Urinary Incontinence Symptoms Singapore

What is Urinary Incontinence?

Urinary incontinence is the involuntary loss of urine. It is a fairly common condition that is more likely to affect women than men, and has a greater likelihood of developing as you age. However, it should be noted that urinary incontinence is not an inevitable consequence of ageing. Regular urinary incontinence can be embarrassing and have a negative effect on your quality of life over time. Treatment for urinary incontinence typically involves both medical care and various lifestyle changes.

Urinary incontinence occurs in 14.5% of people in Asia and has adverse social, occupational, domestic, physical, sexual and psychological effects on individuals.

What are the types of Urinary Incontinence?

There are several types of urinary incontinence. These are:

Stress Urinary Incontinence (SUI)

Stress urinary incontinence or SUI is an occurrence where you leak urine because of a sudden increase in pressure on your bladder. This can happen when performing certain activities, such as sneezing or exercises like running and jumping. Severe cases can involve leakage when one moves (eg, from sitting to standing). It can also happen to males after urological procedures such as prostate or urethral surgeries.

Urge Incontinence (UI)

Urge incontinence is characterised by the sudden and uncontrollable urge to urinate due to contractions of the bladder, associated with leakage. It is hard for one to defer visiting the washroom when they have UI. Most patients will complain of urinary leakage when they reach the door of their house, just before they sit down in the washroom or when they hear running water.

Overflow Incontinence

In overflow incontinence, the bladder is unable to empty itself fully, resulting in frequent or constant leaking of urine.

Mixed Incontinence

This refers to having a combination of different types of incontinence, most commonly SUI and UI.

What causes Urinary Incontinence?

Urinary incontinence can be brought about by a number of factors. Such examples are:

Hormone deficiencies
Urinary Tract Infection
Constipation
Benign prostate hyperplasia
Post urological surgeries
Weak pelvic floor muscles post-delivery
Pregnancy
Childbirth
Menopause
Neurological disorders (eg post-stroke, congenital spinal conditions, post-spinal surgeries)

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What are the risk factors for Urinary Incontinence?

Women are generally more likely to suffer from urinary incontinence than men. In addition, some other known risk factors for developing urinary incontinence are:

Increased age
Being overweight
Smoking
Excessive consumption of caffeine
Excessive consumption of alcohol
Diabetes
Neurological diseases (eg, stroke, Parkinson’s, spinal issues)
Past pelvic or prostate surgery

What are the symptoms of Urinary Incontinence?

You should visit a doctor if you are experiencing any type of urinary incontinence, especially if the condition is affecting your quality of life. Your doctor will be able to begin treatment and provide advice on what changes you can make to your lifestyle to alleviate your symptoms.

When should I visit a doctor?

The symptoms of urinary incontinence will depend on the type of urinary incontinence involved.

In SUI, a person may leak small amounts of urine when sneezing, coughing, laughing, exercising, or lifting heavy objects.

Urge incontinence (UI) is characterised by a sudden and uncontrollable urge to urinate. It may be triggered by a change in position or sexual intercourse, among other factors.

Overflow incontinence typically affects the elderly and results in frequent urination or a constant leakage of urine, also known as dribbling.

What can I expect during my first consultation?

During your first consultation, your doctor will begin by asking you about your medical history and your symptoms. Some common questions to expect are:

When did your symptoms start?
How often do you urinate?
Are there any triggers before the leakage?
How much caffeine and alcohol do you consume in a day?
Are you currently taking any medications?
How are your bowel habits?
How often do you have sexual intercourse?
History of UTI
Any previous surgeries
Any neurological conditions

Your doctor is also likely to perform a physical examination as well as order various diagnostic tests to check for any underlying causes of your urinary incontinence. A pelvic examination for females and a prostate examination for males are mandatory for diagnosis.

How is Urinary Incontinence diagnosed?

Some of the most common diagnostic tests used to diagnose urinary incontinence and any underlying conditions are:

Bladder Diary

This is a detailed record of how much fluid you drink, how often you urinate, and the volume of urine produced throughout a three-day period.

Urinalysis and Urine Culture

Your urine sample will be sent to a laboratory to check for the presence of any infections and/or blood. It is often difficult to get an uncontaminated specimen for a female patient. Your urologist will advise you on the proper way to do this.

Pad Test (optional)

A pad test involves having to wear an absorbent pad for 1 to 24 hours, which will then be weighed.

Various Blood Tests

The most common test will be a renal panel to check kidney function. For males, a PSA (prostate-specific antigen) may be performed to assess the risk of prostate cancer if required.

Uroflowmetry

This is a test that will measure your voiding function by analysing the speed and volume of your urination.

Flexible Cystoscopy

A flexible cystoscopy test may be recommended when you suffer from more serious accompanying symptoms, such as the presence of blood in your urine. This is a relatively painless test that uses a fibre-optic telescope to inspect the bladder, urethra and prostate gland (in males).

Ultrasound Bladder

An ultrasound bladder can show any potential issues with the structure of the bladder and reveal any obstructions or growths. In addition, this test is commonly used in conjunction with a uroflowmetry test to check for residual urine after urination.

Ultrasound Prostate

This is generally used to check for benign prostate hyperplasia in men.

Urodynamic study

This is a real-time functional study of the bladder and the outlet and involves the infusion of saline into the bladder via a small urethral catheter. As the bladder fills and then empties, we will be able to assess its storage and voiding patterns to reach a diagnosis of the patient’s issues. The aim of this study is to replicate the patient’s problem so that we can give more specific treatment.

How is Stress Urinary Incontinence (SUI) graded?

Stress SUI can be broadly divided into 3 grades in terms of severity. These are:
Grade 1 (Mild)
Leakage only occurs when there is severe abdominal straining, i.e. coughing or sneezing. There is generally no need to use pads and there is no leakage during normal exercise at night.

