SFCS Ask me Anything! (AMA) Series

When we age, so does our bladder. OAB affects us more as we get older and strangely, after a certain age, it affects men more! Women are more likely to seek help when compared to men.

When we drink caffeine, it has a diuretic and irritative effect on voiding. A young person may not be so affected by it.

A common complaint is the sleepiness or lethargy associated with the lack of caffeine. This can be solved by having a healthy lifestyle! Good sleep, drinking enough water, exercises and a healthy, balanced diet will all help. In fact, caffeine doesn’t help in all the above! The ability to reduce caffeine starts with the mindset to reduce the OAB symptoms in a more holistic way. A cup of caffeine costs between SGD 1 to 8. A tablet for OAB costs between SGD 0.30 to 3. By reducing caffeine and subsequently medication costs, think of how much savings we would have!

Menopausal females may get genital symptoms of menopause whereby they experience vaginal dryness, itch, burning sensation when they pee and their voiding symptoms such as urgency and frequency may get worse. Some may even get recurrent urinary tract infections. All these are due to the decreased female hormones after menopause which leads to the thinning and drying of the female introitus (area surrounding vagina and urethra). Hence, the urinary symptoms may get worse. A simple way is to use topical estrogen to improve the tissue thickness and vascularity. Except for patients who had previous breast or womb cancer, most females can use topical estrogens. It has very low systemic absorption into the body. The symptoms will usually resolve or improve after treatment.

For young ladies, there is an underdiagnosed condition called urethrovaginal or vesicovaginal reflux. In this situation, the urine backflows into the vagina during voiding and after peeing and on standing, a few drops will wet the underwear. In general, this is a dysfunctional peeing condition (learned behaviours) and does not involve any anatomical abnormality.

This usually affects overweight young girls (due to the fat accumulation around the genital areas) or peeing positions (more upright positions rather than sitting forward position on the WC) which closes the introitus or tight pelvic floor muscles (either dysfunctional or pre-existing neurological conditions).

When they first come for consultations, the urologists will need to rule out other urological abnormalities in the body before coming up with this diagnosis. This is to ensure that we do not miss out other conditions with similar symptoms. The patient may need to undergo some radiological scans and cystoscopy to assess the urethra and bladder.

The young patient may need to do bladder retraining (to regulate the voiding cycle), to sit on the WC in a more forward position with legs wide open and for overweight patients, losing weight will help. Pressing gently onto the introitus near the vagina using tissue paper after voiding will also help.

When incontinence worsens and there is now little or no sensation of leakage, with more leakage at night, screening for diabetes should be part of the workup. Uncontrolled or poorly controlled diabetes causes diuresis (body losing fluids) and polyuria (large volumes of fluid loss through the urine).  As a result, some patients may experience sudden onset of incontinence (with or without urgency) or severe nocturia (voids >1 time each night). If there is recent health screening and diabetes is negative, then we can proceed with other urological tests for incontinence and treatment.

Another possible cause is overflow incontinence which occurs when the bladder is overfilled and any excess urine beyond the bladder’s capacity (the volume of urine that the bladder can hold) will leak out. This requires more investigation and for the elderly, self catheterization before bedtime may be helpful.

As males age, their prostate enlarges and this starts around 40-50 years of age. When younger, the last few drops of urine will go back into the bladder after peeing (milk back mechanism). This mechanism is not so good as we age. As a result, the last few drops of urine comes out and wets our underwear slightly. To prevent this, gently press onto the perineum (the area between the anus and testes) forward (in the direction of the testes) with your fingers after peeing to squeeze out that last few drops of urine out. This usually helps.