I do not want to become old and smelly…

Women with urinary incontinence often lament: “I do not want to become old and smelly”.

It is true that urinary incontinence is smelly and socially unacceptable, but it is NOT true that urinary incontinence occurs only in the elderly.

So why do women leak urine?

The female urinary bladder, together with the uterus and the rectum, resides within the bony pelvis. This bowl-shaped bony pelvis has an inlet and an outlet. The inlet is in continuation with the abdominal cavity, while the outlet is sealed off by a sheet of muscle i.e. the pelvic floor muscle. This pelvic floor muscle appears like a hammock. It spans the pelvic outlet and is suspended from the bony pelvis. It provides support for the pelvic organs i.e. bladder, uterus and rectum, and prevents these organs from prolapsing beyond the pelvic outlet.

It has three openings through which the urethra, the vagina and the anus traverse. These muscular openings provide muscle tone to the vagina and sphincteric function to the urethra and the anus i.e. contraction and closure of the urethra and anus to prevent leakage of urine and or faeces. Like any other muscle within the body, the pelvic floor muscle can weaken with age and use. When the muscle weakens, supportive function may fail, resulting in a prolapse or droop of the pelvic organs i.e. bladder, uterus or rectum. When the muscle weakens, the sphincteric closure of the urethra and anus may also fail, resulting in a leak of urine and or faeces.

Women with pelvic floor muscle weakness may complain of “leaky bladder” i.e. urinary leakage upon straining e.g. coughing, sneezing, laughing, carrying heavy loads, skipping, jumping, running, brisk walking and sometimes even standing. This urinary leakage is termed stress urinary incontinence.

It is true that stress urinary incontinence is not life threatening, but it is also true that stress urinary incontinence reduces one’s quality-of-life.

Thus, this Urological condition should and can be treated. Treatment of stress urinary incontinence begins with pelvic floor muscle exercise i.e. Kegels exercise. This should be practised daily.

Reinforcement of the pelvic floor exercise can be achieved via biofeedback devices and or physiotherapy. Biofeedback devices provide auditory or visual signals that reflect the strength of the pelvic floor muscle contraction. These devices include portable ones for home-based use and non-portable ones for clinic use.

Pelvic floor muscle exercise can improve the symptoms of stress urinary incontinence by 30 – 60% but cure is rare. Surgery is the main curative option for stress urinary incontinence.

FotonaSmooth treatment is a newer, minimally invasive treatment. FotonaSmooth treatment uses a trans-vaginal laser to repair the pelvic floor. FotonaSmooth treatment improves the thickness and structure of the pelvic floor, especially the area adjacent to the urethra, thereby improving the support and closure of the urethra.

Conventional, invasive surgical treatment aims to place a tape below the urethra to provide it with better support and closure. Surgical approach and results have improved over the past half-century. In the past, surgery required a long incision similar to that for a Caesarean section. This evolved to become three smaller incisions, one in the vagina and two over the lower abdomen or upper thighs. In recent years, a single vagina incision is needed. Today, stress urinary incontinence can be treated by a variety of therapeutic options. Treatment of stress urinary incontinence cannot add years to life, but it can certainly add life to years. Stress urinary incontinence is a common problem. Greater awareness will help in the prevention and the treatment of this problem.

Author: Dr Siow Wei Yun, Raffles Urology Centre