Do you experience ‘leaks’ or have difficulty controlling your urge to urinate? Do you have a sense of heaviness in the pelvic area or the lower abdomen region? You could be suffering from a pelvic floor disorder – a medical condition common in women – caused by weakness of the muscles of the pelvic floor.

Dr Mark Wong, Senior Consultant from the Department of Colorectal Surgery, and Dr Ng Lay Guat, Head and Senior Consultant from the Department of Urology, at Singapore General Hospital, give detailed answers to your questions.

Question by esim

Dear Dr Wong,

Is growing age a factor to pelvic floor disorders? Now I have feeling of heaviness in my lower abdomen and my urge holding strength to urinate have weaken as I grow older.

Answered by Dr Mark Wong Consultant Department of Colorectal Surgery Director Pelvic Floor Disorders Service (PFDS) Singapore General Hospital

Yes, pelvic floor disorders are more common as one gets older due to the natural loss of strength in the supporting tissues due to ageing.

Question by pocoyosky

Hi Dr Wong,

Are there any herbs or food that can help to better control the urinate urge? Does exercise helps too? What is the cure for this?

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

There are no specific herbs or food that has been proven to reduce urine urgency. However, cranberry has been shown to reduce risk of urinary infection, which in turn will cause urgency. On the other hand, some beverages can cause increased urge eg tea, coffee, cocoa, reducing these will help

Question by rsim

Is there a normal urinate time/frequency band per day? Everytime after drinking, within an hour, I urine at least 3 times and each time I am not able to control my urge, is this a sympton of pelvic floor disorder?

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

Some people do need to empty their bladders very soon after drinking. This may be due to 2 extremes, either the person is so well hydrated that she does not need the fluid, or, so dehydrated that very concentrated urine is produced very quickly, resulting in very intense urgency. You should examine your own urine colour to decide. If your urine is very yellow, drinking more water will paradoxically reduce the urge, as it dilutes the urine.

On the other hand, if you also note that your urine flow is slow, then you may have an issue of not being able to empty your bladder well, hence needing to pass 3 times to complete the void. Then I will encourage you to consult an urologist to sort out your problem.

Question by simly6

What are the causes of pelvic floor disorder? My wife sticks to a healthy diet and exercises regularly in the past, now as she has 'leaks', have difficulty to control her urinate urge, she hardly do any outdoor exercise. And she drinks little whenever we are out, to avoid the inconveniences. Is menopause one of the causes? What are the treatment available?

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

Menopause can cause irritation to the bladder cause more frequent need to pass urine. Most ladies have stress urinary incontinence from previous multiple births, or previous pelvic surgeries. Other neurological conditions such as strokes , diabetes mellitus can exacerbate the problems.

Question by kellin

Hi,

I do have this symptom. Sometimes it can be quite bad, especially when I cough or sneeze but at times, it is ok. I understand that by doing pelvic floor muscle exercise, it will help, pls advice what other methods are there to improve or maintain(prevent it from deteriorating).

I understand that this is normally due to carrying baby(pregnancy), esp when I have 3 kids. What are the other reasons that could be causing this.

Thanks.

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

The main self-help manoeuvre is through pelvic floor exercises. Other methods may include hormonal replacement therapy, biofeedback, which is essentially assisted pelvic floor exercise. Please see above too.

Question by lucindacheong

Dear Dr Wong,

I had heard that only women who had alot of pregancies will experience pelvic floor disorders more than those who had one or two pregancies. However, I had only given birth to my son and yet I do suffer leaks at times whenever I laughed heartily or sneeze. I am 50 yrs old. Other than that, it's quite OK. So do I suffer from pelvic floor disorder or incontinence? Will exercise helps? The doctor has encouraged me to do pelvic exercises but it does not seem to work. My colleague told me that she has to put on Poise pads every day and she thought of going for surgery, is it safe?

Thanks.

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

  • It is true in general that the more births a lady had, the more likely that she will suffer from stress incontinence later in life. However, this is not exclusive, as I have come across old ladies with 9 kids with perfect control, and ladies with no kids with incontinence.
  • Pelvic floor exercises needs to be done correctly. It will help if you see a continence nurse to make sure that you are doing the exercises correctly. (See below too)
  • Surgery, if selected correctly, is very safe.

Question by ireneneo

Dear Dr. Wong,

Is there any methods that we can used to control such 'leakage' or to lessen the urge?

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

Pelvic floor exercises needs to be done correctly. It will help if you see a continence nurse to make sure that you are doing the exercises correctly.

Pelvic floor excercise involves constant repetitive contraction of the pelvic floor to improve its tone. The main hurdle is usually identifying the muscles. Most people will instruct patients to interrupt their urination. This is a good way to identify the muscles but must not be done as the exercise. After you have identified the muscles, you should practise the exercises while you are not passing urine. If the correct muscles are contracted you should feel your anus being lifted up. Quick contractions and relaxations x 5 then contract and hold to 5 sec then relax for 5 sec x 5 times. Do this at least 5 times a day. You can increase / prolong the contractions as you progress.

Surgery, if selected correctly, is very safe.

Question by estheryapsg

Dear Dr Mark,

I have been experiencing urine leaks especially when I am running or chasing after bus. Please advise whether there is any ways or any operations that can stop the problem.

I am 52 years old and a mother of 3 children.

Your prompt reply is greatly appreciated.

Best Regards
Esther Yap

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

Pelvic floor exercises needs to be done correctly. It will help if you see a continence nurse to make sure that you are doing the exercises correctly.

