Urinary Incontinence

• The urinary bladder reduces in size and contraction
• There is also a decrease in ability to suppress contractions and overactivity
• Prostate issue is more common in older men
• Weak pelvic floor muscles in women, especially with history of multiple childbearing

The causes of urinary incontinence depend on the types of incontinence:

Urge incontinence: 
- Described as feeling the intense urge to urinate and before you can get to toilet, the urine leaks.
- Due to bladder being in a hyperactive (hyper contractility) state.
- Common causes: Urinary tract infection, urinary stones/tumours, stroke, Parkinson’s disease, dementia and aging alone.

Stress incontinence:
- Urine leaks with coughing/sneezing/laughing.
- Due to weakness in the pelvic floor muscles.
- Common causes: Pregnancy, obesity, chronic cough condition, pelvic surgery and prostate surgery.

Overflow incontinence: 
- Due to retention of urine causing the bladder to overflow and urine leaks as a result.
- Can be due to bladder being in a hypoactive (hypo contractility) state or obstruction at the bladder outlet causing urinary retention.
- Common causes of hypoactive bladder are diabetes mellitus, low spinal cord injury, nerve problem and certain medications like antihistamines.
- Causes of bladder outlet obstruction are prostate enlargement and vaginal prolapse.

​Functional incontinence:
- It is called functional incontinence because there is no problem with the urinary tract system.
- It is due to problem in cognition (ie: dementia/depression) causing a loss of awareness of bladder fullness, unable to delay micturition until appropriate timing, unable to communicate toileting needs or lack of motivation to maintain continence
- It can also be due to physical factor, eg: someone who is less mobile will have difficulty getting to toilet on time and as a result urine leaks


When you experience sudden urinary incontinence, do seek medical attention as there are some transient causes of incontinence that are reversible with treatment.​

• Age
• Cognitive impairment
• Functional impairment
• Childbearing/multi-parity
• Obesity
• Chronic cough 

If you experience bothersome urinary incontinence, do inform your doctor.

This is because it may signify a serious underlying condition (i.e. spinal cord injury) and some of the causes are easily treatable and reversible (i.e. urinary tract infection and constipation).

The doctor can also advise on certain lifestyle and behavioural strategies, medications (depending on the causes) and suitable continence aids and appliances.

Certain strategies such as bladder training for urge incontinence and pelvic floor exercises for stress incontinence may help to improve the symptoms:

Bladder training (for urge incontinence)
Step 1: For 1-2 days, take note of how many times you urinate or leak
Step 2: Each day, calculate the amount of time you wait between each urination
Step 3: Based on calculation, choose an interval long enough to hold between urinating
Step 4: Empty your bladder first thing in the morning. Add 15 minutes to each interval each day. Continue with this training.
Step 5: Once comfortable with this schedule, increase the intervals by another 15 minutes.

Pelvic floor exercises (for stress incontinence)
Step 1: Locate pelvic floor muscles (To locate your pelvic floor muscles, squeeze in the muscles around the anus as if trying to stop passing wind)
Step 2: Squeeze pelvic floor muscles as tightly as possible for a few seconds (maximum 10 seconds)
Step 3: Relax completely for at least 10 seconds
Step 4: Repeat for at least a few times or as advised by your doctor


​Do seek medical advice for more information on these strategies.