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Feeling out of control? You’re not alone. Many women face the frustrating and often embarrassing challenge of urinary incontinence every day. This is your guide to regaining mastery over your urinary health.
Urinary incontinence is a common condition that affects millions of women worldwide. It refers to the involuntary leakage of urine, ranging from minor leaks to complete loss of bladder control.
In Singapore, urinary incontinence is also a prevalent problem among females, with an estimated 30% of women experiencing some form of bladder control issue in their lifetime. This can have a significant impact on a woman’s quality of life, causing embarrassment, discomfort, and even social isolation.
There are a few types of urinary incontinence that affect women in Singapore:
Overflow Incontinence
is characterised by small amounts of urine leakage throughout the day.
Mixed Incontinence
is typically a combination of stress incontinence and urge incontinence, it is important for women experiencing mixed incontinence to seek medical advice for a proper diagnosis and treatment.
Stress Incontinence
occurs when small amounts of urine leak out when coughing, laughing, sneezing, or exercising. It is one of the common symptoms of female urinary health issues and can be a result of childbirth or menopause.
Transient Incontinence
is a temporary episode of incontinence that can be caused by medications, urinary tract infections, mental impairment, restricted mobility, and severe constipation. In Singapore, urinary incontinence is commonly treated through bladder training, pelvic floor muscle exercises, and medication. Seeking treatment for urinary incontinence in Singapore can greatly improve one’s quality of life.
Urge Incontinence
is characterised by a frequent and urgent need to urinate that cannot be controlled. It is also one of the common causes of urinary incontinence in females in Singapore and can be caused by bladder irritation or nerve damage.
It is also important to note that delaying toileting while preoccupied with a task can also cause incontinence. To avoid this, it is recommended for women to take regular bathroom breaks and practise healthy toileting habits.
There are several potential causes of urinary incontinence in females, which may include:
The physical strain of pregnancy and vaginal delivery can weaken the pelvic muscles and nerves, leading to bladder control issues.
As a woman’s oestrogen levels decline during menopause, it can cause changes in the urinary tract, making it more difficult to control urine flow.
A condition in which the organs of the pelvic floor fall down from their normal position and begin to press against the walls of the bladder. This can lead to incontinence or urine retention in severe cases because of a decrease in muscle strength or size, along with greater pressure on the urinary tract.
In addition, there are certain medical conditions that can lead to female urine incontinence. These include neurological disorders such as Parkinson’s disease and stroke, urinary tract infections, and bladder or kidney stones. Medications such as diuretics can also cause frequent urination that could potentially lead to incontinence.
Diagnosis of female urinary incontinence involves a comprehensive assessment that may include a combination of medical history, physical examination and diagnostic testing. A careful medical history is taken to identify any medical conditions or medications that could cause incontinence.
The physical examination will typically focus on looking for signs of underlying conditions such as nerve-related causes. Urodynamic testing is often the cornerstone of determining an accurate diagnosis, but it may also include other tests such as urine tests, pelvic scans, and sometimes a cystoscopy to examine the bladder.
A thorough evaluation can help doctors identify the cause of incontinence and recommend treatment options that are tailored to the individual’s needs. The most important aspect of diagnosis is finding the underlying cause of the incontinence, because this will then inform which type of treatment is best suited.
For women in Singapore experiencing urinary incontinence, there are various treatment options available, including:
Eliminating bladder irritants, such as caffeine, alcohol and citrus fruits.
(to improve pelvic muscle tone and prevent leakage)
Biofeedback
It involves using electronic sensors to monitor nerve impulses and muscle contractions while doing exercises under the instruction of a doctor. This technique can help improve bladder control.
Kegel Exercises
To strengthen the muscles of the pelvic floor and sphincter.
Electrical Stimulation
To strengthen the muscles causing stress or urge incontinence.
Continence Devices
Continence devices like a continence pessary or tampon can be used for stress incontinence. Vaginal weighted cones can also be used for training pelvic floor muscles for both stress incontinence and Overactive Bladder Syndrome.
Hormone Replacement Therapy
To help restore normal bladder function.
Medications
– Medications are used to treat overactive bladder muscles to calm abnormal contractions and behaviour in overactive bladders.
– Medications to aid in emptying the urine in the bladder in voiding disorders/overflow incontinence.
Urostym®
Urostym® treatment for a more intensive “crash-course” pelvic floor muscle rehabilitation invoking stimulation, biofeedback and physical training.
Percutaneous Tibial Nerve Stimulation (PTNS)
Where a minute electrical current is used to modulate nerve-muscle activity in patients with OAB and/or voiding disorders, for better symptom control.
Catheterisation
Catheterisation (insertion of a thin tube into the bladder) for women whose bladder fails to empty completely due to loss of muscle tone, prior surgery or spinal injury. The catheter is inserted into the urethra and allowed to drain into a bag attached to the leg.
Tension-free Vaginal Tape (TVT & TVT-O)
A relatively new method for Stress Urinary Incontinence with a very good success rate of 94% since KKH started using it in 1998. It has become the commonest type of continence surgery performed at KKH. It is relatively less painful and requires a short hospitalisation of 2 to 3 days.
Pubo – Vaginal Sling
Placement of a pubo-vaginal sling (‘hammock’) beneath the bladder to provide support.
Artificial Sphincter
Placement of an artificial sphincter (a ring that encircles the urethra) that can be manually inflated to close around the urethra and prevent urine leakage.
While urinary incontinence can be a challenging condition to manage, there are ways to prevent and improve symptoms. These include:
When dealing with urinary incontinence, it is important to talk to a doctor about any questions or concerns you have about the condition. Your doctor will be able to recommend and explain conservative management, medication and surgical treatments that can help treat your condition.
Dr Tseng's expertise covers urinary incontinence and pelvic organ prolapse, apart from that, his particular interest lies in the holistic management of Overactive Bladder Syndrome and other functional bladder conditions. With many years of experience in this field, he is committed to providing patients
