Urinary incontinence means
the uncontrollable leakage
of urine at inconvenient and
socially unacceptable moments.
It could range from a few drops
to significant amounts requiring
the use of pads.
The risk of urinary incontinence
increases with age. Women are more
likely to suffer from this problem. Many
do not seek medical attention due to
Two common patterns are: a person
may leak urine on sneezing or
coughing (stress incontinence) or
there may be an inability to control
flow once the sensation to urinate is
felt (urge incontinence).
Causes of Urinary Incontinence
There are many causes and some
relate specifically to women or men.
In women, the pelvic floor muscle may
become weakened after childbirth
and this becomes more marked
after menopause due to tissue
degeneration. This may occur together
with a condition called utero-vaginal
prolapse, in which the womb sinks
lower down dragging the urethra as
well, affecting urine flow. The urethra is
the passageway opening out from the
bladder to the exterior.
In men, urinary problems may be
due to the prostate gland. This is a
small organ which surrounds part of
the male urethra that tends to get
enlarged in later life. Obstruction of
urine flow results, causing slow stream,
hesitancy on passing urine, incomplete
urination as well as urge incontinence.
Surgery can be done in severe cases,
but sometimes, the problem of
incontinence can result after surgery.
In both sexes, nerve damage from
diabetes and stroke, infection, obesity,
as well as brain changes related
to age can cause the problem of
A urine test (urine microscopy) is
usually done to look for signs of
Urodynamic studies. Pressure
measurements of the bladder while
voiding (passing urine) are taken
to determine how much urine the
bladder can hold, what makes leakage
occur, and if there are problems
emptying the bladder.
Post-void residual urine
measurement. An ultrasound
examination of the bladder is done to
assess how much urine is left behind
after one completes voiding.
In many cases, advice and training
in certain techniques by a skilled
continence care professional will
do much to relieve the issue. These
techniques include pelvic muscle
strengthening exercises, behavioural
techniques, fluid intake as well as drug
and food modification.
Drugs such as tolterodine, flavoxate
and oxybutynin can be prescribed to
reduce urge incontinence.
Surgery is suitable in women with
pelvic floor issues. Many surgical
techniques are available with high
cure rates, which range from very
simple yet effective ‘taping’ techniques
to suspend the urethra in its proper
position, to repair of the pelvic floor or
resection of utero-vaginal structures.
Vaginal ring pessary. This is a flexible
silicone ring that is inserted into the
vagina to reduce or eliminate stress
incontinence, for those who are not
physically fit for surgery.
Preventative measures should
begin early and can be of great
help. For example, good control of
diabetes mellitus prevents many
complications including bladder
problems from nerve damage.
Control of blood pressure, diabetes
and cholesterol levels prevents
strokes which causes incontinence
issues as well. Treating of
constipation improves urine flow
in many elderly people.
In severe cases of incontinence which
fortunately form the minority, the use
of pads, urine tubes (catheters) are
needed. For the majority, the quality of life
that is compromised by the issue of
incontinence can be improved or
overcome by one or a combination of
the above methods.
Please consult your Family Doctor if you have any concerns
about your health.
Specialist services available at the following SingHealth
Singapore General HospitalTel: 6321 4377
KK Women’s and Children’s Hospital Tel: 6294 4050
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