Cervical Cancer Screening & HPV Vaccination In Singapore – A 5 Min Guide

by Dr Juliana Latif
Sunday, May 17, 2020

How HPV Is Linked To Cervical Cancer

Human Papillomavirus (HPV) is one of the most common Sexually Transmitted Diseases (STDs). It is also the single largest risk factor that leads to Cervical Cancer 

There are currently over 200 strains of HPV, and some of these are high-risk strains that can cause cervical cancer.

Most HPV infections will eventually go away on their own after about 1 to 2 years, or cause genital warts which are painful but can be cured.

However, high-risk strains such as HPV 16 or HPV 18 can stay in the cervix for a long time. These strains infect your cervix and may cause the development of cancerous cells, which lead to cervical cancer.

This process can take many years, so an infection you got when you were 25 can start causing pre-cancerous changes when you’re 35, and develop into full-blown cervical cancer by 42. 

That’s why regular screening is so important because you could have a HPV infection developing without showing any symptoms at all.

How Is HPV Transmitted?

HPV is transmitted through skin-to-skin contact such as sexual intercourse, oral sex and anal sex. If you are sexually active or share contaminated sex toys, there is a high chance that you can transmit or contract a HPV infection. 

If you have multiple sexual partners or your partner has multiple sexual partners, you are also at high risk for HPV infection. Condoms do not provide 100% protection against the transmission of HPV.

If you are on long-term oral contraceptives or have a weakened immune system, you also face the increased risk of HPV infection.

Other risk factors include being sexually active from a young age, or having a history of Sexually Transmitted Diseases like herpes or chlamydia, or smoking. 

You can’t catch HPV from touching common surfaces, casual contact such as shaking hands or hugging, or from toilet seats. 

Symptoms Of HPV Infection

Most HPV infections do not show any symptoms. Even the pre-cancerous changes that take place after a persistent HPV infection may not show any symptoms.

Some strains of HPV may cause genital warts. 

Many women often only see the symptoms of cervical cancer, long after transmitting HPV and after any preventative treatment could have taken place.

This is why doctors keep stressing how essential it is for you to undergo regular screening especially if you are sexually active. If detected early, treatment can be undertaken before a high-risk HPV infection can develop into cervical cancer.

Symptoms Of Cervical Cancer

If you have cervical cancer, you may display some or all of the following symptoms:

  • Bleeding between your periods or after menopause
  • Bleeding after intercourse
  • Periods that are heavier and last longer than normal
  • Pelvic or back pain that is unusual and may not be related to your period
  • Pain during intercourse
  • Abnormal vaginal discharge that may be thick and foul in odour
  • Pain during urination 
  • Increased frequency of urination
  • Constipation and feeling like stool is present despite your bowels being empty
  • Urine or faeces leaking from the vagina

HPV Vaccination In Singapore

Fortunately, it is possible to get HPV vaccinations in Singapore to reduce the risk of cervical cancer. The vaccinations can protect you against 70-90% of the high-risk HPV strains that can cause cervical cancers.

In Singapore, these vaccinations are recommended for girls and women 9 to 26 years and it is recommended you take the vaccination before you first have sexual contact and have not had exposure to HPV.

Even if you are sexually active, you can still benefit from the HPV vaccinations as you may not have been infected with the high-risk HPV strains. You can check with your doctor to find out if you are suitable to receive HPV vaccinations.

Remember that HPV vaccinations do not guarantee 100% protection so you still should go for regular screening even if you have had your injection.

The different types of HPV vaccinations in Singapore are Cervarix, Gardasil and Gardasil 9. All of them require multiple vaccinations taken a certain amount of time apart. 

As of April 2019, all 13-year-old Singapore Citizens or PRs can get the HPV vaccination for free. However, this is optional and parents must opt-in for their daughters to receive the free vaccination.

Cervarix

Cervarix protects you against HPV 16 and HPV 18, two of the high-risk HPV strains that are responsible for more than 70% of cervical cancer cases.

