Urinary incontinence is not a natural process of ageing.

Urinary incontinence or the involuntary leakage of urine is a common but often under-discussed issue affecting people of all ages, especially women and older adults.

It can result from various causes, including weakened pelvic floor muscles, overactive bladder or even because of prostate surgery in men.

Thankfully, a wide range of treatments are available, from lifestyle changes and pelvic floor exercises to medications and surgery.

In this 'Ask the Specialist' Q&A forum, please feel free to ask Dr Yong Jin any burning question about urinary incontinence and learn how it can be effectively managed.

Don't let urinary incontinence affect your quality of life, put a stop to it!

Dr Yong Jin graduated from the National University of Singapore Yong Loo Lin School of Medicine in 2012. He obtained his post-graduate degrees - MRCS and Master of Medicine (Surgery) in 2013 and 2018 respectively.

Dr Yong underwent specialist Urology training at Singapore General Hospital and graduated as the top candidate in his exit examination. He is a Fellow of the Academy of Medicine, Singapore.

Dr Yong has recently completed a one-year Ministry of Health awarded overseas fellowship with renowned urologist A/Prof Vincent Tse (Sydney, Australia), where he was involved cutting edge incontinence and reconstructive surgeries.

Dr Yong is deeply involved in many clinical trials in functional urology and within SGH. In 2023, he was awarded the prestigious NMRC Clinician Innovator Award for his work on nocturia.

Dr Yong is also actively involved in teaching medical students and junior doctors. He has teaching appointments in all 3 medical schools locally, and is a Clinical Assistant Professor with the National University of Singapore.

1. Question by Samuel

Dear Dr Yong Jin, 

Is it possible to put a complete stop to urine incontinence? 

I'm 77, had a prostate surgery 2 years ago and practised pelvic floor exercise very hard and regularly. 

However, it dribbles annoyingly especially just after visiting the toilet. Dribbling is a new normal to me and I wear one piece of pad 6am - 6pm during my working days. 

Is there a way to stop incontinence like what it was before the surgery? Thank you for your advice.

Answer by Dr Yong Jin

Yes, there are options available for post prostate surgery incontinence.  Was it a radical prostatectomy that you had?

In general, these can be treated with either a male sling or an artificial urinary sphincter with fairly good results. 

I encourage you to make an appointment to consult me in the clinic.

2. Question by Pang SM

Dear Dr Yong, greetings. 

I am a male Singaporean Chinese, aged 64 this yr. I exercise quite regularly. 

My issue is: whenever I get up from a sitting position (at the desk) and stand up, I have a strong urinary urgency to urinate. 

During the earlier onset of this condition, whenever I bend forward at the sink to brush my teeth, this urgency surfaces also. And when I squat down and do some mopping of the floor, after a while, this urgency also surfaces. 

I sought advice from the polyclinic. I did a PSA and finger anal check on the prostate. And later on, a CT Scan on the prostate. 

The doctor said, I have a slightly enlarged prostate but is not malignant, and the enlarged prostate is within limits. 

In the meantime, I also went to TCM. They prescribed me TCM medication and performed acupuncture on me (prostate and bladder). And over a period of some time (should be more than a yr), my condition improved. 

The urgency still surfaces whenever there is a change in position (from sitting to standing or walking). But I am able to control it and the urgency goes away. But it does come back after a short while and I need to go and ease myself. 

I was told that holding back urination might not be good, as it might lead to UTI and other issues. 

My mail to you is because I want to know why the urgency occurs whenever there is a change in position? (The TCM physician said - this could be due to a hyperactive bladder and the slightly enlarged prostate also activate this urgency). 

Thank you for your advice. 

Answer by Dr Yong Jin

Yes, this is positional related urinary urgency, which is indeed likely related to overactive bladder. If you have an enlarged prostate, you need to be evaluated for obstruction. 

Usually once the obstruction is treated, the overactive bladder goes away with time. In the same vein, if the prostate obstruction is not completely treated, the overactive bladder will usually not resolve. 

I encourage you to make an appointment to consult me in the clinic.

3. Question by WP

Dear Dr Yong Jin, How are you? I am a woman who suffers from regular UTI in every quarter since 2017. 

I am a person who always takes every advice to prevent the reoccurrence of regular UTI – such as to drink more than 8 glasses of water, clean myself properly etc. 

However, these didn't help to reduce it on me until I took cranberry tablet daily from 2018. Unfortunately, 3-3.5 years later, it lost its effects on me. 

After struggling with UTI on a regular basis from 2021 to 2022, at the end of 2023, I started myself on strong biotics tablet daily (as recommended by a GP) and also drinking a yogurt drink daily. It seems to calm down the bacteria.

My concern is once the above recommendation loses its effect on me, what else can I do to prevent it coming back to me in regular basis? 

Greatly appreciate your advice. Thanks.

Answer by Dr Yong Jin

I suppose you have reached menopausal age? As this is the time point that many women suffer from recurrent UTI. 

In general, you will need to be assessed to make sure that you have no urination issues.If there are, these need to be treated, else the recurrent infections will never resolve. 

If there are no identifiable causes, topical oestrogens will usually help to reduce the incidence of UTIs in menopausal women. Else recently, there is also the option of a urinary tract oral vaccine. 

I encourage you to make an appointment to consult me in the clinic.

4. Question by Yingxi

Dear doctor, I have the following questions: 

1. What causes overactive bladder?
2. At what stage would you recommend one seeks help?
3. What are the treatments available? Thank you.

