Leaking urine when you sneeze, cough, laugh or lift your three-year-old, may indicate that you suffer from Stress Urinary Incontinence (SUI).

SUI is caused by the weakening of the pelvic floor, the group of muscles and ligaments that keep the urethra closed to contain urine in the bladder. Factors that can weaken the pelvic floor include pregnancy, childbirth, menopause or pelvic surgery.

“Stress urinary incontinence is very common during pregnancy and childbirth. About a third of first-time mothers will experience some SUI in the third trimester and the majority of women will have some SUI in the first three to six months after the birth,” says Dr Suresh Nair, Obstetrician & Gynaecologist at Seed of Life, Fertility & Women’s Care Medical Centre, Mount Elizabeth Novena Specialist Centre.

The accidental and involuntary leakage of urine is said to affect about 15% of women in Singapore, whereas urinary incontinence is said to affect up to 30% of Malaysian women. However, because it is a largely under-reported condition, the exact number of cases are difficult to determine.

Degree of severity

SUI is classified as mild, moderate or severe, according to the amount of leakage and how easily it occurs.

For example, occasional small leaks triggered by strong sneezing or laughing fits would be classified as mild. More frequent or larger leaks caused by lifting heavy shopping bags or running might rate as moderate. The condition is classified as severe when the leakage is heavy, and/or caused by almost any normal physical exertion such as walking up the stairs, even standing for a long time or getting up after sitting for a prolonged period.

Most new mothers tend to experience mild to moderate post-partum SUI, but it usually clears up within a few months to a year. The number of pregnancies can however affect the seriousness and duration of the problem. “Other risk factors that can increase the incidence of SUI in women include being overweight or obese, if the baby is particularly large and the mother very petite, if forceps or suction were used in delivery, or if there is any tearing during delivery,” says Dr Nair.

Leak Myths

There are still many myths and misconceptions surrounding SUI, its causes and treatments, such as:

  1. It happens with age. Many older women may have SUI but never seek medical attention either because they are too embarrassed to confide in their doctors or simply believe it is part of ageing. This is not true, and if it does happen to you, there are many ways to get this problem under control.
  2. It’s caused by a small bladder. This is a myth; involuntary leakage of urine is not caused by a smaller bladder but rather the organ’s inability to hold the fluid, due to the weakening of the muscles and ligaments.
  3. C-section can reduce the severity of SUI. This is not necessarily true, although an elective C-section with no labour may reduce the incidence of SUI significantly. “The baby’s weight also plays a factor, where a birth weight of more than 3.5kg puts extra pressure on the pelvic floor, causing it to weaken,” explains Dr Nurul Ain Abdullah, aesthetic physician at Alainn Clinic.
  4. Only surgery can fix it. While this was once true, there are now several non-surgical and non-invasive alternatives available to women with this condition. Apart from injectable fillers, there are also non-invasive treatments which have revolutionised the treatment of SUI for women.

(Left) Dr Suresh Nair (Right) Dr Nurul Ain Abdullah

Treatments for SUI

For mild or post-partum SUI, behavioural modification is usually advised. This can include physiotherapy to strengthen the pelvic floor in combination with Kegel exercises, bladder training, maintaining good bowel function, maintaining a healthy weight, and not smoking.

“Kegel exercises during and after pregnancy, proper posture and exercises to strengthen the core muscles, are some ways to hasten the recovery of the pelvic floor muscles and increase one’s chances of not developing SUI,” says Dr Nurul.

However, behavioural modification can take time and one has to diligently keep up with the recommended exercises and lifestyle modifications in order to retain the benefits.

Today, there are also many non-invasive treatments for SUI available in the market, including treatments with medical devices such as FotonaSmooth Intimalase and BTL Emsella.

The FotonaSmooth Intimalase, a non-invasive treatment, uses a non-ablative Erbium YAG (Er:YAG) laser to produce thermal effects in the vaginal tissue. This stimulates collagen remodelling and the synthesis of new collagen fibres, restoring the elasticity of the connective structures of the vaginal wall and tightening of vaginal canal.

BTL Emsella uses high-intensity focused electromagnetic (HIFEM) technology. HIFEM induces muscle contractions wherever it is applied on the body. These muscular contractions are at much higher rates and are far more intense than are possible to achieve voluntarily. A single session on the BTL EMSELLA is equivalent to 11,000 supramaximal pelvic floor muscle contractions, comparable to 11,000 Kegel exercises.

The advantages of these treatments are that they are non-invasive, require no incisions or injections, and typically involve minimum to zero downtime.

For more serious cases that do not respond to behavioural modification or non-invasive treatments such as the above, injectable fillers or injectable bulking agents (IBA) are the other options. As a last resort and in severe cases, specialists may recommend surgery to counter SUI.


Featured photo by Shutterstock. Doctor photos by respective doctors.