Suffering in silence

by | June 23, 2015

More awareness is needed to educate people on incontinence so they know there are treatments available and don’t have to be embarrassed.

BY: Eleanor Yap

Chu Mee Yann.

Chu Mee Yann, who is her 60s did not share about her recent diagnosis of an overactive bladder (OAB) to her children. OAB is a condition where one has a sudden and compelling urge to pass urine, which is difficult to ignore. Sometimes a sufferer would urinate frequently, usually eight or more times in 24 hours, and awaken two or more times in the night to urinate.

Chu explained her condition started off with a few drops but it later increased to a teaspoon-full. She wasn’t embarrassed to share her condition to her children but felt they wouldn’t understand, as they are younger. However, she did share it with her friends and even talked about treatments with them.

In fact, she herself had sought treatment and is on a course of medication. She has not had to make any major lifestyle changes however, she shared that she stays at home mostly, and her urges often occur if she is standing or if she goes out.

What Chu suffers from is very common, “more common than hypertension, depression and diabetes,” shared Dr Tricia Kuo, co-chair for the organising committee for Singapore Continence Week. It is estimated that OAB affects more than 400 million people worldwide. In a community-based survey conducted by the Singapore General Hospital’s (SGH) Department of Urology, the prevalence of OAB was found to be slightly higher than 30 percent.

With many being affected, more women than men, very few tend to seek treatment. Dr Kuo shared that according to a survey in Asia, only 21 percent do so.


Bringing more awareness

With this sobering realisation and the growing need to bring awareness to the condition, the Society for Continence (Singapore) (SFCS) and the Singapore Urological Association (SUA) have come together for the first time this year to organise Singapore Continence Week, which will have a number of activities from June 27 to 28. For the past six years, both of these organisations have done their own part in bringing awareness to urinary and bowel incontinence.

However, this year, there will be 20 training seminars for healthcare professionals as well as caregivers, which will cover topics on urinary catheters, bladder training and more. There will be talks in English and Mandarin for the public on urinary and bowel incontinence. According to Professor Peter Lim, president of SFCS and director of andrology, Urology and Continence Centre at Gleneagles Hospital, there will be leaflets on incontinence at the hospitals in a month’s time and a hotline (6513 7313), which has been launched to cater to sufferers of incontinence.

He said, “Twenty years ago, people would come to me secretly as they were embarrassed about their condition and some of the women don’t tell their husbands. The husbands don’t acknowledge that such a condition exists and blame it on old age (incontinence is not a normal part of ageing). Today, as more are recognising it is a problem, they seek out a doctor.”


The urge to go

Dr Tan Yeh Hong of SUA, left, and Prof Peter Lim of SFCS at the launch of the Singapore Continence Week.

So what exactly is OAB? When a bladder is full, one would normally then pass urine. However, with OAB, even before one’s bladder is full and because of faulty nerve and or muscle signals, one feels a need to pass urine, resulting in more trips to the bathroom in the day and night. Triggers or aggravating factors differ from person to person, and can include simple things like hearing a running tap, turning the key at the door on reaching home, etc.

Explained Dr Kuo, who is a consultant in the Department of Urology at SGH, there are also less obvious symptoms such as people preferring an aisle seat so they can easily go to the bathroom, tend to avoid long trips as well as trips overseas, and when they are going outdoors, they bring extra clothing. She added they also do “toilet mapping” or plan their route out noting where the bathrooms are.

She said: “Urinary and bowel incontinence is not life-threatening but it can take a toll on a person emotionally. Some fear accidents will happen and some are embarrassed and they isolate themselves including from their families.”

If one has OAB, the first line of treatment is to make lifestyle changes including reducing caffeine and alcohol intakes, reducing fluid before sleep, and doing Kegel pelvic floor exercises to strengthen pelvic floor muscles and urinary sphincter (muscles that control the exit of urine in the urinary bladder), and bladder training where one delays voiding when one feels an urge to urinate.

If all this does not work, the next approach is medications, which include non-selective and receptor subtype anti-muscarinic agents. These medications, shared Dr Kuo, have side effects like dry eyes and mouth, and constipation, and they are contraindicated with other conditions like narrow-angle glaucoma and gastric or stomach obstruction. She said, “Half of the patients stop taking the medication after three months because of ineffectiveness, side effects and/or cost.”

A new class of drugs called beta 3 agonists (which includes a drug launched this year called mirabegron by pharmaceutical company Astellas) can help to increase bladder relaxation by increasing the bladder holding capacity and extending the duration between passing urine. It does not affect bladder emptying so there is less likelihood of urine retention. Studies show that patients made fewer trips to the bathroom and have fewer leaks, however, these compare mirabegron to a placebo and not to an anti-muscarinic agent. It also has lesser side effects than anti-muscarinic agents. The medication is taken for at least three months and evaluated by the doctor.

If the medications are not effective, other options can be considered like botulinum toxin (commonly known as Botox), which paralyses the bladder muscle, and electrical stimulation, which reduces incontinence symptoms. If all that fails, surgery is the last resort and is irreversible. There are two surgical procedures available – surgery to increase bladder capacity and bladder removal. Dr Kuo said that if one is not fit for surgery, one could use pads, undergarments or catheters.

Emphasised Dr Tan Yeh Hong, president of SUA and senior consultant urologist/medical director, Centre for Urology, Robotic & Minimally Invasive Surgery at Mount Elizabeth Medical Centre, “More people are coming forward [for treatment] and [it is important to note] the condition is treatable.”


(** Homepage photo credit: bathroom signs, clambert, freeimages)



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