How often have you coughed or laughed too hard and experienced leaking urine, but were too embarrassed to tell anyone?

Well, you are not alone.In the US alone, it is estimated that there are about 10 million to 20 million women suffering from the involuntary loss of urine. In Singapore, about 15% of women suffer from stress urinary incontinence. Yet few women are talking about it, being too embarrassed to mention it even to their friends or doctors. Most adapt by altering their lifestyles so as to avoid embarrassment, thinking that urinary incontinence is a normal process of ageing.

What Is Stress Urinary Incontinence?

You may experience leaking of urine with exercise or exertion that increases intra-abdominal pressure. These include aerobics, running, and even laughing, coughing or sneezing. Different women have different degrees of urinary leakage — some suffer only a few drops, others leak in spurts. Some may leak so frequently that they need to wear sanitary pads every day or change their lifestyles to reduce the chance of embarrassing themselves.

What Causes Stress Urinary Incontinence?

Stress urinary incontinence is caused either by the weakening of the pelvic floor support, which results from pregnancy, childbirth and menopause, or by the intrinsic loss of normal urethral function. Conditions that increase the intra-abdominal pressure may further worsen the problem, like obesity, prolonged coughing, constipation and heavy lifting.

Who Can I Consult for Stress Urinary Incontinence?

• Gynaecologist
• Urogynaecologist: a gynaecologist with further training in common bladder disorders and pelvic floor dysfunction.
• Urologist: a surgeon who is trained in managing bladder and kidney disorders.

What Investigations Do I Need to Go For if I Have Leaking Urine?

The following tests may be ordered for you:

• Urine Test: to exclude urinary infection
  
• Pad Test: you are asked to drink 500 millilitres of water. A pre-weighed sanitary pad is worn and weighed one hour later. During which time, you are asked to perform activities such as walking, bending, coughing and climbing stairs. It is done to quantify incontinence• Erect Stress Test: you are asked to cough in a standing position onto a pre-weighed incontinent sheet, which is then weighed to quantify the loss
• Residual urine: to exclude voiding difficulties and overflow incontinence
• Uroflowmetry: to measure urinary flow rate
• Urodynamic study: a test that measures the detrusor muscle pressure at rest and during activities like coughing and passing urine. It helps in differentiating the various types of urinary incontinence and voiding disorders
• Ultrasound scan: to exclude associated gynaecological conditions, to measure bladder volume and bladder neck mobility

Is There Any Treatment Available for Stress Urinary Incontinence?

Yes. It can be divided into conservative and surgical treatment. There are, at present, no effective drugs in treating stress urinary incontinence.

Conservative/Non-surgical Treatment for Stress Urinary Incontinence

• Pelvic Floor Exercises: the physiotherapist will teach you how to strengthen your pelvic floor muscles. You have to do it every day in your own time
• Vaginal Cones: cones of increasing weight will be inserted into the vagina and you will have to contract your pelvic floor muscles in order to retain these cones
• Electrical Stimulation: Electrical current is used to stimulate your pelvic floor muscles to contract. It is for women who have poor result from pelvic floor exercises. The improvement from the above treatment is observed only after 2-3 months. If there is no improvement, you may consider surgical intervention.

Surgical Treatment for Stress Urinary Incontinence

The objective of the operation is to restore urinary continence. If you also have an associated uterovaginal prolapse, you may be advised to have a hysterectomy and pelvic floor repair as well.The main types of surgery are:

• Tension-free Vaginal Tape (TVT & TVT-O): a relatively new method with very good success rate of 94% since KKH started using it in 1998. It has become the commonest type of continence surgery performed at KKH. It is relatively less painful and requires a short hospitalisation of two to three days
• Burch Colposuspension: it has been superseded by the TVT in recent years but is still a reliable procedure used in treating female stress urinary incontinence. It has an 85% success rate in the first year and up to 70% in 10 years. It requires a seven-centimetre abdominal incision and an average of four-days stay in the hospital

Other surgeries include needle bladder neck suspension, suburethral slings and collagen injections.

Stress urinary incontinence can be cured or improved. Please do not suffer in silence; instead, see your doctor early for assessment and advice.