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Urinary Incontinence

​Urinary Incontinence: What is it

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.

Risk Factors of Urinary Incontinence

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 embarrassment.

Symptoms of Urinary Incontinence

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 incontinence.

Diagnosis of Urinary Incontinence

A urine test (urine microscopy) is usually done to look for signs of infection.

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.

Treatment of Urinary Incontinence

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

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 institutions:

Singapore General Hospital
Tel: 6321 4377

KK Women’s and Children’s Hospital
Tel: 6294 4050