MPharm, PhD, RPh
“My husband and I were happy for twenty years; then we met.”
“Best slogan on a man’s t-shirt: Please do not disturb me; I am married and already very disturbed.”
“Employee: Sir, you are like a lion in the office, what about at home?
Boss: I am also a lion at home. But there we have a lion tamer.”
You giggled. You leaked. Not funny.
Talking about how you wet yourself (with urine, if I’m not making myself clear) when you are on a night out is probably not the best topic that you and your friends want to talk about. We get it. However, would you want to leak urine for the rest of your life? Unlike urinary tract infection or diarrhoea which can resolve by itself, your urine leak will not get better if you do not take any action. And when your friends start detecting that urinary odour, arghhhh!
Am I alone here?
This condition where you leak urine when you laugh, cough, sneeze, exercise, do any physical activity etc is known as stress incontinence. Stress incontinence is a very common condition affecting 2 in 5 women. It is relatively uncommon in men, although some men may have stress incontinence following surgical removal of prostate due to prostate cancer.
“Oh, so it only affects women. That’s none of my business then.”
Sorry darling, not so fast.
Women who suffer from this condition find it extremely bothersome. Studies have shown that this condition negatively affects couples’ sexual function. Some women avoid having sex for fear of leaking urine during sexual intercourse. (Now that I’ve got your attention, can you please share this article with your partner?)
Why do you leak urine when you cough, laugh or jump?
A simple way to explain stress incontinence is to use an analogy. Imagine a reusable shopping bag that you bring to do your grocery shopping every week. You put in many items, some very heavy ones. If you do not make an effort to preserve the bag, the reusable bag starts to wear and tear and can no longer ‘support’ your items. Similarly, we have a group of muscles called the pelvic floor muscles which act as a “hammock” (refer figure) to support the pelvic organs (bladder, uterus and rectum). As we age, the pelvic floor muscles begin to weaken. This is further aggravated by other factors such as childbirth, obesity, pelvic surgery and certain medical conditions such as stroke. In particular, pregnancy and vaginal delivery put a lot of pressure on the pelvic floor muscles while menopause causes the muscles to lose their elasticity.
Figure 1: When you cough, laugh or do any physical activity, there is added pressure on your pelvic floor muscles. If your pelvic floor muscles are strong enough, you will not leak urine.
Figure 2: However, you will leak urine if your pelvic floor muscles are weak.
“A clever person solves a problem. A wise person avoids it.” -Albert Einstein
There are several preventive measures that can be taken to prevent stress incontinence.
- Maintaining a healthy lifestyle
- Maintain an appropriate fluid intake (2 to 2.5 litres of fluid per day including water, coffee, tea, juice, soup, porridge etc)
- Minimise caffeine (coffee, tea) and alcohol intake
- Stop smoking to avoid getting chronic cough
- Reduce weight if you are overweight (target body mass index of <25)
- Eat more fibre-rich food to avoid constipation
- Pelvic floor muscle training (more commonly known as Kegel exercise involves manual (self) contractions to strengthen the pelvic floor muscles. This video explains how to perform the Kegel exercise correctly. If you are concerned whether you are doing the exercise properly, please talk to your doctor or pharmacist.
It’s too late…..I’m already leaking!
It is NOT too late! There are various non-surgical and surgical options to treat your condition.
These include non-surgical options such as:
- Supervised pelvic floor muscle training – ensure that you are performing the exercise correctly and regularly
- Vaginal cone – insertion of cone into the vagina to help you identify and contract the correct muscles
- Electrical stimulation – insertion of electrodes into the vagina to stimulate and strengthen the pelvic floor muscles by applying small electric currents
- Magnetic stimulation – automatic repetitive contractions of the pelvic floor muscles to increase strength and endurance
For more information regarding the treatment options above, talk to your doctor or pharmacist. Note: Please consult your doctor or pharmacist prior to starting any treatment.
If the non-surgical methods do not work for you, you can opt for surgical treatments (e.g. midurethral slings) where a tape is placed under the urethra to keep the urethra in a normal position. Thanks to the technological advances in surgery, the conventional open surgery has been supplanted by the minimally invasive techniques. The procedure only takes between 15 and 30 minutes and can be performed on an outpatient basis.
Why suffer physically, mentally and socially in silence? Here’s your to do list!
To do list
- Consult your doctor or pharmacist for advice on prevention or treatment of stress incontinence
- Spread the awareness among your friends!
- Bukhard FC, Lucas MG, Berghmans LC, et al. EAU guidelines on urinary incontinence in adults. 2016. Accessed 13 September 2017. Available from https://uroweb.org/wp-content/uploads/EAU-Guidelines-Urinary-Incontinence-2016.pdf
- Abrams P, Cardozo L, Wein A, Wagg A. Incontinence: 6th International Consultation on Incontinence, Tokyo, September 2016. 6th edition, 2017.
- Lim R, Liong ML, Leong WS, et al. Effect of stress urinary incontinence on sexual function of couples and quality of life of the patients. The Journal of Urology 2016;196:153-8.