Pregnant woman with incontinence

Suffering From Stress Incontinence? Here’s How To Treat It In Singapore

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Urinary incontinence refers to the unintentional loss of urine. Stress incontinence is a type of urinary incontinence and refers to the involuntary loss of urine when there is raised intra-abdominal pressure, which can happen during laughing, sneezing, coughing, or lifting. Such activities/physical movements put stress and pressure on the bladder, causing the leakage of urine.

About 15% of women in Singapore suffer from stress incontinence. The levels of urine leakage can vary from a few drops to excessive leaking that may require the use of sanitary pads to avoid staining their clothes. Because of this, stress incontinence has the propensity to cause embarrassment and distress in the lives of those who have it, and those with stress incontinence may end up isolating themselves or find themselves limiting their work and social life. 

What are the Signs and Symptoms?

Those with stress incontinence may find themselves leaking urine when they:


  • Laugh
  • Sneeze
  • Cough
  • Lift something heavy
  • Bend over
  • Exercise
  • Have sexual intercourse 


The chances of urine leakage are higher when the bladder is full. However, it is of note that the leakage of urine may not happen every time during such activities/ physical movements. 

What are the Causes?

The causes of stress incontinence are generally related to pelvic floor muscle weakness, i.e. weakness of the structures that support the urethra and the muscles that control the release of urine (urinary sphincter).

During the normal process of urination, the bladder will first expand as it fills with urine. The urethra, a small short tube that is joined to the bladder and carries urine out of the body, usually stays closed as the bladder expands, preventing urine leakage until you reach the bathroom.

However, when these muscles weaken, anything that puts pressure on the pelvic muscles (such as sneezing, coughing, lifting) can put pressure on the bladder and cause urine to leak out as there is a loss of urethral support as well as an opening of the bladder neck as a result of weaker muscles.


Common causes for pelvic floor muscles and urinary sphincter weakness include: 

  • Pregnancy
  • Childbirth risk is higher in those who have had natural vaginal deliveries
  • Previous pelvic surgery
    • Prostate removal in men
    • Womb removal in women (hysterectomy)
  • Obesity
  • Chronic cough (causes include e.g. COPD, smoking)

Is it important to go to a specialist immediately?


Stress incontinence is a long-term condition. Proper treatment is required in order to clear it. While not urgent or a medical emergency, stress incontinence may lead to further complications down the line such as the increased risk of urinary tract infection, skin irritation (due to urine leakage around the area), emotional distress, and the development of mixed urinary incontinence, which is when someone has both stress incontinence and urge incontinence.

As such, it will be good to seek medical advice as soon as you can get an appointment, to mitigate the severity of the incontinence and effectively treat it. It also helps rule out any underlying conditions that may be causing your urinary incontinence. 

 What should you expect the Doctor to Recommend?

Typically, doctors will first try to diagnose your stress incontinence. This includes taking a detailed account of your medical history, conducting a physical examination, taking urine samples, and testing your bladder function.

A urinary stress test can also be done, which involves looking out for any urine loss when you cough or when you bear pressure on the bladder. After the diagnosis, several stress urinary treatment options may be recommended. These include:

  • Conservative management usually the first line of management
    • Pelvic floor exercises — these are simple exercises that can be done consistently to help strengthen your pelvic floor muscles.
    • Vaginal cones — cones of increasing weight are inserted into the vagina, and you have to contract your pelvic floor muscles to keep the cones retained in the vaginal canal. This helps with pelvic floor muscle strengthening
    • Neurotoxin bladder injections — Neurotoxin injections may be administered into the bladder to help relax the bladder and reduce urge incontinence.
    • Nerve modulation — A thin wire is placed close to the spinal nerve which controls the bladder and regulates the signal that is being sent to the bladder. Alternatively, a small needle can be placed at the ankle to stimulate a smaller nerve which leads to the spinal nerve.
    • Electromagnetic stimulation (HIFEM) — electric currents that target the neuromuscular tissue are used to help modify muscle structure and the growth of new muscle fibres to strengthen the pelvic floor.
  • Surgical treatment — in those who failed conservative management 
    • Tension-free vaginal tape (TVT, TVT-O) — a new method that is the most common type of continence surgery nowadays. Success rates are high and hospital stays are shorter for this method of surgery.
    • Surgery Surgery may be used for patients with severely overactive bladder and is done to increase the bladder capacity of the patient. The bladder may be completely removed in some cases and be replaced with a stoma bag. 
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