Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is characterised by the unintentional passing of urine, and can be due to a variety of causes. In women, it is more common among older women and women who have given birth before.

Urinary Incontinence in Women During & After Pregnancy

Pregnancy and childbirth—particularly vaginal birth—places great strain on women’s pelvic floor muscles by stretching and weakening them. In serious cases, it can even tear the supports of the bladder and uterus.

While in most cases the woman’s body can recover back to its pre-pregnancy state within a few months after delivery, it is understandable why some cannot, causing the woman to live with weakened pelvic floor muscles and its common resultant problem—urinary incontinence.

Not only does pregnancy and childbirth weaken the pelvic floor muscles, they can also cause urinary incontinence due to damage of the nerves that supply the pelvic floor muscles, including the bladder.

What are the Types of Urinary Incontinence?

  • Stress Urinary Incontinence: This is when urine leaks out when sudden pressure is placed on the bladder and urethra, such as a sneeze, cough or laughter. In more severe cases, one may also leak urine when bending over or just walking.
  • Urge Incontinence: This refers to a sudden and strong urge to urinate, and may sometimes be referred to as an unstable or overactive bladder. This occurs when the bladder abnormally contracts when it shouldn’t, causing urine to leak.
  • Mixed Incontinence: A mix of the above two types.
  • Overflow Incontinence: This occurs when one is unable to completely empty their bladder (urinary retention), resulting in the bladder getting too full and leaking.
  • Total Incontinence: This is when the bladder is unable to store any urine at all, causing one to pass urine constantly or experience frequent leaking. This may occur due to issues with the bladder since birth, a spinal injury or a fistula forming between the bladder and a nearby area.

Risk Factors of Urinary Incontinence

  • Pregnancy: Hormonal changes during pregnancy can weaken the pelvic floor where the bladder is located; and the increasing weight of the foetus can also press onto the bladder.
  • Childbirth: Vaginal delivery can weaken the muscles necessary for bladder control and damage bladder nerves and supportive tissue.
  • Menopause: During menopause, women produce lower levels of oestrogen, a hormone that keeps the lining of the bladder and urethra healthy. Deterioration of the tissues may result in incontinence.
  • Obesity: Obesity causes increased intra-abdominal pressure which places stress on the pelvic floor, contributing to urinary stress incontinence.
  • Chronic constipation: An over-full bowel can press on the bladder, decreasing the amount of urine it can hold or make you feel the need to pass urine urgently.
  • Pelvic trauma: In some cases of pelvic trauma (e.g. pelvic bone fracture), bladder nerves are damaged which can lead to problems such as urinary incontinence.
  • Ageing: As we age, the bladder usually becomes weaker or overactive, resulting in the unexpected relaxation of the bladder muscles or the involuntary leakage of urine.
  • Urinary tract infection: Infections can irritate your bladder, resulting in one experiencing strong and frequent urges to urinate, and sometimes incontinence.
  • Smoking: Cigarette smoking may increase the risk of urinary incontinence as the smoke irritates the bladder.

How is Urinary Incontinence Diagnosed?

  • Medical history: This involves evaluating one’s symptoms, details about previous pregnancies, medical and surgical history and medications.
  • Physical examination: The doctor may palpate the patient’s bladder, as well as perform a pelvic and/or rectal examination (as needed) in order to try and assess the cause and severity of the urinary incontinence.
  • Urine test (if a urinary tract infection is suspected): This test will test the urine for red blood cells, white blood cells and bacteria to determine if there may be an infection.
  • Residual urine test : This allows doctors to see how the bladder is draining during urination and measure the amount of urine left in the bladder after urination (normally, the bladder should be completely emptied).
  • Urodynamic tests: This refers to a series of tests used to check the function of your bladder and urethra. Tests can include measuring the pressure in your bladder by inserting a catheter into your urethra, or urinating in a machine that measures the amount and flow of urine.
  • Cystoscopy: This involves using a thin tube with a camera attached to it, also known as an endoscope, to look inside your bladder and urinary tract which can identify abnormalities that may cause incontinence.