This vaccination is approved for girls and women from 9 to 25 years old, or as advised by your doctor.

For girls between 9 to 14 years of age, you need to take two vaccinations between 5 to 13 months apart.

Females between 15 to 25 years of age need to take three vaccinations with the second vaccination between 1 to 2.5 months after the first vaccination, and the third vaccination 5 to 13 months after the first vaccination.

Polyclinics only have the Cervarix vaccination available which costs $360 excluding consultation fees and GST. You can use Medisave to subsidise the cost of your vaccination for up to $500.

Gardasil 4

Other than protecting you against HPV 16 and HPV 18, Gardasil also vaccinates you against HPV 6 and HPV 11 which can cause genital warts and lesions. 

Females between 9 to 14 years old need two injections 6 to 12 months apart, while ladies aged 15  and above require 3 vaccinations. You take the second injection 2 months after the first injection, and the third vaccination 6 months after the first one.

The cost of Gardasil varies between clinics but you can expect to pay $386 at least including GST. Gardasil 4 vaccination can be subsidised using Medisave for up to $500. 

Gardasil 9

Gardasil 9 is named as such as it vaccinates you for 9 strains of HPV. These are HPV subtypes 6, 11, 16, 18, 31, 33, 45, 52 and 58​.

The vaccination schedule is the same as that of Gardasil.

At this time, you cannot use Medisave to subsidise your Gardasil 9 vaccination even though it is the most expensive, costing at least $632 with GST.  At Fusion Medical, a package of 3 doses of Gardasil 9 costs S$642 nett.

Can Pregnant Women Get Vaccinated For HPV? 

If you’re pregnant, you’re advised not to get the HPV vaccination.

If you find out that you’re pregnant after taking one or more of the vaccinations, don’t continue with the vaccinations until after the end of your pregnancy.

Let your doctor know if you’ve inadvertently taken the HPV injections while pregnant and seek his or her advice.

Can Medisave Be Used For HPV Vaccination?

Yes, you can use up to $500 of your Medisave to subsidise your Cervarix or Gardasil vaccination if you are between 9 to 26 years old.

However, Gardasil 9 injections are not eligible for the subsidy. 

If you are using Medisave, you can also use the Medisave of your parents or spouse to make payment. Medisave deductible and co-payment rules are not applicable for HPV vaccinations.

Cervical Cancer Screening In Singapore

There are 2 main tests for cervical cancer screening which are Pap smears and HPV tests (or HPV DNA test). 

You should start going for regular screening within the first 3 years of your first sexual contact or when you are 21 years old, whichever is earlier. 

Ladies who are between 21 to 29 years old should get a Pap smear every 3 years. If you are between 30 to 64 years old, you should get a Pap smear and HPV test every 5 years, or a Pap smear every 3 years.

Once you’re 65 years old and over, your doctor may allow you to stop going for cervical cancer screening if you have had normal results in all your previous tests. But if you’re 65 years old and you’ve never had a Pap smear, you should go for it to check that you are not at risk for cervical cancer.

The purpose of the Pap smear is to detect cell changes in your cervix. The doctor uses a speculum to widen your vagina, examine it, and swabs cells from the cervix to send to the laboratory for analysis.

You might feel some discomfort or pain during your Pap smear and you should let your doctor know once you feel discomfort.

As with most medical testing, Pap smears are not 100% accurate. 

Don’t go for your Pap smear test if you’re having your period as the blood shed might affect your test results. Make sure you do your test at least 14 days after the start of your period.

If you have had a total hysterectomy (removal of the uterus and cervix) for a non-cancerous condition, you may not need to go for regular Pap smears and you should verify this with your doctor. He or she may recommend having one Pap smear done after your hysterectomy procedure.

If you had a partial hysterectomy and your cervix was not removed, or your total hysterectomy procedure was done for a cancerous or pre-cancerous condition, you will still be required to undergo regular Pap smear testing.

HPV tests, which you can start undergoing after you’re 30 years old, tests for the presence of high-risk HPV strains in your cervix.

