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Can’t hold your pee? See the doctor immediately

SINGAPORE — For years, Madam Lina Soh (not her real name), an avid mahjong player in her 50s, kept her overactive bladder problems under wraps.

SINGAPORE — For years, Madam Lina Soh (not her real name), an avid mahjong player in her 50s, kept her overactive bladder problems under wraps.

But when her mahjong friends could no longer tolerate her never-ending toilet breaks — which took place as frequently as every 15 to 30 minutes — and began shunning her, she knew it was time to seek medical attention.

Mdm Mary (not her real name), who suffered similar bladder woes, was thought to be skiving at work because of her frequent toilet breaks.

On the home front, things were just as bleak. She avoided having sex with her husband, as urine would leak every time she had intercourse or an orgasm.

Welcome to the world of living with an overactive bladder (OAB).

Mdm Soh and Mdm Mary are two patients Dr Christopher Chong, obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital, has encountered in his practice. He estimated that OAB affects one in 10 people here.

Dr Ng Lay Guat, head and senior consultant at the department of urology at Singapore General Hospital (SGH), said OAB is a medical condition that causes the sufferer to experience a frequent and sudden urge to urinate.

Patients who have severe OAB may even end up having to wear adult diapers to deal with the massive volume of urine leakage, she added.

Dr Ng explained: “This is because the warning time from the urge to urine is so short that the person does not have the time to rush to the toilet. Usual pads for urinary incontinence may not be able to hold the large volume of urine leakage that occurs when the bladder contracts involuntarily. Some patients can be so affected that they become homebound as a result.”

In many cases, the exact cause remains unknown. However, certain factors that increase the urge to urinate — including caffeinated beverages, alcohol, cold temperature as well as touching or hearing sounds of water — can worsen the symptoms, added Dr Ng.

Dr Lim Kok Bin, specialist in urology at Raffles Hospital, said OAB is more common among women who experience frequent urinary tract infections and menopause, diabetics, as well as men with prostate enlargement.

Dr Chong added that it is also possible OAB may signal other medical conditions such as bladder stones, cancer and pelvic organ prolapse.

IT CAN BE TREATED

Despite the inconvenience, most people are so embarrassed by their condition that they suffer in silence for months or even years before they seek treatment, said Dr Chong.

“My advice would be to see a doctor as soon as possible. The earlier OAB is detected, the higher the success rate from treatment,” he said.

Dr Ng said most doctors start off by teaching the patient simple remedies such as lifestyle modifications and pelvic floor exercises. They may also prescribe daily medication that relaxes the bladder.

Dr Chong added that patients are also put on a bladder “retraining” regime, which slowly “teaches” the bladder to hold larger volumes of urine over several weeks.

If the above treatments fail, then your doctor might suggest having Botox injections.

Dr Chong explained that Botox, which is injected into the bladder muscles, works by minimising sudden bladder contractions.

Dr Lim said one of the advantages of the Botox injections, which are administered under general or spinal anaesthesia, is that the effect is immediate and can last six to nine months, so patients do not need to take daily medication during that period.

However, Dr Ng said there could be side effects such as pain, blood in the urine and urinary tract infections, so candidates for the treatment need to be selected carefully to ensure they are suitable.

She added: “The most unpleasant side effect is over-relaxation of the bladder to the extent that the patient is not able to pass urine.

“If this happens — the risk is approximately 5 per cent — the patient will need to perform self-catheterisation to let the urine out four to five times per day until the effects of the Botox wear off.”

Dr Ng added that if all else fails, there are other even more invasive, surgical treatments that may offer a permanent cure for OAB.

One example is the clam cystoplasty, reconstructive surgery that increases the size of the bladder. However, due to its invasive nature, this major surgery is seldom performed in Singapore.

WHAT IS NORMAL?

A normal person’s bladder can hold about 400ml (that’s about two glasses of water) before he feels the urge to visit the toilet. This occurs about seven times a day, or every two to three hours in the day, and maybe once at night.

However, an overactive bladder may feel the urge to pass urine when it holds only 150 to 200ml of urine, said Dr Christopher Chong, obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital.

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