Urinary Incontinence

Urinary incontinence is a condition when one involuntarily leaks urine under certain circumstances. This can be a common and persistent issue that affects your daily activities and quality of life. Although there can be instances when this is temporary, such as when you have a urinary tract infection (UTI), urinary incontinence can be a long-term concern for many women.

Several types of urinary incontinence exist and include:

• Stress urinary incontinence (SUI): leaking urine involuntarily during physical activities such as coughing, sneezing, laughing, or exercising (anything that increases intra-abdominal pressure). 
• Urge urinary incontinence (UUI): involuntary urine leakage preceded by a strong urge to urinate, often manifesting in one being unable to reach the toilet in time before leakage occurs.
• Mixed urinary incontinence (MUI):  condition where one experiences both SUI and UUI. Usually, one type may occur more frequently than the other.
• Overflow incontinence (OI): incomplete bladder emptying due to specific medical conditions, resulting in overdistension of the bladder and involuntary urine leakage (i.e. overflow).

There are many causes of urinary incontinence. Some major causes include:

• Weakened pelvic floor muscles: pelvic floor muscles can weaken due to factors like pregnancy and childbirth-related damage, natural weakening from ageing, menopause, and obesity.
• Weakened bladder muscles: typically from ageing and/or nerve damage.
• Medications: such as certain blood pressure or heart medications, can exacerbate urinary incontinence.

Other factors that may not cause but can worsen urinary incontinence include:

• Consuming caffeine: diuretics such as tea, coffee, and/or alcohol act as bladder irritants, increasing the risk of urge urinary incontinence.
• Medical conditions: such as asthma, chronic cough, and poor diabetes control can worsen urinary incontinence.
• Smoking: smokers develop coughs which, over time, may cause increased pressure on the pelvic muscles, leading to a worsening of urinary incontinence.

Urinary incontinence can be associated with other bothersome symptoms, such as:

• Frequent and urgent need to urinate
• Nocturia
• Recurrent urinary tract infections
• Difficulty maintaining perineal hygiene

These can affect one’s ability to function in both their family/work roles and erode one’s self-esteem and ability to engage in intimacy with their partners. 

It is essential to consult a urogynaecologist, a specialist who focuses on female urinary issues, to determine the type of urinary incontinence you (may) have, the severity of your condition and the treatment options available. Your medical history will be reviewed in detail, and a pelvic examination will be performed to check for pelvic organ prolapse and/or pelvic floor muscle tone.

Additional assessments such as ultrasound scans of the uterus and ovaries, urine tests, bladder scans to measure post-void residual urine, and possibly a urodynamic study to evaluate bladder function and muscle stability may also be recommended.

Several treatment options are available if you are experiencing urinary incontinence in Singapore. The approach varies depending on the underlying cause and severity of your condition.

Some of the common treatment options include:

• Lifestyle changes: adjusting your lifestyle can often help manage urinary incontinence (such as maintaining a healthy weight, staying hydrated, avoiding caffeine and alcohol, and doing pelvic floor exercises).
• Physical therapy: pelvic floor physical therapy can be effective as a non-invasive management option for urinary incontinence. These exercises strengthen the muscles that control urine flow.
• Medications: certain medications can help manage overactive bladder symptoms and reduce episodes of urgency, frequency, and incontinence.
• Bladder training: slowly increasing the time between each bathroom visit to help improve bladder control (a bladder diary should be kept and reviewed prior to this). 
• Medical devices: in some cases, medical devices such as pessaries can provide additional support to the pelvic organs and reduce leakage.
• Botox injections: botox injections into the bladder can help relax muscles and reduce overactivity.
• Nerve stimulation: this involves using electrical stimulation to influence bladder function and improve control.