Don’t put off your screening because early detection saves lives. Even if you have no family history of cancer, you might still be at risk of getting cervical cancer. There are no symptoms for HPV infection so you should still go for a Pap smear even if you feel healthy.

If cervical cancer is found in the very early stages, the five-year survival rate is as high as  90%. However, if you only detect it when the cervical cancer has reached Stage 4 or spread to other organs, the five-year survival rate drops to 10%.

Is Cervical Cancer Screening Required After HPV Vaccination?

Yes, it is.

Even though you’ve had the HPV vaccination, you are not 100% safe from cervical cancer. This is because the vaccine can reduce the risk of cancer by protecting you against 70-90% of high-risk HPV strains but not 100%.

Furthermore, if you got the vaccine after being sexually active, you might have already been exposed to a HPV infection. 

 

Flu Shot In Singapore – Everything You Need To Know

by Dr Wenus Ho
Thursday, April 23, 2020

Influenza is a viral infection that is highly contagious and mainly affects the upper respiratory organs.

It is estimated by the World Health Organization that influenza (flu) kills half a million people globally every year. The worst flu pandemic in 1918 killed 50 million people worldwide.

The flu virus is easily transmitted from person to person when an infected person coughs, sneezes, or spits, and droplets produced by them land on the eyes, nose or mouth of the person nearby. Less often, a person might get the flu by touching a surface or object that has flu virus on it and then touching their faces. Influenza is at its most contagious during yearly seasonal epidemics.

People who have the flu usually recover after a few days, but for certain high-risk groups, such as pregnant women, and people over the age of 65, complications can occur, and may even cause death.

Symptoms Of The Flu

Often mistaken for the common cold in the initial infection stage, as they share many similar symptoms such as runny nose, sneezing, and sore throat. 

However, unlike the cold where symptoms tend to progress gradually, symptoms of the flu come suddenly. You may experience:

  • Fever over 38 ℃ (100.4 F)
  • Aching muscles
  • Chills and sweats
  • Headache
  • Dry, persistent cough
  • Fatigue and weakness
  • Nasal congestion
  • Sore throat

Some may experience more severe symptoms such as: 

  • Trouble breathing or shortness of breath
  • Pain or pressure in your chest or belly
  • Sudden dizziness
  • Confusion
  • Severe vomiting

Seek medical help immediately if you experience any of the above symptoms. 

Treatment Options For The Flu

For most patients, medical intervention is usually not required, and your general practitioner may advise you to: 

  • Get plenty of rest at home and take a few days off work.
  • Consume plenty of fluids.
  • Avoid physical contact with your friends and family members to prevent the infection from spreading.

Your doctor may give you some anti-viral medication if you belong to one of the following high-risk groups: 

  • Children younger than 5, but especially children younger than 2 years old
  • Adults 65 years of age and older
  • Pregnant women (and women up to two weeks postpartum)
  • Residents of nursing homes and other long-term care facilities

Patients in the above groups have a higher chance of developing complications arising from the flu. 

Who Should Get Vaccinated For The Flu?

Unless advised otherwise by your doctor, it is recommended that you go for flu vaccination even if you are healthy, especially if you live with or take care of people belonging to high-risk groups.

In Singapore, MOH has informed medical practitioners to advise their patients on the importance of influenza vaccination for the following groups of people:

  • Children between six months and five years
  • Adults aged 65 years or older
  • Persons with chronic medical conditions

How Effective Is The Flu Vaccination

Flu vaccines are developed annually, and according to this CDC Effectiveness Report, the 2019-2020 flu vaccine reduces your chance of being infected by 50%.

Having the flu vaccination helps to rule out the differential flu diagnosis for the symptoms despite similar symptoms with COVID-19 and hence reduces the burden on testing as well as the health system.

Please contact your medical doctor to find out more about how this information affects you or your loved ones, and everyone has a different medical history, so effectiveness may vary.

