Date: 30 January 2020
Comparing Treatment Options for Urinary Incontinence in Malaysia
Read on to learn about the currently practiced methods and compare urinary incontinence treatment options in Malaysia.
Signs of Urinary Incontinence
Is Urinary Incontinence common?
Comparing Urinary Incontinence Treatment Options in Malaysia
Why is coping with Urinary Incontinence bad for you?
What is Urinary Incontinence?
Urinary incontinence is the loss of bladder control or in other words, the involuntary leakage of urine with a varying range of severity depending on the root cause behind your leakage.
Here are some instances of urinary incontinence:
- Leaking whenever we cough, sneeze and/or pass wind
- Leaking when engaging in high impact exercise (such as jogging, diving), or
- Leaking when lifting heavy objects (children and grandchildren counts too!)
- Having a frequent strong and unstoppable urge that you don’t reach a toilet in time
Many people think urinary incontinence is inevitable as we age, but it is simply NOT TRUE. Furthermore, involuntary urine leaking is not a unique problem to the elderly.
Urine leaking can happen to us at various stages in life due to our lifestyle, weight, diet, whether we have undergone hysterectomy (removal of uterus due to medical reasons), pregnancy and childbirth. All of these impact and weaken our pelvic floor, which is the main reason why urinary incontinence happens to us.
When you experience your first episode of urine leak, regardless how little you leak, it is likely a sign that your pelvic floor is no longer as strong as it needs to be to maintain our quality of life. A loss in pelvic floor muscle mass and strength will not get better over time by itself – so you can expect things to only go downhill from there if we do nothing about it.
Prevalence of Urinary Incontinence in Women
Studies show that about one in every three women (1 in 3) suffers from pelvic floor disorder, which includes urinary incontinence (Kaiser, 2008). That is about 1.2 billion women but yet we hear so little about this negatively life-changing condition.
Back home, it is reported that 44.1% women in Malaysia are also facing this bladder dysfunction. Urinary incontinence statistics are usually regarded as under-reported because most women do not bring it up with their doctors. Most of the women who have urinary incontinence usually suffer in silence and think it is a normal part of ageing, while others feel embarrassed to talk about it. There is also social stigma especially in our generally conservative culture.
Despite the high prevalence, based on our medical data and references, only a small percentage sought treatment (Samiah et al, 2013). Most women would prefer to cope with the symptoms instead of finding the correct, permanent solution to their problem to their long-term detriment.
With so little being taught to women about the subject, it comes as no surprise that many of us do not even know that urinary incontinence can be treated, reversed, and fully cured.
Comparing Treatment Options for Urinary Incontinence
As we have learned, the loss of our bladder control and urinary incontinence is a main result of weakened pelvic floor which could arise due to many factors discussed earlier.
As medical professionals, we will share with you the prevailing medical practices for treating urinary incontinence which are also practiced in Malaysia at the time of writing.
Due to the lack of scientific research and clinical evidence, we will not be comparing traditional or alternative methods such as “urut” (massage) and “jamu” (tonic). Most of the time, the traditional methods do not reliably address the root cause and are likely to act as temporary relief mechanism only.
Below are the medical treatment options currently practiced to treat and manage urinary incontinence:
|Treatment||Medication||Surgery||Laser therapy||Pelvic Floor Muscle Rehabilitation|
|Who is it for? (Or what stage is it suitable for)||Patients who have been diagnosed with overactive bladder and urge urinary incontinence only||Patients who are at the severe stage of incontinence or when medication is not working for them.||
Claims to be able to treat vaginal conditions and symptoms related to menopause, as well as for urinary incontinence.
However, FDA (2018), stated that the safety and effectiveness of laser treatment has not been established.
People who have urinary incontinence symptoms include urge incontinence, stress incontinence, mixed incontinence and overflow incontinence due to weak pelvic floor muscles or loss of pelvic floor muscle strength.
