Why urine leakage is abnormal and not a matter of age

Pelvic floor care is “very important” to women’s health, but we don’t know about it and don’t give it the importance it deserves.

“The pelvic floor is a part of the human body that, in the specific case of women, can be affected by various risk factors that contribute to the development of pelvic floor problems, such as loss of urine, feces or gas, sexual dysfunction or pelvic organ prolapse, i.e. prolapse located in the pelvis.”

Dr. Maria Torres Lacomba is a physiotherapist specializing in women’s health and a researcher at the University of Alcalá (UAH). He assures that “knowledge and ability to control the pelvic floor muscles will protect us from future problems.”

This indicates the need to focus on this part of the human body, especially in women, since “menopause, prolonged participation in impact sports, pregnancy, constipation or obesity are factors that increase intra-abdominal pressure and contribute to weakening of the muscles in the pelvic area.”

That’s why he states that “modifying those factors that can change or restore the pelvic floor area after physiological processes such as pregnancy will also prevent health problems from occurring.”

The prevalence is higher among women, but it also affects men.

The prevalence of pelvic floor dysfunction is significantly higher among women, although it also occurs in men. “In men, most of the problems are associated with prostate cancer; the consequences of its treatment can lead to functional impotence or urinary incontinence,” the expert recalls.

“These are problems that significantly affect the quality of life of women, as well as men, although they are not sufficiently addressed,” notes the biomedical doctor.

Remember that there are “tools for improving pelvic floor health” associated with pelvic-perineal physical therapy, but there are also social and cultural conditions that prevent us from putting them into practice. “I’m still embarrassed to talk about it.”

This physiotherapist, who specializes in women’s health and the pelvic floor, laments that “it has become the norm, that this happened to us. For example, it is considered normal that we pass urine and that we use thinner and thicker pads as the solution, with or without wings.” He believes it “shouldn’t be considered normal” and shouldn’t be attributed to “things related to age or menopause.”

In addition, there are sexual dysfunctions such as vaginismus or loss of libido and others. This applies to women of all ages. Keeping your pelvic floor in optimal condition is also important for good sexual health. “We need to know that the pelvic floor can recover like any other muscle in the body. This way we will avoid their dysfunction.”

Maria Torres goes much further, remembering that when it comes to women’s health, the World Health Organization (WHO) has been insisting for 20 years on the need to strengthen research into women’s pathologies. “For many health problems, we express illness and respond to treatment differently than men. We are different, and this needs to be deeply studied so that every person in society is given all the guarantees.”

There are not enough professionals and a “prevention plan”

There are pelvic floor units in the public health system, but this specialist acknowledges that most resources and specialists in this area are “primarily” in the private sector. Still, he says, “they are not enough to care for all people with pelvic floor dysfunction.”

Dr. Torres also overlooks the “prevention plan.” As an example, he cites the situation after childbirth. “We are treated by a midwife or gynecologist, but then it all depends on the capabilities of each person when it comes to paying for the services of a physiotherapist in the private sector for pelvic floor rehabilitation; provided you know you can see a specialist physiotherapist to do this.”

Physiotherapy is a key discipline when we talk about preparation, physical and functional recovery and prevention of dysfunctions associated with physiological processes such as pregnancy, childbirth, the postpartum period or menopause. And also in the therapeutic and palliative process of various types of cancer with a high prevalence in women and even fibromyalgia. “We have enough scientific evidence,” the researcher emphasizes.

“The main problem is that public health does not include it in its portfolio of services,” he laments. Added to this is the fact that physical therapy has no formal specialties, “although it does have informal specialties, such as those related to women’s health and pelvic health,” he explains.

He has been in the profession for 35 years and requires a higher degree of medical specialization to solve “the problems of the functioning and movement of the human body because they are enormous.”

It already exists in those countries that follow the recommendations of the World Confederation of Physiotherapy. “Worldwide, the first line of treatment (gold standard) for urinary incontinence is pelviperinal physiotherapy, which we also know as pelvic floor physiotherapy, but I think there is no money or desire to implement it.”

In Spain, these professionals require additional training. “The most ‘official’ now are university master’s degrees, which represent a proof of quality and skill compared to what we know as proprietary degrees or advanced courses.”

The University of Alcalá has an official Master of Physiotherapy degree in Women’s and Pelvic Health, which gives access to doctoral studies. The directors of the project are Maria Torres and Maria José Yuste, who are also members of the Physiotherapy Research Group on Women’s Health Processes (FPSM), created in 2007.

At the moment they have several projects. Among them is the one associated with the Carlos III Institute of Health, which is about to conclude on the effectiveness of physiotherapy in the postpartum period.

In addition, they are collaborating with the Ramón y Cajal Hospital, together with the obstetrics and gynecology service, on a study on the effectiveness of physical therapy for genitourinary menopausal syndrome in women treated for breast cancer. “We know that these treatments cause menopause that comes suddenly, has a greater effect and lasts longer than natural menopause.”

Other studies, conducted in collaboration with the Prince of Asturias Hospital, are testing the effectiveness of certain exercises in combating pelvic floor dysfunction. “For example, the famous hypopressive exercises among other therapeutic exercises.”