Is The Flu Shot Safe For Pregnant Women?

Yes. 

Millions of pregnant women have been administered flu shots over the years with a good safety record. 

For pregnant women who would like more information, here are some studies that have been conducted on flu vaccine safety during pregnancy

Why Pregnant Women In Singapore Should Get The Flu Shot

Pregnant women are more likely to be susceptible to severe illness caused by the flu than non-pregnant women of reproductive age. 

Pregnant women experience changes in their immune system, heart, and lungs that make them more prone to developing severe illnesses from the flu, resulting in hospitalization. 

This 2018 study showed that pregnant women’s risks of getting hospitalized with the flu were reduced by almost 40%. 

As antibodies are passed onto the developing baby by the mother during pregnancy, the flu shot can also protect your baby for the first few months after they’re born, when they’re too young to get vaccinated.

How Much Is The Flu Vaccine In Singapore

You can get the quadrivalent (4-in-1) flu shot at any of our clinics at Fusion Medical for $37.45 Nett. Please contact us to book an appointment

Can You Use Medisave For Flu Shot (Please vet this section for accuracy)

Yes, Medisave can be used for flu shots for the following groups of people: 

  • Persons aged 65 years or older;
  • Persons aged 18 years and older and receiving long-term aspirin therapy;
  • Persons who have chronic medical conditions such as diabetes mellitus, asthma, and heart disease;
  • Persons who are immunocompromised;
  • Persons receiving intermediate and long term care services;
  • Women at all stages of pregnancy.

Fusion Medical is a Medisave accredited clinic, call us to find out more about the flu shot.

When Is The Flu Season In Singapore?

In Singapore, the flu season is generally during the cooler months with rain, such as May – July, and December – February. 

It is generally advisable to get your flu shot before the flu season starts. 

The flu vaccination is available at any of our Fusion Medical clinics located at Wheelock and Nexus. Please contact us to find out more information.

Women’s Health

10 Health Screenings Every Woman Should Have, Especially If You’re Over 25

by Dr Juliana Latif
Saturday, February 8, 2020

Our Health is not to be taken for granted in our modern society laden with stress and sometimes irrational indulgences. Each of us should make time for healthy habits such as exercising regularly and having a balanced diet. On top of those, routine health screenings should also be a part of your health protection measure.

The following 10 health screenings are important for every woman and play a vital role in early detection of various diseases.

Such screenings should be done even if you do not experience existing discomfort, and could make a world of difference in preserving your health and quality of life.

Blood Pressure & Heart Health Screening

Why you need it: To ensure that you are not at risk for heart disease, a leading cause of deaths of women in Singapore. Every day, 17 people die from cardiovascular disease (heart diseases and stroke) in Singapore. Cardiovascular disease accounted for 30.1% of all deaths in 2017. This means that 1 out of 3 deaths in Singapore, is due to heart diseases or stroke.

When and how often: Starting at age 20, you should have your blood pressure checked once every two years. If you have existing conditions such as diabetes, kidney problems and obesity, or a family history of hypertension and heart disease, you may be recommended to have your blood pressure checked at least once a year.

What to expect: During your screening, your doctor checks your blood pressure. Ideally, your blood pressure should be below 120/80 millimeters of mercury (mm Hg) accodring to the American Heart Association (AHA). If your reading is higher than 130/90, you could be developing hypertension.

Your doctor also listens to your heartbeat for irregularities or murmurs, which may indicate medication or further checks. You should also let the doctor know if you have been experiencing chest pains or shortness of breath.

Lipid Profile/ Cholesterol Screening

Why you need it: One of the most effective tools to asses your risk for developing heart disease or stroke is to measure your cholesterol levels. Elevated cholesterol has also been linked to gallbladder disease.

When and how often: If you’re age 20 or older, you should have your cholesterol measured at least once every five years. More frequent monitoring may only be necessary if you have certain risk factors such as diabetes, heart diseases, kidney problems, or have sudden changes in lifestyle causing weight gain.

