Frequently needing to get
up at night to urinate or
being unable to control
an overwhelming urge to
pee can cause inconvenience and
embarrassment, and affect one’s
quality of life. The reality is, many
cases of urinary incontinence — an
involuntary leakage of urine — can
improve through relatively simple
measures, and people should
seek help rather than suffer in
silence, said Dr Ami Nagashima,
Senior Staff Registrar, Sengkang
There are various types of
urinary incontinence, with the
more common ones being stress
and urge incontinence. Some may
suffer from more than one type of
Stress incontinence occurs when
an activity, such as coughing,
laughing or exercising, puts
pressure on the bladder, resulting
in leakages when the muscles
controlling urination are weak.
Patients with urge incontinence
experience a strong urge to pass
urine immediately, due to an
Overflow incontinence is
more prevalent in elderly men
with prostate problems. This is
when the bladder muscle fails to
function properly or there is an
obstruction to the bladder outlet,
which causes urine to be retained.
Urine leaks out due to an overflow
when the bladder fills up.
For patients with mobility or
cognitive problems, including
stroke and dementia, they may
not be able to get to the toilet in
time when the need arises. This is
a condition known as functional
incontinence, which is contributed
by cognitive, functional or
Quality of life at stake
Urinary incontinence can erode
patients’ quality of life and selfesteem.
“Those affected may go
into social isolation because they
prefer to stay home to prevent
embarrassing situations. Besides
affecting their daily life and
activities, their quality of sleep
suffers if they have to wake up
multiple times at night because of
the urge to pee,” said Dr Ami.
However, not all with urinary
incontinence seek help for this
condition. “Patients may feel too
uncomfortable or embarrassed to
volunteer information, even with
their doctor. It may also be due
to a lack of knowledge about the
causes and available treatment
options. Some also assume that
urinary incontinence is a natural
part of ageing, which is a myth,”
Causes for incontinence
Age is a risk factor but urinary
incontinence is not a normal
part of ageing. The condition
may be reversible and treatable.
When patients experience
urinary incontinence, it is
important for doctors to
determine whether the condition
is transient or chronic. For
instance, a sudden onset of
incontinence may be due to a
urinary tract infection (UTI),
and doctors will check for other
symptoms of UTI, such as fever
and pain when passing urine.
If tests confirm an infection,
antibiotics can be used to clear it
and resolve the incontinence.
Medication that patients take
for other conditions can also
lead to urinary incontinence as
a side effect. For example, there
are drugs that affect the bladder
muscles, and cause urine retention
and overflow incontinence. In such
cases, switching to other suitable
drugs can be a solution.
Very often, doctors will suggest
ways that do not involve
medication to relieve incontinence.
Some ways patients can ease
their symptoms, such as nocturia or
frequent urination, include limiting
the intake of caffeine and alcohol,
and avoid drinking any fluids at
least two hours before bedtime.
As obesity and smoking are
also risk factors, losing weight
and quitting smoking would be
suggested where appropriate.
Exercises to strengthen
pelvic floor muscles can be especially helpful for stress
and urge incontinence, while
bladder training can help in urge
incontinence. In bladder training,
patients are taught ways to focus
on reducing the sense of urgency
when it occurs, such as pelvic
muscle contractions or relaxation
techniques, with the aim of
the interval between voiding
Symptoms usually improve after
the various non-drug measures.
“It takes time and compliance
for these measures to help,” said
Dr Ami. Age is no barrier to these
If non-drug measures do
not work, medication may be
prescribed to counter
overactive bladder muscles.
Surgery may be an option in cases
whereby measures such as
lifestyle changes and exercises
fail to improve symptoms.
Patients are recommended to
consult their family doctors
should symptoms arise.
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