Urinary Incontinence in Singapore - A/Prof Fong Yoke Fai

What is Urinary Incontinence?

Urinary incontinence occurs when an individual faces involuntary urine leakage. It can be temporary or a chronic loss of bladder control. Apart from the physical inconvenience of this condition, the psychological impact of urinary incontinence tends to be more burdensome for patients. It is important to note that urinary incontinence is not a disorder or condition, but rather a symptom of other health conditions.

An estimated 15% of Singaporean women are actively struggling with the inconveniences of urinary incontinence. Additionally, a study conducted in Singapore estimated that almost 41% of Singaporean women do not seek medical intervention for urinary incontinence. The lack of proactivity in seeking medical help is often affiliated with patients feeling embarrassed.

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Urinary incontinence may manifest in a few forms, these include:

Urgency incontinence: intense urge of needing to urinate with subsequent unintentional urine leakage– also referred to as an overactive bladder.
Stress incontinence: urine leakage caused by pressure exerted on the bladder from coughing, laughing, sneezing, or physical activities.
Overflow incontinence: urinary bladder that does not completely empty leading to uncontrollable urine dribbles.
Neurogenic incontinence: nerve damage that reduces nerve communication between the bladder and the brain.
Functional incontinence: not related to urinary bladder dysfunction but rather the physical inability to make it to the toilet in time due to other health-related impairments.
Mixed incontinence: a combination of one or more urinary incontinence stated above.

What are the common causes of Urinary Incontinence in Singapore?

Urinary incontinence can be caused by various issues such as:

Hormonal changes: changes in hormones such as low oestrogen impacts the function of the urinary bladder as they are essential in maintaining the structural strength of the lower urinary tract.
Prolapsed pelvic organ: particularly, a fallen bladder known as a cystocele in which muscles around the bladder and vagina weaken.
Interference of nerve signal: neurological disorders may disrupt nerve signals involving bladder control.
Infections: such as urinary tract infections caused by bacteria can cause irritation to the bladder leading to urinary incontinence.
Dietary and lifestyle habits: excessive smoking, lifting heavy weights, and consuming beverages like caffeine, carbonated drinks, and alcohol (diuretics) would lead to bladder pressure and subsequent incontinence.

What are the usual symptoms of Urinary Incontinence in Singapore?

Given that urinary incontinence is a symptom by itself, one may look out for other signs to indicate the occurrence of urinary incontinence:

Urine odour on undergarment: if you notice sudden and persistent urine odour on your undergarment, it may indicate involuntary release of urine and lack of awareness of occurrence.
Bedwetting: also known as adult enuresis is a sign of reduced neuro-motor skills of a functioning bladder.
Inhibited from conducting daily activities: when an individual’s ability to conduct daily activities is impeded due to fear of urinary leakage.
Frequent toilet visits: urination frequency of 11-20 times a day and more than 2 times at night.

If you notice any of the symptoms stated above, make an appointment (link to contact us) today to get an accurate diagnosis and effective treatment.

Is Urinary Incontinence painful?

Urinary incontinence by itself is not a painful symptom. However, affiliated conditions such as pelvic floor dysfunction could cause pain in the lower abdominal area. Pain affiliated with urinating is known as dysuria.

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Who is at risk of Urinary Incontinence in Singapore?

There are several risk factors contributing to this incidence:

Pregnancy: foetus growth places pressure on the bladder, urethra, and pelvic floor muscles of pregnant women, subsequently causing stress incontinence. On top of that, increased levels of progesterone during pregnancy too, is a contributing factor as it weakens the pelvic floor muscles.
Gender: urinary incontinence is almost twice as prevalent in women than in men.
Childbirth: known as postpartum incontinence, anatomical changes from vaginal childbirth in new mothers may temporarily reduce pelvic muscle strength leading to loss of bladder control.
Age: menopausal women (between 45-55 years old) tend to be prone to urinary incontinence due to oestrogen loss and weaker elasticity in vaginal tissue.
Obesity: women with obesity are more likely to face urinary incontinence due to abdominal pressure from excess body weight.
Diabetes: increased blood sugar levels, nerve damage, and high likelihood of urinary tract infections in diabetic patients can contribute to the development of urinary incontinence.

How is it diagnosed?

Urinary incontinence can be diagnosed by reviewing your medical history such as assessing urinary patterns.

Other than that, some tests that may be administered to confirm urinary incontinence diagnosis include:

Urine tests: aid in the identification of infections which result in loss of bladder control.
Imaging tests: such as ultrasounds would provide a clearer depiction of the lower urinary tract to identify changes in the bladder and urethra.
Cystoscopy: if the cause of urinary incontinence is inconclusive, a scope would be necessary to obtain visualisation through a camera to assess conditions of the urethra, bladder, or other abnormalities.

What are the treatment options available for Urinary Incontinence in Singapore?

The treatment employed will depend on the type of urinary incontinence and the severity of the condition.

Some treatment methods include:

Lifestyle and dietary changes: initially, you may be advised to lose a certain amount of weight and to abstain from sugary drinks and caffeine as a conservative measure.
Physical therapy: pelvic floor therapy may be prescribed as a means of rehabilitating muscles.
Medication: oral medication may be given to reduce stress on bladder muscle and increase the capacity of urine stored in the bladder.
Hormone therapy: topical oestrogen may be prescribed to help strengthen urethral and vaginal muscles.
Nerve stimulation: rehabilitation method employed for incontinence is caused by neurogenic factors.
Surgery: laparoscopic colposuspension is a surgical method to lift the bladder where prolapse has occurred.

Frequently asked questions

Does urinary incontinence go away?

With treatment and lifestyle management, urinary continence will eventually subside. The time taken to be alleviated of urinary incontinence symptoms will depend on the type of incontinence one faces. With older patients, incontinence management would be advised instead of treatments such as surgery or rehabilitation. This may include easier access to the toilet, improved communication with the caregiver, and placing a portable urinal in the bedroom.

How do I know if urinary incontinence is a result of bladder damage?

Bladder damage may be caused by serious conditions such as bladder cancer or traumatic injury. Urinary incontinence from bladder damage would be accompanied by sharp pain and blood when urinating. Immediate medical attention is advised if you suspect bladder damage has occurred.

Urinary Incontinence