When you feel the urge to sneeze, do you stifle it for fear of having an embarrassing “accident”? If you cough too much, will that cause a bit of urine leakage? Do you literally laugh so hard that you pee your pants?
This could be due to stress urinary incontinence (SUI), which is quite common among women.
About 15% of women in Singapore suffer from stress urinary incontinence but may feel too embarrassed to talk about it or seek medical treatment.
So what exactly causes this condition and is there anything you can do about it?
theAsianParent spoke to Prof. Peter Lim from the Andrology, Urology and Continence Centre at Gleneagles Hospital, for his expert insight on SUI and the treatment methods available.
What causes stress urinary incontinence?
According to Prof. Lim, pregnancy and childbirth are the major causes of SUI in women because they cause stretching and weakening of the ligaments, nerves and pelvic floor muscles that normally work together to support the bladder and keep the urethra closed so urine doesn’t leak.
Menopause-induced vaginal atrophy is the main reason older women suffer SUI, because the pelvic floor muscles and tissues that provide support to the pelvic organs (bladder, uterus and rectum), depend on oestrogen to maintain their strength and elasticity.
Pregnancy and childbirth are the two main causes of stress urinary incontinence
The decline in the production of oestrogen during menopause causes thinning and weakening of the pelvic support structures making women more susceptible to SUI.
Other risk factors include:
- Being overweight or obese
- Smoking
- Chronic coughing (which puts strain on the pelvic floor muscles)
- Childbirth
- Menopause
- Constipation
There is also increased risk of getting SUI if your baby is particularly large or you are very petite. If forceps or suction are required during the delivery or there is any tearing during the delivery, there is an even greater likelihood of postpartum SUI.
Stress urinary incontinence can even occur in a small percentage of young women who have not been pregnant but there is usually some other underlying cause so they should see a medical professional to have it checked out.
Common misconceptions
“There are some misconceptions about SUI and the biggest is that it is just a part of being a woman a you have to put up with it. It might be a part of childbearing and ageing but women no longer have to put up with it”, explains Prof. Lim.
Another big misconception is that it is hereditary and that if your mother had SUI then you will too — but there are no obvious genetic indicators of a hereditary factor to SUI and just because your mum had it and suffered with it for years does not mean that you will too.
Even if you do develop stress urinary incontinence, there are treatments available now that were not available to your mother back then.
Is your stress urinary incontinence mild, moderate or severe?
How severe is your stress urinary incontinence?
There is a basic factor to determine the severity of SUI — it can be classified as mild, moderate or severe according to the amount of leakage and how easily leakage occurs.
Mild
Occasional small leaks triggered by strong sneezing, laughing fits or heavy lifting would be classified as mild.
Moderate
More frequent or larger leaks caused by the occasional sneeze, running for the bus or lifting a heavy shopping bag might be rated as moderate.
Severe
If leakage is heavy or caused by almost any normal physical exertion such as walking upstairs or even standing for a long time or getting up after sitting for a prolonged period, it would be classified as severe.
How to prevent stress urinary incontinence
“Some women wonder if it is their fault, if there is some way they could have prevented it, but the answer is no. There is no way to guarantee you won’t have SUI after childbirth so there is no fault or blame”, says Prof. Lim.
To reduce the chances of having SUI he recommends you take the following steps:
- Maintain a healthy weight
- Exercise during your pregnancy and after the birth
- Do your Kegels!
Vaginal birth vs Caesarean section (C-section)
According to Prof. Lim, an elective C-section with no labour does seem to reduce the instance of SUI significantly — however expectant mothers should keep in mind that C-sections come with their own risks, especially for first time mothers planning on more children.
Several studies have also shown that mothers who delivered their baby via Caesarean section were just as likely to develop SUI in later life as mums who had given birth naturally.
Treatment options available
Most new mothers experience some mild to moderate SUI after giving birth but it usually clears up within a few months to a year if they do their Kegel pelvic floor exercises (PFEs) to strengthen the muscles and ligaments of the pelvic floor.
“A lot of women in Singapore, especially older women, may have SUI but never seek medical attention either because they are too embarrassed, or they simply believe it is an unavoidable part of ageing and they think nothing short of surgery can fix it because they are unaware of the modern non-surgical treatment options”, says Prof. Lim.
Don’t be embarrassed to tell your doctor about your stress urinary incontinence so you can get the proper treatment required
Currently there are a range of treatment options for SUI depending on its severity, which include:
Behavioural modification
Suitable for mild or post-partum SUI, this treatment includes fluid and dietary management, bladder training and timed or prompted voiding combined with PFEs like Kegels.
Pros: No cost, no downtime, no side effects, and subsequent pregnancies are not affected.
Cons: Takes time to be effective; and one has to keep up the exercises and lifestyle modifications to retain the benefits.
Injectable bulking agents (IBAs)
Suitable for mild or moderate SUI not responding to behavioural modification and PFEs.
Injectable bulking agents (IBAs) can be injected into the supportive tissues beneath the urethra to bulk them up and stiffen them so that they offer more support.
Pros: Effective, minimally invasive and cost effective compared to surgery and they can last a long time.
Cons: Requires a trip to the hospital as they need to be done in an operating room; not as long lasting as surgery; and depending on the choice of IBA there is a limit to the number of follow-up injections that can be administered.
The FotonaSmooth laser treatment is virtually painless and is suitable for all cases of stress urinary incontinence (Image credit: Servicom Medical )
FotonaSmooth laser treatment
The latest treatment for SUI is best suited for mild to moderate cases which can usually get close to 100 percent results, but can also be used for even severe cases and will significantly improve even those — although not completely curing them.
This non-ablative photothermal technology works by thermally affecting the vaginal tissue, stimulating collagen remodelling and the synthesis of new collagen fibres around the opening to the urethral and the vaginal wall.
The new and strengthened collagen causes the shrinking and tightening of the vaginal mucosa tissue and collagen-rich endopelvic fascia and subsequently gives greater support to the bladder and greatly improves continence function.
Pros: Non-invasive as it requires no incisions or injections; no cuts, abrasions or burns so no risk of wound infection; virtually painless (just slight discomfort); can be done in the urologist’s clinic where the patient can walk out after 20 minutes and continue with her day as normal; if you plan on having another baby, you can still give birth naturally.
Cons: Requires several rounds of treatment (typically two to three treatments spaced over two or three months is sufficient); an annual maintenance top-up laser treatment is needed to sustain the improvement almost indefinitely.
Surgical procedure
Suitable for severe cases, the surgical options available nowadays are much less invasive than the techniques compared to a couple of decades ago.
Today there are a variety of surgical options dependent on how the individual patient presents and most operations to treat SUI are now done as laparoscopic or ‘keyhole’ surgeries.
Pros: Relatively safe; effective; and very long lasting solution to most cases of SUI.
Cons: Invasive; expensive, requires at least one or two nights’ stay in hospital; as with any surgery there is some risk involved (especially for older patients); any subsequent babies would have to be delivered by Caesarean section.
Don’t be embarrassed if you think you suffer from stress urinary incontinence, and remember talk to your healthcare provider about which form of treatment is best suited for your case to avoid any more embarrassing accidents from happening!
Do you pee a little when you sneeze or laugh? Share your stories about stress urinary incontinence with us in the comments section below!