It is estimated that 7 million Italians suffer from urinary (five million) and fecal (two million) incontinence, with levels of variable gravity. But the involuntary loss of urine or fecesdue to various causescould concern many other compatriots, since often we don’t even talk about it with the family doctor, out of shame and embarrassment. Yet, of incontinence it can be healed in most cases. This is why, from the first hints, it is good contact own doctorwho will evaluate whether to prescribe one urological visit or refer the patient to one of the clinics or hospital centers of the National Health Service.
What assistance, the «La Network of Centres»
As indicated in the «Technical guidance document on problems related to urinary and faecal incontinence», the result of a Agreement between State and Regions in 2018this condition should be treated by «network” among the Centers for the prevention, diagnosis and treatment of incontinence, based on the degree of intensity and complexity of the pathologyin order to guarantee incontinent people, in every Region, the right amount Diagnostic-therapeutic care path (Pdta).
So far what the Agreement provides. But, six years later, how are incontinent people assisted in Italy? “There Network of Centres turns out operational only in Piedmont and Veneto; she was established in Basilicata and Sardinia but it is left on paper – begins the president emeritus of the Italian Continence Foundation, Roberto Carone, who was part of the ministerial technical table –. In some Regions it is in the process of being established, in others there is no action underway” (data updated to February 2024, ed).
Support to the Regions to implement the Agreement
The good news is that just for ensure full implementation throughout the national territory of actions envisaged by the 2018 Agreement, a new technical table on incontinence was established at the Ministry of Health, composed of institutional representatives, doctors, scientific societies and patient associations. He has the task monitor interventions and provide support to the Regions in implementing the organizational assistance model indicated by the Document. Professor Carone, who is part of the technical table, reports: «The ministry has identified four main macro-areas: Regional networks of reference centres, disposable medical and surgical devices, drugs, communication. Four working subgroups have been set up to identify solutions to the critical issues.”
Where incontinence is treated
The first reference for patients they are the dedicated clinicswhere the rehabilitation of the pelvic floor (still lacking). If the problem is not resolved, we move on to 2nd level single-specialist centres (of urology, gynecology, physiatry), with dedicated beds to hospitalization. THE more complex cases of incontinence, like those of neurological originmust be treated in Third level centresthat is, structures of neuro-urology or pelvic units.
«Due to the non-homogeneous presence of the Centers in the Regions, patients have serious difficulties in accessing care and they often have to move, usually from the South to the North. If the network of Centers were activated throughout Italy, it would be possible not only to have the same opportunities for access to care but also continuous monitoring of the real needs of incontinent people” underlines Pier Raffaele Spena, president of Fais, Federation of incontinent and ostomates.
Aids: disposable pads, catheters, sleepers
There unequal treatment between patients, even from one local health authority to another, it also concerns aids which catheters, sleepers, diapers. «Procedures for purchasing devices Not still allow the free choice based on the specific needs of the person – Spena reports –. The only parameter remains the lowest pricewhich affects the quality of the product disbursed. As a patient association we have always supported the model indicated in the Agreement: allowing the participation of different companies in order to guarantee a wider choice of products».
Diapers: who is entitled to have them for free and how
Those who suffer from incontinence often have to resort to the use of disposable sanitary pads, commonly called “diapers”. It’s about medical devices which fall within the essential levels of assistance (Lea), the services that must be guaranteed to everyone by the State, free of charge or by paying the ticket if due. Basically, diapers have to be provided free of charge to anyone he has the rightor whoever has a «severe chronic urinary or fecal incontinence» (DPCM Lea 2017). Who formulates the incontinence diagnosis and the specialist doctor employed by the National Health Service (or affiliated with it), which specifies the severity level and indicates the need for aids.
The Regions can decide to identify the ways in which the prescription of disposable sanitary pads it is also permitted to general practitioners, paediatricians of free choice and doctors of local services.
Incontinence medications
To date theirs prescription paid by the National Health Service And limited to patients with “urgency” urinary incontinence, in cases where the urination disorder is related to pathologies of the central nervous system (note 87 Aifa).
In other cases, however, they are paid. «We are the only country in Europe where patients are entirely responsible for this» points out Professor Carone. President Fais adds: «A serious reflection on the opportunity of provide some medicines necessary for the treatment of incontinence at the expense of the Health Service».
It affects not only the elderly. You have “tailor-made” remedies
L’incontinence Not interest only the elderly. «It can manifest itself in the child that the night does wetting in bed (nocturnal enuresis), in the athlete (from effort), in pregnant or postpartum womanin some patients undergoing surgery at the prostatein people with incontinence of neurological origin – explains Stefania Chierchia, urologist at the Neuro-urology departmental structure of the CTO-Spinal Unit hospital of the University Hospital Città della Salute e della Scienza of Turin –. One must be given objective response to a symptom which instead it is subjective; for example, for a person young man or an athlete it’s very serious and losing even a few drops of pee is unacceptable. Based on international guidelines – clarifies Stefania Chierchia – for a “appropriate” treatmentor adequate to the needs of the incontinent person, it is necessary to take into account the type of incontinence and of severityof her motor abilityof the lifestylesof the any diuretic drugs that he assumes.”