Also for patients who have undergone hysterectomy surgery.
|How It works?||
Medication is one of the conservative management methods that uses pharmacological therapy and can only be prescribed by physicians only.
Medication or creams work by relaxing or toning the muscles related to our bladder control.
Does not increase pelvic floor muscle strength.
Surgery might be an option depending on the type and severity of urinary incontinence.
Most urinary incontinence surgery treat stress incontinence only. It’s known as sling surgery.
A sling is placed under the tube that urine passes through (urethra).
It is like a hammock that lifts and supports the urethra and the neck of the bladder to help prevent leaks.
Transvaginal laser treatment is a non-surgical approach that claims to use heat to rebuild and restructure damaged tissue of the vagina walls through collagen and elastin recovery stimulation.
Caution is to be exercised in terms of treatment efficacy – there are warnings in many medical authorities internationally.
Pelvic Floor Muscle Rehabilitation is a non-surgical approach following clinical guidelines with supervised and guided training of:
· Pelvic Floor muscle exercise (Kegels)
· Behavioral therapy
· Bladder training
· Electrical stimulation
· Biofeedback training
This method naturally restores the pelvic floor strength to help patients regain bladder control.
||Non-invasive procedure, claims to:
|Dosage / sessions needed to see results?
Overall effectiveness in reversing UI (rank)
Varies in individual and depends on the severity of incontinence.
Requires lifelong reliance on medication.
|One-time procedure but have risk of recurrence and re-operation can only be done up to several times.||
Claims that one need 3-4 session to see results.
However the regeneration process fades over time, and operators advise to repeat the treatment to sustain (not permanent results)
(American Society of Plastic Surgery, n.d)
4-7 rehabilitation sessions (1 session every 2 weeks).
(JJ Schmitt, 2017)
Minimum of 5 therapy sessions reported to give improvement to urinary incontinence symptoms.
(Julie. S et al, 2013)
Highly effective for reversing pelvic floor weakness when done right and with guidance.
2. Dry mouth
3. Extreme tiredness (fatigue)
1. Invasive procedure
2. Temporary difficulty urination
3. Urinary retention
4. Urinary tract infection
5. Difficult or painful intercourse
6. Risks and complications
1. Vaginal burns,
2. Hypopigmentation (discolouration)
5. Chronic pain.
1. Incorrect Kegel technique may worsen the symptoms
2. Slower results if individual does not follow the rehabilitation plan.
|Cost consumed||Varies with dosage, typically above RM250 for 30 pills||RM8,000 and above||RM 2,500 and above for each session||
Government: around RM5
Private: around RM250 and above
It is essential for every woman to know and to understand for each possible available treatment to treat urinary incontinence in Malaysia. Medical practitioners such as Uro-gynaecologists, Gynaecologists, and Urologists in Malaysia strongly agree that pelvic floor muscle training (PFMT) is the first-line conservative treatment and it has been clinically proven to be effective for women with urinary incontinence.
It is safe, relatively cheap and supported by years of clinical evidence. This training is also very practical; though studies show that 30% women are unable to do the Kegels exercise at their first consultation (Bo, 2007). Unsurprisingly, with proper instructions, supervised training and close follow-up sessions, patients and women has shown fast progression and were able to maintain their pelvic health longer (Bo 2012; Dumoulin et al 2014).
While the claims of using laser in treating urinary incontinence may seem like a captivating ‘quick fix’, there is a lack of clinical data to show its significant effect in improving urinary incontinence. Recently, US Food and Drug Administration (US FDA) announced that the treatment of these symptoms using lasers may lead to serious adverse events including vaginal burns, scarring, pain during sexual intercourse and recurring/chronic pain (Issued on 30 July 2018, FDA).