Pelvic floor excercise involves constant repetitive contraction of the pelvic floor to improve its tone. The main hurdle is usually identifying the muscles. Most people will instruct patients to interrupt their urination. This is a good way to identify the muscles but must not be done as the exercise. After you have identified the muscles, you should practise the exercises while you are not passing urine. If the correct muscles are contracted you should feel your anus being lifted up. Quick contractions and relaxations x 5 then contract and hold to 5 sec then relax for 5 sec x 5 times. Do this at least 5 times a day. You can increase / prolong the contractions as you progress.

Surgery, if selected correctly, is very safe.

Question by larkygal

Hi Dr Wong, I have certain questions pertaining to the topic: 1)Will Kegel exercises reduce the chances of getting pelvic floor disorder? 2) Will the exercises also help to alleviate the symptoms associated with pelvic floor disorder? 3) If the exercises do help, how long should I perform them to see improvement, and will the benefits disappear once I stop performing the exercises? Thank you for your time!

Answered by Dr Mark Wong Consultant Department of Colorectal Surgery Director Pelvic Floor Disorders Service (PFDS) Singapore General Hospital

Kegel exercises are only one kind of pelvic floor exercise. For example, for treating faecal incontinece, we prescribe biofeedbak therapy instead. All these exercises are aimed at strengthening or conditioning different parts of the pelvic floor musculature.

Doing these exercises are not a guaranteed ‘cure’ for any pelvic floor disorder, and is usually part of a larger treatment regimen, including dietary modifications and medications. As with any treatment, results of the exercises depend on how severe the illness is and how regularly you perform them. They should be done for life and results are never immediate. For instance, patients on biofeedback therapy for faecal incontinence are encouraged to do them at least 120 repetitions per day for life.

Question by elizabethlcs1988

Dear Dr.Mark, May I know is there any remedy to treat the pelvic floor disorder?

Answered by Dr Mark Wong Consultant Department of Colorectal Surgery Director Pelvic Floor Disorders Service (PFDS) Singapore General Hospital

Pelvic floor disorders refer to a large group of illnesses arising primarily from a loss of support from the pelvic floor muscles. As such, this can affect the bladder (eg. urinary incontinence), womb (eg. womb prolapse) and rectum/anus (eg. incontinence, constipation or rectal prolapse).

Treatment ranges from conservative (non-surgical) to surgical treatments and depend on the type of pelvic floor disorder.

Taking faecal incontinence for example; dietary modifications (fibre to bulk up liquid stools), medications (anti-diarrhoea types), pelvic floor exercises (biofeedback therapy) and surgery to repair damaged muscles of the anus (sphincter repair, injectable bulking agents, sacral neuromodulation, artificial spincter implants, stoma).

Question by esprit

Hi Dr Wong, My daughter (aged 12) recently told me that during a roller coaster ride, whenever the ride was going downwards, she felt like her bladder was full and heavy. It was normal when the ride went upwards. She also admitted that since young, whenever she is in a lift that is going down, she feels heavy in the bladder region. For my case, after releasing myself, while getting up, I will feel a tinge of urgency to pass urine again. But when I am upright, the feeling is gone. Are there anything wrong with us? Thank you!

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

These are normal feeling of the the effect of gravity on a full bladder. You do not need to be too alarmed.

Question by octane

Dear Dr Mark Wong, What treatment options are available for urinary incontinence in Singapore?

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

This depends on the type of incontinence. Treatment may range from exercises, medical therapy, injection therapy or surgery

Question by helene

Hi, I am 58 years old with 3 children. Initially when I experienced leaks some 15 years back, I did kegel exercises and it helped somewhat. But over the years I stopped doing the exercises and simply esorted to the use of light pads for convenience when I read somewhere that it is a common problem after menopause. I experience sudden leakage only after violent coughings especially when I go through a flu bout. Other than that I dont have difficulty controlling urge to urinate nor do I experience a sense of heaviness in the pelvic area. As of now, I am quite happy just using light pads daily to deal with the leak. I am wondering, whether my condition will worsen as I aged? Thanks.

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

Stress urinary incontinence is a condition that only affects your quality of life. You should continue to do the kegel exercises to prevent your condition from worsening

Question by healthylife

I will have the leakage while running, coughing and jumping. The worst is when I vomit, the urine will also be squeezed out. The feeling is terrible.

Is it true that using pad lining is not good as it will cause infection?

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

Using pads is ok as long as it is changed regularly. However, it does not cure your condition.

Question by li_jiali

Is there any truth in the saying that woman after childbirth will have "loose" pelvic?

Answered by Dr Mark Wong Consultant Department of Colorectal Surgery Director Pelvic Floor Disorders Service (PFDS) Singapore General Hospital

This is partially true. The pelvic tissues are ‘loosened’ for childbirth to accommodate the passage of the baby through the natural birth canal.

In some cases, the over-stretching that occurs leads to permanent damage and this manifests as tears in the muscles or damage to the nerves, resulting in the various pelvic floor disorders seen.

This is especially true when the baby is large, requiring vacuum or forcep-assistance, when the labour is prolonged or with multiple births.

Question by hnulhll

I find myself leaking whenever I do my Zumba dance. Any pelvic exercise that I can do to strengthen the muscles? And the frequency to exercise?

Answered by Dr Ng Lay Guat Consultant Department of Urology Head & Senior Consultant Singapore General Hospital

Pelvic floor excercise involves constant repetitive contraction of the pelvic floor to improve its tone. The main hurdle is usually identifying the muscles. Most people will instruct patients to interrupt their urination. This is a good way to identify the muscles but must not be done as the exercise. After you have identified the muscles, you should practise the exercises while you are not passing urine. If the correct muscles are contracted you should feel your anus being lifted up. Quick contractions and relaxations x 5 then contract and hold to 5 sec then relax for 5 sec x 5 times. Do this at least 5 times a day. You can increase / prolong the contractions as you progress.

Ref: S13 ​