Grade 2 (Moderate)
Leakage occurs when there is moderate abdominal straining, i.e. while running or during exercise. There may be a need to use pads and the number of leakages is greater than Grade 1.

Grade 3 (Severe)
Leakage occurs when there is mild stress, i.e. standing up from a sitting or lying down position. The patient may need to wear pads consistently because of frequent leakage episodes, causing social or hygiene issues.

Can Urinary Incontinence be cured?

Urinary incontinence can mostly be cured if it is caused by an underlying condition that can be successfully treated or reversed. However, in other cases of urinary incontinence, there might not be a permanent cure. Instead, the condition will require long-term treatment and management.

What are the symptoms of Urinary Incontinence?

The symptoms of urinary incontinence will depend on the type of urinary incontinence involved.

In SUI, a person may leak small amounts of urine when sneezing, coughing, laughing, exercising, or lifting heavy objects.

Urge incontinence (UI) is characterised by a sudden and uncontrollable urge to urinate. It may be triggered by a change in position or sexual intercourse, among other factors.

Overflow incontinence typically affects the elderly and results in frequent urination or a constant leakage of urine, also known as dribbling.

How is Urinary Incontinence treated?

Treatment methods for urinary incontinence will vary greatly depending on the type and severity of the condition, as well as any underlying causes. Such treatment methods can range from training exercises and management techniques, to medication and surgical intervention. Some examples are:

Bladder Training
This involves deliberately delaying urination in order to train the bladder to hold urine more effectively.

Double Voiding
This refers to urinating, then waiting for a few minutes and trying to urinate again. It helps to completely empty the bladder to prevent leaking.

Pelvic Floor Exercises
More commonly known as Kegels, these help to strengthen the muscles that control urination.

Oral Medications
Some drugs that can be used to treat urge incontinence include anticholinergics, beta-3 agonists, and alpha-blockers.
For women, topical oestrogen may be prescribed because of the important role it plays in female continence. It helps reduce vaginal dryness and maintains the strength of the urethra and vagina.

Electrical Stimulation Therapy (eg HIFEM-high intensity focused electromagnetic stimulation)
This is a method of strengthening the pelvic floor muscles over time using an external device.

Use of Medical Devices
One example of this is a catheter, which can be inserted into the urethra to help empty the bladder completely.

Injection of Neurotoxin A
Neurotoxin may be injected into the bladder muscles to relax them and prevent spasms for UI and occasionally, bladder pain syndrome.

Neuromodulation
The tibial and sacral nerves help with bladder control and stimulating them – with various devices such as percutaneous needles or implants- can help in controlling an overactive bladder.

Tensi+
A device attached to the ankle that enhances message transmission between the bladder and the brain. Improves neurological control of urination, subsequently reducing symptoms of urinary leakage.

For patients with grade 1 to 2 SUI, lifestyle modifications and minimally invasive treatments can be tried first, especially for younger females who are still in their reproductive age or have just delivered.

HIFEM (Minimally invasive)
In this procedure, the patient sits on a chair/device which uses focused electromagnetic waves to stimulate the pelvic floor muscles. It is useful for individuals who are unable to isolate their pelvic floor muscles during Kegels.

Laser treatment (Minimally invasive, new and experimental)
For this procedure, an intravaginal probe will be placed and an energy device will be used to stimulate the vaginal walls. This treatment increases the thickness of the vaginal walls and helps in stress incontinence.

For patients with grade 3 or severe incontinence, surgery may be offered. In general, these are the patients who are unsuitable for more conservative modes of treatment or who desire a better quality of life. Surgery may involve lifting the urethra or bulking up the sphincter muscle so that the closure mechanism improves. Additional surgeries to correct pelvic organ prolapse may also be necessary. These are:

Midurethral Sling (MUS)
In this surgery, a pelvic sling made of synthetic mesh is placed under a woman’s urethra through a small cut in the vagina wall to keep the urethra closed in cases of SUI and to provide support.

Autologous Fascial Sling A strap/ribbon made from the patient’s own body tissue, usually grafted from the abdomen or thigh) is placed under the urethra to provide support.

Burch Colposuspension An operation to support the bladder neck, which connects the bladder to the urethra to resist pressure. This surgery can be done laparoscopically or open.

Injection of Bulking Material The bulking material is injected into the tissue around the urethra using a scope, which supports the urethra and prevents leakage.

Artificial Urinary Sphincter In extreme cases, an artificial urinary sphincter may be implanted around the bladder neck. An implanted valve controlling the inflation and deflation of the artificial urinary sphincter will have to be pressed in order to urinate.

Your urologist will work with you in determining the best course of treatment for your condition. Outside of the above treatment methods, your doctor may also prescribe certain lifestyle changes to help manage urinary incontinence. For example:

Changing your diet
Reducing alcohol consumption
Reducing caffeine consumption
Losing weight
Avoiding certain physical activities

What lifestyle changes can I expect?

Self-management is the first step in the treatment of urinary incontinence. It is possible to lead a normal life by properly managing the condition. Your urologist will guide you and work with you to actively manage your symptoms. Some measures that may help you are:

Fluid restriction after counselling
Wearing absorbent pads or adult diapers
Bladder retraining
Avoid constipation and known triggers
Weight loss
Pelvic floor exercises (also known as Kegel exercises)

Summary

Urinary incontinence can be an embarrassing condition that is difficult to manage and often harms your quality of life over time. If you are experiencing any type of urinary incontinence, you should make an appointment to see a urologist as soon as possible. Your doctor will be able to diagnose and begin treatment for any issues you face and provide you with suitable management techniques that you can easily incorporate into your lifestyle in cases that require long-term treatment or management.

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