More Than a Physical Condition

Urinary incontinence can be a very distressing condition. Beyond the physical inconvenience of constantly having to rush to the bathroom and wetting one’s pants, it can also result in significant embarrassment and social withdrawal.

It is a common misconception that urinary incontinence is a necessary effect of pregnancy—it can definitely be treated and one’s quality of life can be greatly improved.

How is Urinary Incontinence Treated?

Minimally Invasive Treatment & Prevention Tips

Depending on the type and severity of urinary incontinence, treatment options vary and can involve a combination of laparoscopic surgery, medication, lifestyle and dietary changes, as well as pelvic floor exercise.

Self-Care/Prevention Tips

  • Kegel Exercises: Stronger muscles will reduce the severity of the incontinence or even help prevent it altogether. This can be achieved through performing Kegel exercises regularly, which is done through repeatedly contracting and relaxing your pelvic muscles. You should consult a gynaecologist to find out how to do this correctly.
  • Prevent Straining: Prevent factors that place excess pressure and constant straining to your pelvic floor: chronic constipation, chronic coughing, excess weight or constant lifting of heavy items.
  • Lifestyle & Diet: Cut down on caffeine and alcohol, which are diuretics and irritate the bladder. Drink more water instead. Do not cut down on water intake thinking that it will help—it will actually worsen the incontinence as it further reduces the bladders capacity.


Various types of medicines are available that serve different purposes—speak to your doctor to find out which may be suitable for you:

  • Medicine that helps the bladder relax and thus fill up and store urine better
  • Medicine that treats urge incontinence through blocking certain nerves
  • Medicine that improves the muscle tone of the urethra and thus keeping it closed better

Minimally Invasive Surgery

Should the problem persist in spite of conservative treatment methods, surgery may now have to be considered.

It is worth thinking if you plan to have future pregnancies, as some women may wish to wait until they are done having children before opting for surgery; because the strain of pregnancy and childbirth can sometimes affect the results of otherwise successful surgical treatments.

[Tension-Free Vaginal Tape (TVT)]

Of all the surgical procedures available for treating stress urinary incontinence in women, the Tension-Free Vaginal Tape (TVT) is the most well-researched and preferred method in most cases. Designed to provide support for a sagging and weakened urethra, the cure rate (depending on patient profile) stands between 80% and 90% even after 10 years.

In TVT, a mesh tape will be placed under the urethra like a sling to keep it in its normal position, keeping the urethra and bladder neck closed.

Why “tension-free”? Because the doctor will carefully adjust the tightness (tension) of the tape such that it is just enough to support the urethra—not too much, and not too little. For instance, if the patient is not under general anaesthesia, she may be asked to cough so that the doctor can check and adjust the tension of the tape.

The tape will be inserted through tiny incisions in the abdomen and vaginal wall, with no sutures required and is held permanently in place. This is typically performed as a day procedure under anaesthesia with just a one night’s hospital stay and full recovery takes one to four weeks.

When Should I See a Gynaecologist?

Talk to a gynaecologist if you still have bladder problems six weeks after delivery. Accidental leaking of urine may mean that you have another medical condition. The loss of bladder control should be treated or it can become a worse or long-term problem.

More specifically, should you notice that you involuntarily pass urine when you laugh, sneeze, cough, or exercise, constantly wake up at night to go to the bathroom or feel a strong urge to pass urine even when your bladder is not actually full, you should pay a visit to a gynaecologist for an evaluation and diagnosis.

Rest assured that regardless of cause or severity, a range of treatment for urinary incontinence is available for women in Singapore.

For a personalised consultation, please contact our clinic at 6472 2283 today

6 Napier Road, #07-11, Gleneagles Medical Centre,
Singapore 258499

Tel : 6472 2283 (call for appt)
Fax : 6473 5928
Email : kaiyinseetho@gmail.com
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