The illness that many mothers have suffered in silence all their lives (and that can be prevented)

BarcelonaFina's birth was traumatic: her daughter was born with the umbilical cord tied around her neck, and any movement she made could have been a risk to the baby. Four long hours of labor and forceps delivery resulted in the safe and sound birth of the baby. However, her pelvic floor was doomed, and she has had to learn to live with urinary leakage. Susagna had a kidney and her uterus removed to prevent the progression of her bladder cancer. A couple of years ago, she had an ostomy placed on her, and she has had to get used to doing it "by force." normal life with a hole and a sphincter bag in the abdomen. However, for a long time, its head was disconnected from the pelvis downwards.

Peeing out of laughter or "hiding the leaking droplets" with pads has become normalized, but urinary incontinence has a significant impact on the lives of those who suffer from it. "Since 2016, we've seen many women in a lot of pain, not just physical, but also mental and emotional," says Núria Borrell, a nurse and director of Owings, a center specializing in intimate health founded in 2016. The center is staffed by professionals in nursing, psychology, physiotherapy, and nutrition.

Ninety percent of people who suffer from urinary incontinence are women. Furthermore, some estimates estimate that in Catalonia it affects between 30% and 40% of those over fifty. These are women who suffer from the aftereffects of instrumentalized parts, surgeries, menopause without proper follow-up... In other words, everything that causes pelvic floor disorders and provokes certain dysfunctions such as prolapses, leaks, pain during sexual intercourse, or damage to the genital mucosa. Chemotherapy also leaves the vagina completely dry and atrophic. "It's impossible that there are still women without information during the oncological process," says Borrell. Furthermore, many of them suffer from self-esteem issues or struggle with socializing.

The importance of the pelvic floor

Urine loss usually occurs when straining, such as coughing, but there are bumps that can be suffered even while walking. More and more hospitals have pelvic floor units, and specialized physical therapists are becoming available in many primary care centers (PCCs). However, the public health system has not yet consolidated genital care within the system. "I made an appointment at a pelvic floor unit and they never returned my call. There's a lot of demand," explains Susagna.

Before the ostomy, she suffered from minor incontinence and somewhat embarrassedly told her friends that she had to wear a diaper. "They weren't surprised; they thought it was normal," she says. It's no surprise. Women with pelvic floor dysfunction often follow two paths: suffering in silence or navigating the healthcare system. In some cases, one leads to the other. As in Fina's case: "When I dared to talk about it, the gynecologist played the menopause card. He said, 'Because of your age, it's normal for you to have urinary incontinence.' I had explained my delivery and that all these problems had started before menopause, but she must have had it, but, it was said, she thought.

The risk of incontinence does increase with age. "When a woman loses estrogen, the pelvic floor loses consistency and stops supporting as it once did," explains Borrell. And medical history such as birth defects, surgeries, or infections can all contribute to it. Age doesn't exempt any woman. However, an early approach can resolve 50% of cases and improve 20%, says Borrell.

However, Fina was only advised to carry "something" in her purse in case she leaked urine "in public." And, if things got worse, she was to try diapers. Other women, even less fortunate, were prescribed antidepressants or anti-anxiety medications "for nerves or for empty nest syndrome if their children had left home," the nurse complained.

A "feminine" cooperative

Now, Owings' team has launched a project called Salut en Femenino (Feminine Health) to create a cooperative: Owings Lab. The goal is to train women between the ages of 25 and 70, whether or not they suffer from pelvic floor dysfunction, to understand their anatomy and the processes that can cause disorders, as well as tools to treat them. The plan targets approximately 750 women.

The frequency of visits to specialists is also not optimal, and Owings Lab also aims to raise awareness among healthcare professionals so they can perform early detection of urinary incontinence and prescribe appropriate treatment. If necessary, the plan is to refer patients to specialized centers. "We want to help break down stigmas so this begins to become visible," says Borrell. He concludes: "Let none of them ever have to hear the phrase, 'Don't worry, that's normal,'" he says.