A number of people who suffer from urinary incontinence has the notion that medication is the magic pill and is the only treatment for urinary incontinence. However, medical practitioners and clinical studies regard the best treatment for urge incontinence to be behaviour therapy in the form of pelvic floor muscle exercise (Barry D, 2005). Medications usually are used as an adjunct (supporting element) to behaviour therapy for urge incontinence. To date, there are no FDA approved medications for stress incontinence; most of the physicians consider only pelvic floor exercise and surgery as the option to treat stress incontinence. These medications are not the most effective and is not considered as the first line of treatment for treating urinary incontinence by medical practitioners.
Surgery intervention will be considered if any of conservative treatment is not effective or if the patient has reached a point of severity. Before you subject yourself to surgery, you need to consult your doctor for possible risks and adverse effects after a urinary incontinence surgery (Rehman et al, 2017). There are also instances where pelvic floor rehabilitation exercise is prescribed post-surgery.
As a general rule of thumb in the clinical and medical practitioner’s ‘handbook’, conservative management must be taken into account in managing urinary incontinence and it is almost universally accepted that conservative treatment in terms of pelvic floor muscle training is still the safest, effective and clinically proven treatment option among other solutions.
Why is Coping with Urinary Incontinence Bad for You?
With so little knowledge about the issue let alone the treatment methods available in Malaysia, it is no surprise that many women are merely coping with their incontinence. Some may feel reluctant or embarrassed to seek medical advice, while some do not have the awareness about the correct way to treat urinary incontinence.
Whether embarrassed or unaware, medical practitioners like us have heard many creative methods that our patients and clients use to keep their urine leaking problem silent and unknown to anyone. Coping mechanisms such as reducing fluid intake, holding in urine for long hours, using urine collectors, changing their wardrobe to dark colors, scouting for and making sure there are toilets nearby that they can go whenever they feel the need to go and minimising or avoiding sexual activity. Some even resort to drinking “jamu” or traditional Malay concoctions that are of unknown origins or without proper quality control, which is a highly risky thing to do.
Many of us know that reducing fluid intake might reduce the numbers of toilet visit and the urge from urinating. But not many of women know actually it can lead to other complications such as urinary tract infection (UTI) (Delarmelindo et al., 2012) and body dehydration too (Urology Care Foundation, 2019).
The habit to delay urination also one of the coping strategy for incontinence. Continuous and prolonged holding in urination during full bladder can expose women to weak bladder muscles, can make the bladder even more stressed, eventually finding themselves having difficulty to pass urine and catching UTI (Watson, 2019).
Some women cope with pads, adult diapers and little piece of cloth to deal with their incontinence issue to avoid medication, rehabilitation and surgery. Anyhow, this way will cost them more as they need to change it frequently and increase the risk to get UTI (Omli et al., 2010).
Even after using urine collectors, women still have their insecurities, especially when going out from their house. From wearing bright colors of clothes, they change and wearing dark colors. From wearing skirts and dresses, they change to pants to avoid embarrassment of leaking when going out, or even at working place. They even need to bring a change of clothes, especially for those who didn’t use any urine collectors (Omli et al., 2010).
When going out, women with leaking problem are very concerned with toilet locations, whether there is available toilet at that place, will the toilet be near enough to the place that they are going and how many toilets do the place have, as they very nervous about the long queue (Omli et al., 2010).
Last but not least, women with incontinence also will put their sexual activity on hold. They feel more anxious and afraid of leaking happens during intercourse. This lead to lack of confidence and make sexual interest reduce due to repeated avoidance of sexual intercourse.
If you have been suffering from urinary incontinence symptoms, do get your bladder and pelvic floor check-up done as soon as you can. Leaving it unchecked can greatly take the fun out of your life. Seek professional help from pelvic care physiotherapists to take your first step in pelvic floor muscle strengthening and rehabilitation. As we already know, prevention is better than cure. Take charge of your pelvic health, take charge of your life!
Women’s Health Physiotherapist at Vibrance Pelvic Care Centre
Tel: +603-22012115 / WhatsApp Careline +011-59385962 (W.P. KL – Bangsar, Kuala Lumpur, Malaysia)