What to expect: A comprehensive lipoprotein profile measures the total cholesterol in your blood, which includes “bad” LDL (low-density lipoprotein) cholesterol, “good” HDL (high-density lipoprotein) cholesterol, and triglycerides. If you’re at risk for heart disease, some doctors may test your apoB levels, a measure of fat particles in the blood.

Ideally, your total cholesterol levels should be less than 200 milligrams per deciliter (mg/dl); a borderline high reading is between 200 and 239 mg/dl.

Pap Smear

Why you need it: It is the best tool to detect cervical cancer in time for effective treatment. According to the Singapore Cancer Society, cervical cancer is currently the tenth most common cancer amongst women in Singapore. Every year, almost 200 new cases are diagnosed and 70 deaths occur from cervical cancer alone.

When and how often: An initial screening should be performed at age 21 or once a woman is sexually active, up till age 65. Pap smears could be done every 3 years. If you have multiple sexual partners, are a smoker, are HIV positive or have a Sexually Transmitted Disease, you should have a Pap smear screening annually.

What to expect: During the Pap smear, your doctor uses a speculum to widen the vaginal canal. This exposes the cervix allowing a sample of cells to be taken with a small brush. The sample is smeared onto a glass slide and then sent for analysis. The doctor will also perform a pelvic examination to check your uterus, ovaries and fallopian tubes.

Your pap smear results will reflect your reading as normal or abnormal and requiring follow up with the doctor.

Mammogram & Clinical Breast Exam

Why you need it: Mammograms can detect the presence of cancerous lumps even before they can be felt with hand, it is currently the most reliable tool for early breast cancer detection. Despite being the most commonly occurring cancer amongst women in Singapore, more than 90% of women diagnosed with breast cancer at the earliest stage remain well and disease-free after 5 years or more, compared to around 15% for women diagnosed at the most advanced stage.

Urinary Incontinence

A Complete Guide to Urinary Incontinence in Singapore

by Dr Amy Kaonang
Friday, November 29, 2019

Introduction

“Mdm X walked into my clinic one day for her annual health screening with me.  She is 49 years old and works as a corporate executive in the busy finance industry.  She is very well groomed and the strong scent of Chanel No. 5 was evident as she walked in.  Yet, below the strong perfume scent, permeated an unmistakable smell of urine which was very familiar to me from my days working in the hospitals.  As I went through her medical history and physical examination, I decided to probe further about her urinary symptoms.  Suddenly, she broke down and started crying in my clinic…”

Sounds like a familiar situation to you?  Mdm X is suffering from urinary incontinence, which is a medical condition resulting in the involuntary leakage of urine.  Urinary incontinence is actually a very common condition which is under-reported and under-diagnosed, but it is actually a very treatable condition.  In this article, I will share with you the causes of urinary incontinence and the treatment options available to you.

Are there different types of urinary incontinence and what are their causes?

1.Stress Incontinence
This type of incontinence results from increased pressure within the abdomen and my patients usually tell me they find urine leakage when they sneeze, cough or laugh. For the gym goers, they may find themselves leaking whenever they exert themselves or carry weights. The mechanism whereby this occurs is due to the weakening and laxity of muscles and connective tissues controlling “continence”, controlling our flow of urine.

2.Urge Incontinence
This type of incontinence results from the bladder muscles being hyperactive and my patients usually complain of a frequent urgency to pass urine, even though the volume of urine may not be much. Before they manage to find a toilet, invariably, they find themselves start to leak, and it can be from as little as a few drops to completely soaked undergarments. It is often paired with symptoms of frequent urination and waking up at night to pass urine multiple times and is called the “Overactive Bladder Syndrome”.

3.Overflow Incontinence
In contrast to Urge Incontinence, this results from the bladder muscles being underactive, or some form of obstruction to the urine outlet, resulting in urine being retained in the bladder and slowly starts to leak out. My patients usually complain that they feel a sensation of incomplete urination or dribbling of the urine every time they go to the toilet, yet there is still leakage of urine in between their toilet visits.