Answer by Dr Yong Jin

There are many potential causes of overactive bladder. In most instance, they are idiopathic in nature (no one really knows what the cause). Sometimes it can be related to high caffeinated beverages intake, or related to neurological disorders or even because of bladder obstruction. 

If it affects your quality of life, or if you have very frequent urinary leakage, you should seek help. 

Treatment will depend if there are any identifiable causes. Usually, first line lifestyle changes and bladder training can help. Otherwise the next step is to consider medications and even possibly botox injections to the bladder.

5. Question by Tina

Dear Dr, 

How to strengthen my bladder so that when I clear my dry throat on a full bladder, urine does not leak?

Answer by Dr Yong Jin

You have stress urinary incontinence (SUI). 

Pelvic floor (kegel) exercises may help reduce the leak for mild SUI. Otherwise, SUI is a disease that can be treated with surgery. 

I encourage you to make an appointment to consult me in the clinic.

6. Question by Valli

Dear Doctor, I am a 58-year-old woman of Indian descent. I underwent Vaginal Hysterectomy in 2019 for Uterus prolapse.  

I have been having urinary incontinence since then, once I get the sensation to pass urine, I am unable to hold it longer. Before I hit the toilet it starts leaking. 

I have read about urge incontinence but I’m not sure what kind of incontinence I have. Kindly advise how can I manage this condition. Thank you.

Answer by Dr Yong Jin

What you have described is indeed urge urinary continence and it sounds quite bothersome. 

In general, these can be treated with lifestyle changes, medications and even botox injections to the bladder. However, given your history of prolapse, I will also want to assess you for any other urination problems. 

I encourage you to make an appointment to consult me in the clinic.

7. Question by Prem

Dear Doctor, 

I am 71 years old and I underwent Prostate removal operation in 2021 due to prostate cancer. 

Till date I am doing fine on cancer part. But I have been having urinary incontinence since the surgery. I did my surgery followed by months of physiotherapy. 

Even though I can manage to have my normal life, it is causing anxiety on several levels. 

Is there anything that can be done so that I can regain my life without urinary incontinence? Thank you.

Answer by Dr Yong Jin

Yes! There are options available for post prostatectomy incontinence. 

In general, these can be treated with either a male sling or an artificial urinary sphincter with fairly good results. 

I encourage you to make an appointment to consult me in the clinic.

8. Question by Mdm Lee

Dear doctor, 

My husband is in his early 70s and he is experiencing heavy urine flow at nights lately. 

Some nights when he could not control he would wet the bed.  Most of the time now he wears a thick, pull-up pants with a regular pull-up pants on the outside just before he goes to bed. 

In the evening, he drinks water mainly for taking his medication. If he feels well and not too tired he will wake up to use the toilet, and mentions that it can be up to 5 times in the night. 

He had a stroke in late 2018 and actually recovered well. However about 2 years ago he was diagnosed with Parkinson’s Disease when he kept falling at home and was hospitalised. 

He has just been referred to the Geriatric Clinic at CGH as requested by me due to other concerns about his weakened walking and likely sarcopenia as well as weight loss.  He is already seeing the dietician at CGH.

What can be the cause for him to have so much urine at night? 

Thank you for your advice.

Answer by Dr Yong Jin

Thank you for taking care of your husband.

From the history, there seems to be quite a few things going on. Parkinson’s patients usually have overactive bladder, and that is likely to be the cause of his night bed wetting and possibly the frequent episodes of urination at night. 

However, these needs to be assessed still with a bladder diary, to see if the amount of urine at night is excessive. 

You should seek a urological consult for him.

9. Question by Tham

Hi Dr, 

I feel urine is leaking when I give a hard sneeze and cough, and have to dash quickly to toilet when my bladder is very full. 

If pelvic exercise can help to strengthen my control, please help to recommend various exercises that is safe for a 70-year-old lady to do. Thank you.

Answer by Dr Yong Jin

From your provided history, it seems that you have mixed urinary incontinence: both stress urinary incontinence and urge urinary incontinence. 

Pelvic floor exercises (Kegel) exercises can help with the stress incontinence, but you should be supervised or taught by a pelvic floor physiotherapist or a continence nurse. 

Otherwise, you should really be assessed by a urologist.

10. Question by Mdm Ang

Dear Doctor, 

How much water should a diabetic senior aged 69 be drinking daily? Is there a maximum or minimum no of glasses to adhere to? Should we hold our urine & if so for how long? Will this cause urinary tract infection? 

Or should we pass urine when there is an urge? 

How to reduce the number of times to pass urine at night? How to improve urinary incontinence? 

I understand there's a "study" on urinary incontinence in polyclinic, how do I register for this? 

Thank you for your advice.

Answer by Dr Yong Jin

There is no maximum or minimum. Usually, a ballpark average is 1.5L, but obviously this varies person to person, depending on body habitus, activity level, sweat level etc. 

You should certainly not be holding your urine for prolonged periods of time, as this can certainly lead to UTIs and other bladder problems. However, your bladder is supposed to be able to store urine for at least 2-3 hours usually (about 300ml) before you should really feel the urge to go. 

Passing of urine at night is a complex topic and requires further evaluation to see if there are any measures that can reduce the number of times you have to go. However in general, you should not drink much fluids after about 7pm and you should also aim to do some exercises in the afternoon/early evening and perhaps also elevate your legs in the evening as well before sleep. This may reduce your night urination episodes. 

Similarly, urinary incontinence is another complex issue that needs personalised assessment. You should seek a urologist consult if you are bothered by this. 

I am not aware of any study on urinary incontinence in the polyclinic, maybe you can approach the polyclinic you saw this to ask for more details.

Ref: G25