Report on Talk: Management of Urinary Incontinence

Involuntary leak of urine (incontinence) is a growing concern among the aging people and its effects on socio-economic condition of any population are innumerable. Though with increasing age, high risk for incontinence is noted, even at 20 years people present with incontinence, said Dr Pearllyn Quek Leng Choo, Associate Consultant, Department of Urology, Changi General Hospital in her talk on “Management of Urinary Incontinence”. Thirty to 40% of women in their 60-80 years is likely to encounter this problem. In Singapore, 11.8% of women are known to have incontinence but only 22.2% of them are seeking medical help. Many patients think that it is a consequence of aging, which is a big reason for not seeking medical help in our community. Besides this, symptom may not be so severe, embarrassment, expensive, not possible to treat or treatment is not available are some of the misconceptions of non-treatment seekers. Good bladder control, tight pelvic floor muscles and competent sphincter mechanism (effective open and closure) are needed for good urinary system, which is controlled by brain, Dr Quek said.

Incontinence is of different types viz., stress, urge, and overflow, total and temporary incontinence. Stress incontinence, which is due to increased intra-abdominal pressure, is the most common type of incontinence occurring in 49%. In this case urine will leak when coughing, laughing, sneezing and straining. Pelvic floor muscle strengthening, electrical stimulation, medications and surgical methods can easily treat this condition. Urge incontinence noted to occur in 40%, is due to an overactive bladder. People with this condition will be peeing more than 8 times a day, 2 or more times at night, wanting to pass urine after every drink and bed-wetting. At times, urge incontinence is associated with other conditions like urinary tract infection, bladder outlet obstruction and stress urinary incontinence. Thus, before embarking on the treatment for urge incontinence, proper evaluation is necessary to derive full benefits from the treatment. Bladder training and medications are some of the easiest treatment options available now. Overflow incontinence, the incomplete emptying bladder, is predominantly due to either weak bladder muscles or blockage at the urethra. Catheters or medications or surgery can simply overcome this problem. Total incontinence would probably occur in patients with prior surgery, pelvic trauma, nerve damage, sphincter insufficiency or damage and abnormal tract, for effective treatment for this problem surgery is the best option, said Dr Quek.