“It took me like a desire to pee”. The expression could not be more eloquent: when we feel like it, we only think about that, sometimes to the point of doing the famous pee dance hoping to teach our bladder patience, which is just waiting to empty itself. Action – reaction: the answer is simple, just go to the toilet!
Except that for many women, getting there when you’re not at home isn’t as simple. Often out of fear that they are dirty, or for a whole host of reasons that cause them to hold back more than necessary, or to urinate in a squatting position to avoid sitting on the seat. Widespread habits, but which are not without health consequences.
Urination disorders developed in childhood
As soon as she leaves her house, the toilets, Sarah avoids them, almost always. “That’s what my mother taught me from a very young age: wait until you’re home, and if you can’t, never sit in a public toilet,” says the young woman. When I was very little, she cheerfully lined the seat with toilet paper so that I wouldn’t come in contact with it. And as I got older, away from home, I got into the habit of either holding myself back or squatting, which is frankly uncomfortable. Impossible to do otherwise, it disgusts me, I hold back until I get back home.
And Sarah is far from alone. “This is the real problem for women, who have learned from childhood to refrain from going to the toilet at school, due to a certain social pressure. Because the toilets are not clean, out of embarrassment to go there in front of the girlfriends or to ask to go there, or even because the master or the mistress does not want, ”explains Dr. Anthony Giwerc, urologist surgeon at the Saint-Louis hospital in Paris.
A problem against which warned Professor Michel Averous, former head of the pediatric urology department at the Montpellier University Hospital. As early as 2004, he spoke of an “unrecognized educational scourge”.
Long-lasting problems with urination
These bad habits taken from childhood are a royal road to lasting disorders of urination. “Urinating with bent legs will create an acute angle with the urethra and cause difficulty in urination,” warns Dr. Giwerc. This tense position therefore frequently prevents the bladder from being emptied. And whether you are semi-squatting or holding back, “the more urine you accumulate in the bladder, where it stagnates, the more you increase the risk of urinary tract infection,” warns Dr. Giwerc.
You would think that by holding back, our bladder would be well trained. But “when it is too full, it not only causes pain, but also a blockage: the more you teach your bladder to hold you back, the more its wall will relax, like a worn rubber band, with the key to difficulties in completely evacuating urine”. Sarah confirms: when she holds back too long, “the bladder can be very painful for a while, and I find it difficult to pee all the way, I have to push harder to empty it”.
“All these bad reflexes lead to the development of vesico-sphinterian dyssynergia, explains Dr. Giwerc. The sphincter is a muscle that acts as a lock so that urine does not come out, but which must open when we pee. If, by holding back frequently, you have taught this muscle to overdevelop, the bladder must force itself to empty when it should not. This will increase the pressure in the bladder and damage it. In practice, we will not suffer from incontinence because we have leaks and we have damaged the sphincter, but we will accumulate so much urine in the bladder that it will seek to evacuate the overflow, which will lead to urges and small leaks by engorgement ”.
Learn to urinate again
However, “the system is very well done: the kidneys produce urine, evacuate it via the ureters into the bladder, which stores it before emptying, describes the urological surgeon. But if you have trouble evacuating, there will be too much pressure and this creates reflux, a rise between the bladder and the kidneys, with a risk of repeated infections”.
Twenty years ago, Professor Averous recommended “teaching or relearning the child to urinate well, at home and at school”. Because “urination is an essential mechanism since it participates in the evacuation of waste from our body, recalls the French Association of Urology (AFU). The best way to disinfect a bladder is to ensure its frequent and complete evacuation,” prescribes the AFU.
However, it is still far from being a reflex for everyone. “When I was intern in pediatric surgery, I happened to see cases of repeated cystitis in little girls, to the point of having to make medical certificates to give to the mistress to prescribe visits to the toilet, deplores Dr. Giwerc. The first thing we do in a uropediatric consultation is to teach the little girls to go to the toilet again: at least six times a day, giving them timetables: in the morning when they get up, at school at 10 a.m., at lunch break, at afternoon recess, at snack time, and before going to sleep.
Support best practices
Reflexes that must be accompanied “by improving hygiene in the toilets, starting with those in schools, insists the urological surgeon. Everything must be done to allow children to go there more regularly. This requires encouraging them to drink more, not just at lunchtime in the canteen. As soon as they acquire cleanliness, they must be given the reflex to ask when they need to, so that they are not ashamed to say so. And if ever there are warning signs, such as pain, repeated urinary tract infections, requiring emergency visits, do not hesitate to talk to a pediatrician or a pediatric urologist.
And there is no age to rectify the situation. Fortunately because “we see women arriving late in consultation, when the symptoms are no longer tenable, observes Dr. Giwerc. But even later, you can get rid of your micturition disorders. We first draw up the balance sheet by asking the patient to fill in a urination calendar, we observe her symptoms, her feelings, and we set up the necessary support. Voiding disorders are not inevitable, you just have to know how to get back to good habits”.