4.Functional Incontinence
Functional incontinence is when there exists no physical problems with the bladder storing or emptying urine, but due to physical impairments like arthritis or mental impairments like dementia, the patient is unable to empty urine in a timely fashion.

5.Mixed Incontinence
Not exactly a group of incontinence by itself, but mixed incontinence happens fairly frequently as well, and it refers to when patients have both symptoms of Stress Incontinence and Urge Incontinence.

6.Others
Other causes of incontinence include urine tract infections which can be treated with antibiotics, constipation, alcohol and caffeine intake, certain medications and less commonly neurological conditions and cancers like bladder or advanced cervical cancer.

Are there risk factors linked to urinary incontinence?

Risk factors for urinary incontinence, are those that affect the muscles and tissues of the urinary tract and include the following

  • Pregnancy and Childbirth can stretch and weaken the pelvic floor muscles of a woman
  • Ageing and Menopause induces changes in the tissues of the female genital tract, resulting in the muscles and tissues becoming weaker
  • Obesity causes additional stress to the muscles, resulting in them becoming weaker as  well
  • Repetitive strenous activities that increase pressure within the abdomen, for example a chronic persistent cough, persistent constipation or even high impact sports
  • Certain medications can cause or contribute to incontinence
  • Caffeine, alcohol and spicy food are bladder irritants that can worsen incontinence
  • Constipation which hinder the normal urine flow, resulting in urge or overflow incontinence

Is it a common condition and who does it affect most?

Mdm X is just one of the many examples of patients affected by urinary incontinence.  It affects about 30 – 40% of women worldwide and of this group, less than 50% actually seek help for their condition.  In Singapore, it is estimated that about 4.6% to 14.5% of adults are affected by urinary incontinence but the numbers are likely higher due to significant under-reporting of symptoms in the community.

The reasons for avoidance of treatment are mainly due to social embarrassment and a misconception that this is invariably an ageing process and nothing much can be done about it.

Although women and elderly are more likely to be affected by urinary incontinence, men and children can be affected as well.  Common causes for men are related to both stress and urge incontinence as well and they are usually due to prostate issues like enlarged prostate or after surgery of the prostate, while for children, it can be due to urine infections or other congenital issues.

How is it diagnosed in Singapore?

Urinary incontinence is a clinical diagnosis.  Firstly, I would go through a very thorough history with my patient.

a. Targeted questions to find out type of incontinence

  • Does the leakage happen during strenous activities like coughing or sneezing?
  • Is there repeated and frequent urges to pass urine?
  • Or is there a mixture of both?

b. Possible contributing factors

  • Pregnancy and childbirth history
  • Menstrual history
  • Previous surgeries
  • Other chronic conditions like diabetes?  Or if of any long term medications?
  • Any symptoms of urine infection?
  • Dietary history like caffeine or alcohol intake?
  • Amount of water drank daily?
  • Bowel history

c. Social history

  • How the symptoms have affected her socially?
  • Any symptoms of depression, etc?

Generally, the history alone is sufficient for me to diagnose urinary incontinence, but I would still proceed to examine my patient for any other causes that may contribute to urinary incontinence, like the presence of masses in the abdomen, or an enlarged fibroid or prostate that may cause the incontinence.

I will also perform a simple urine dipstick in my clinic to rule out any urine infections that may cause the incontinence as well.

How can it be treated?

