Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intra-abdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence.
Studies in Singapore indicate that about 1 in 7 people aged 60 years and above have urinary incontinence. Many older people mistakenly believe that it is a normal part of aging. Urinary incontinence can affect people from any age group and from every socio economic level.
Treatment is keyed to the type of incontinence. The usual approaches are as follows: • Stress incontinence - Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication • Urge incontinence - Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention • Mixed incontinence - Anticholinergic drugs and surgery.
Tension-free Vaginal Tape (TVT & TVT-O) - a relatively new method with very good success rate of 94% since KKH started using it in 1998. It has become the commonest type of continence surgery.