3 Mount Elizabeth #05-05
Mount Elizabeth Medical Centre
Singapore 228510

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Urine Leak

Urine Leak in woman

Many women suffer from involuntary urine leakage, which is also known as urinary incontinence. In addition to urinary incontinence, many also experience frequent urination, sudden urges to pass urine as well as night-time urination. The night time urination and urgency are troublesome occurences as the need to go to the toilet frequently comes unexpectedly, with some women suffering the embarassment of urine leakage even before reaching the toilet. Frequent night time urination can also cause deprivation of sleep, thus affecting the ability to concentrate during the day.

Some women experience urine leakage upon coughing, laughing, sneezing, brisk walking or climbing stairs. These women often have had many childbirths – vaginal (normal) deliveries, in the past. While many experience the occasional urine leak for many years, the leak worsens upon reaching menopause.

Oftentimes, urine leakage adversely affects the women’s lifestyles. Many end up having to change their lifestyles such as avoiding social functions or sports, preferring to stay at home instead.

There are different types of urine leakage with different treatment options, depending on the underlying cause. The more common types are urge incontinence and stress incontinence.

Urge incontinence

It is primarily a condition of the bladder. There are muscles and nerves within the bladder. Sometimes, these muscles develop unwanted contractions or the nerves send signals to the brain, resulting in frequent urges to pass urine. This causes frequent urination, night-time urination and possibly urine leakage.

Treatment is aimed at decreasing or abolishing these sensations / contractions. The usual treatment for such urine leak is behavioural change and oral medication. Behavioural change may include timed voiding i.e. setting a minimal time interval between urination. As for oral medication, there are different types of medication and a common one is anti-cholinergic medicine. Examples of anti-cholinergic medicine include oxybutynin, tolterodine, solifenacin and darifenacin. More recently, a new class of medicine has been developed. They are beta-3 agonists and the first to be available is mirabegron.

Sometimes, oral medication may not be effective. In such instances, other treatment options are available. One such alternative is the injection of botulinum A into the bladder, which has been shown to be effective in treating this type of urine leakage.

Stress incontinence

This refers to urine leakage on coughing, laughing, sneezing, etc. This is due to the inability to hold urine when pressure is applied to the outlet of bladder i.e. when the bladder is ‘stressed’. The bladder outlet consists of a tube through which urine is passed out of the bladder. The function of the bladder outlet is, among others, maintained by the health of the tissues around it as well as the strength of the pelvic floor muscles. After multiple childbirths and on reaching menopause, these pelvic floor muscles and surrounding tissues are weakened, resulting in stress incontinence.

Treatment is aimed at strengthening the outlet. This can be accomplished by pelvic floor exercise. Also known as Kegel exercise, this is effective but requires perseverance. For some, other forms of treatment are needed such as surgery. There are many types of surgery available for stress incontinence. One effective surgical option is mid-urethral sling. The sling surgery involves placing a synthetic material beneath the bladder outlet where it acts as a backstop during urination. This can be done as a day procedure i.e. without the need for overnight stay in the hospital and has been shown to be an effective way of treating stress incontinence.

Evaluation

A urodynamic study may be required in some instances. It is basically a test to evaluate the function of the bladder and outlet. It involves placing a tube (catheter) into the bladder and another tube (rectal probe) into the rectum. The 2 tubes are then connected to a computer.

The bladder is then filled with liquid. When the bladder is full, the patient will be asked to pass urine. During this process, information of the function of the bladder and outlet will be collected and stored in the computer. These can then be downloaded and printed.

The urodynamic study provides additional information on urinary incontinence which may aid in the management in many patients.

Should I seek medical attention?

Many women do not seek medical attention as urine leakage is often attributed to ageing where nothing much can be done. As such, many suffer in silence.

However, with better understanding of the condition and medical advances, much can be done to help those who suffer from urine leakage.

Summary

Urine leak is not uncommon among women and often affects their lifestyle negatively. There are different causes of urine leak and management depends on the underlying cause. While cure may not be possible in all cases, many can be improved with current medical options.