are not helped by the high social stigma. The disease is not talked about much, they feel judged and misunderstood, and society does not seem to want to get its hands dirty with them. "There are several treatment options, and something different suits each patient, so the most important thing is that they solve their problems in time and don't let it go too far. The most successful treatment is usually the one that starts early," explains MUDr. Julius Örhalmi, Ph.D., FASCRS, MBA from Hořovice Hospital.
A method called sacral neuromodulation offers a permanent solution. It is a minimally invasive procedure that can relieve the patient of his or her problems, or at least make him or her feel much better. The patient returns to the time when his problems did not limit him so much. A small stimulator is inserted under the skin of the buttocks and connected to an electrode placed in the sacrum. This sends out weak impulses and helps restore the brain-pelvic floor connection, giving the correct information about bladder fullness, the need to empty, etc. The battery lasts for 7 years, then the whole device is replaced. The procedure is fully covered by health insurance. As of June 2024, a new stimulator Interstim X is registered, which will last 10-15 years without a charge.
"The sacral neuromodulation method is an effective but at the same time maximally gentle method with excellent long-term results. It is normally performed in two steps, first the electrode is implanted "on trial", for fourteen days the effectiveness of the therapy and the stimulation settings are tested, at this stage it is controlled by an external stimulator. In the second phase, a long-term stimulator is implanted into the area above the coccyx "permanently". The procedure is reversible; should the causes of incontinence disappear over time, the device can be easily removed," says Julius Örhalmi, M.D., Ph.D., FASCRS, MBA.
One method, happy patients
Mrs. Beranek began having incontinence problems after giving birth. She started to solve everything right away, but she encountered a lack of information. Moreover, she did not meet with much understanding at work, and lost her job several times because of her problems. Now she is setting up a patient organisation that should be there for patients like herself. "Colleagues at work and friends wondered why I had to go to the toilet all the time, I even lost my job twice because of it. As I was plagued by both types of incontinence, urinary and faecal, doctors repeatedly recommended an outlet - but I was very resistant to the 'bag' and tried to find another solution. After about 18 years of difficulties, I learned about the sacral neuromodulation method. Although my problems have not yet been 100% resolved, the procedure has relieved me considerably. And because I know what it is like to struggle with the disease and to be in an information vacuum, I decided to start a patient organisation to help other patients find solutions and support each other," says Ms Beránková.
Pavel Řeřicha, who started suffering from internal haemorrhoids when he was 44, also has a neurostimulator that helps. Several surgeries followed, but the problems kept coming back until, on his doctor's advice, he got sacral neuromodulation, which helped him to live a normal life again. "The most important thing is not to be afraid, not to be ashamed, to go to the doctor and talk openly about your problems. And also not to settle for a solution that would limit the person, but to look for one that will allow him to live again," recommends Mr Řeřicha.
Where to go for help
The sacral neuromodulation procedure can be performed in specialised centres in six locations in the Czech Republic. Urinary incontinence is dealt with at the Motol and Ostrava hospitals, while faecal incontinence is dealt with at the Bulovka Hospital, Hořovice Hospital, the Brno FNUSA, the Olomouc Hospital and now also at the Ostrava Hospital. In the Czech Republic, patients have been able to use this method since 2018, since when almost two hundred patients have undergone the procedure. All information, as well as a questionnaire that can be filled out by those interested in the sacral neuromodulation treatment method, is available at www.bezomezeni.cz.
On 18 June 2024, from 8:00 to 15:00, the hospital will hold a counselling session for patients with urinary and faecal incontinence. These patients can come to the Surgical Clinic of the hospital (Coloproctology Outpatient Clinic, ground floor) at any time during these hours and consult with the doctors about treatment options.
