Urinary Leakage and Incontinence

What is Urinary Incontinence?

It is the involuntary leakage of urine that is a social or hygienic problem.

It affects 10-20% of women in Singapore and increases with age.

How common is it?

What are its causes?

There may be more than a single cause (multifactorial), these include:

• Urinary tract infection
• Complication due to medications
• Congenital weakness of ligaments, collagen deficiency
• Pregnancy and natural childbirth leading to damage to the pelvic floor muscles, ligaments, fascia and nerves
• Pelvic organ prolapse
• Menopause
• Ageing
• Stroke, dementia
• Spinal cord disease or injury
• Complication of surgery
• Restricted physical mobility (inability to reach the toilet in time)
• Obesity, heavy lifting, constipation, chronic cough

Types of Urinary Incontinence

There are generally 4 types of primary urinary incontinence:

• Stress incontinence: Involuntary urinary leakage on effort or exertion, e.g., when you cough, sneeze, laugh, run, exercise or lift something heavy. This is usually due to pregnancy, natural childbirth, congenital causes, prolapse, obesity.
• Urge incontinence: Involuntary urinary leakage accompanied or immediately preceded by urgency, e.g., before you can reach a toilet or before you can undo your clothes. This is due to the causes of overactive bladder (please refer to the web page on Frequent urination and overactive bladder)
• Some patients may present with both stress and urge (mixed) incontinence.
• Overflow incontinence: Involuntary urinary leakage not related to physical exertion or urgency, e.g., when you experience occasional dribbling of urine due to difficulty in emptying your bladder adequately or obstruction to your urine-pipe. This is can be due to stroke, dementia, spinal cord disease or injury, diabetes mellitus, significant pelvic organ prolapse, post-delivery or surgical complication.
• True incontinence: When there is continuous urinary leakage due to congenital abnormality of the urinary tract or a fistula (false passage) from the urinary tract to the vagina, a rare complication of vaginal delivery, Caesarean section or gynaecological surgery.

Therapeutic options

The treatment of urinary incontinence depends on its type.

Please refer to the web page on Frequent urination and overactive bladder (OAB) for the treatment of urge incontinence.

Women suffering from stress incontinence may be taught or referred for pelvic floor (Kegel) exercises. If the latter fails a urodynamics, investigations will be performed to confirm the diagnosis and to exclude detrusor overactivity (abnormal bladder contractions) before surgery is planned.