“In between sobs, Mdm X shared with me that she has been having symptoms of urinary incontinence for the past 1 year and she frequently feels the urge to pass urine with leakage of urine whenever she laughs or coughs as well.  It seems to be getting progressively worse, to the point it is affecting her work and personal relationship with her husband.  She feels her colleagues have been avoiding her and she has also started to be more withdrawn from them.  Her husband has also been complaining of a urine stench whenever she is around him.  She is despondent and feels nothing can be done about this as this is part of her ageing and menopause process… ”

I reassured her that the above is not true.  Urinary Incontinence is not a natural process of ageing!  Do not accept the status quo as there are treatment options available to her.  Some of these options can be managed by myself as well without the need to go through surgery.  I classify the options into 3 big categories

  • Conservative
  • Medications
  • Surgical

Conservative

1. Eliminate the contributing factors to urinary incontinence

  • For obese patients, start an exercise regime to lose weight
  • Cut down on caffeine, alcohol and spicy food
  • Ensure enough fibre intake to reduce constipation

2.  Daily Pelvic Floor Exercises
Kegel exercises developed by Dr Kegel strengthen the pelvic floor muscles which support the uterus, bladder, small intestines and rectum.

  • Start by identifying the correct pelvic floor muscles and the BEST way to do it, is to try to stop your urine halfway during urination.  The muscles activated for you to do that are your pelvic floor muscles.
  • Once above is done, you can practise your Kegel exercise in any position comfortable for you.  For beginners, lie down on the floor and tighten your pelvic muscles for 3 seconds, then relax for another 3 seconds.  Repeat 15 times for each set.
  • It is important to do your Kegel Exercises daily for 3 sets.  This will help strengthen your pelvic floor muscles and reduce the incidences of stress incontinence.  Your incontinence symptoms should start to improve after 3 to 6 weeks.
  • An important point to note will be to focus on tightening only your pelvic floor muscles.  Some of my patients find it hard initially to coordinate their muscle movements and end up tightening their abdominal muscles at the same time.  As this increases the pressure within the abdomen, they find that during the practising of Kegel exercises, they end up leaking even more and eventually give up on practising further!

3.  Incontinence Laser for women

I classify this laser as a conservative management option as I find it very non-invasive, yet effective for mild to moderate cases of stress or mixed urinary incontinence.  It is convenient, virtually painless and usually my patients report marked improvement after 2 sessions.

The incontinence laser works by stimulating collagen production and rejuvenation around the female genital and urinary tract.  This rejuvenation results in shrinking and tightening of the tissues in the area and in turn gives greater support to the bladder, thus improving the symptoms of urinary incontinence.

Medications

A course of antibiotics can be prescribed if the incontinence was due to urine infection.

If the stress incontinence symptoms are due to “ageing” of the female genital tract after menopause, I will prescribe a trial of oestrogen creams or pessaries to my patients.  These topical medications are very safe and usually patients do report an improvement in their stress incontinence symptoms.

For urge incontinence symptoms, another type of medications which decrease the activity of the bladder can be prescribed, like Tolerodine or Oxybutynin.  However, my own experience with these medications has not been ideal due to patients finding it hard to be compliant on a daily basis with these medications or the side effects like headache or fatigue making them stop taking the medications.

Surgery

For severe cases of urinary incontinence that do not respond to the above conservative and medication therapies, I usually refer my patients to my urologist colleagues for consideration of surgical options.

Most of my patients shudder at the thought of surgery as they worry about long incisions and ugly looking scars after operation.  However, surgery has very much evolved with the times and the days when long Caesarian section looking scars were needed for incontinence surgery has now evolved to just a simple vaginal incision with no need for any skin incisions on the abdomen and pelvic areas.

This new technique is called Miniarc surgery and it involves the insertion through the vaginal incision of a Miniarc tape which has tension around it to support the urine tract, thus reducing the stress incontinence.  This is usually done under general anaesthesia but the procedure is completed within 10 minutes and can be done as a day surgery without the need for hospitalisation.

CONCLUSION

“Mdm X found that her symptoms have coincided with the onset of her menopause.  After starting on Kegel exercises, and 2 treatments with the incontinence laser, she came back 2 months later, with all her symptoms resolved.  She was much happier and felt much more refreshed and energetic to cope with the challenges at work.”

Urinary Incontinence is a common problem affecting many people but should not be part of your natural ageing process.  Many treatment options are available to reduce or even cure the symptoms.  The key is to speak to your doctor about it today and work with him or her to find a management option that works best for your symptoms and you.