SINGAPORE – Could “smart” underwear help people with leaky bladders get more out of their pelvic floor exercises?

An upcoming trial at the National University Hospital (NUH) aims to find out the extent to which a new invention can help people with mild to moderate stress incontinence – a condition marked by involuntary leakage of urine during activities such as jumping, sneezing, coughing or lifting of heavy objects.

Developed by Dutch wearable technology company LifeSense Group, the high-tech undergarment uses a combination of absorbent material, a Bluetooth sensor and a tailored exercise programme to provide users with the tools to strengthen their pelvic floor muscles and improve their bladder control more efficiently.

Versions of the underwear, available for both genders, have been dubbed Wil and Carin for men and women, respectively.

Recruitment for the study by NUH will begin in October and it is expected to take place over a two-year period, said Dr Fiona Wu, associate consultant at the hospital’s department of urology.

About 50 patients, who are either existing patients or those referred to NUH Urology Centre, are expected to be recruited.

During the trial, participants will undergo an app-based programme using the smart underwear, which is fitted a removable Bluetooth-enabled sensor that detects and records leaks in real time.

The underwear is made of a quick-drying fabric that can absorb around 10ml of leaks each time and up to 100 ml over a 24-hour period, which would help most users to stay dry, said Dr Valer Pop, chief executive of LifeSense Group.

“The sensor then sends the information wirelessly to an app on a mobile phone, which reminds the patient to practise pelvic floor exercises,” said Dr Pop. Data collected is used to track progress and follow up on bladder control improvements.

Once the NUH trial is completed, patients who are able to utilise the app together with the underwear’s technology can use it to supplement their treatment, said Dr Wu.

“It will be easier for patients to communicate their leakages to their doctor and, hopefully, help them to practise their pelvic floor exercises more regularly and thus improve their continence,” said Dr Wu.

Patients will need to do the pelvic floor exercises regularly to sustain its effects, she said.

Pelvic floor exercises, or Kegels, are commonly prescribed as a conservative treatment for those suffering from urinary incontinence. But targeting the right muscles and doing the exercises regularly remains a challenge for many patients here. 

One of the advantages of the smart underwear is that it allows users to track their progress. This helps them to be more motivated to keep up with their pelvic floor exercises, said Dr Pop.

“When Fitbit was first introduced, many people asked why they would need it to run 10km. Its biggest advantage is that it motivates users to reach their goals. Doing pelvic floor exercises for 10 minutes every day for six to eight weeks is not easy. Being able to see their progress on the app keeps them motivated,” he said.

Based on the sensor measurements, the app can also identify and recommend the type of pelvic floor fibre (slow or fast-twitch muscle fibre) that requires training, said Dr Pop.

LifeSense Group’s smart underwear was among 12,000 medical and healthcare technological innovations showcased at the Medical Fair Asia and Medical Manufacturing Asia 2018, which ended on Friday (Aug 31) and was held at Marina Bay Sands.

The female and male versions of the underwear (full set including underwear, sensor, app and exercise plan) retail at S$180 and S$280 respectively, and there are plans for a distributor partner in Singapore to offer it online from November, said Dr Pop. It is currently available in Japan, the United States and Europe.

A COMMON CONDITION

Local studies show that over 40 per cent of women and about 5 per cent of men in Singapore have urinary incontinence, said experts.

The NUH Urology Centre currently sees about 120 to 150 patients each month for various types of urinary incontinence, and the number is expected to rise due to the ageing population and greater awareness of such conditions, said Dr Wu.

One of the most common forms of urinary incontinence, stress incontinence is usually caused by damage to the pelvic floor muscles or nerves, and damage or loss of connective tissue supporting the bladder neck and urethra, said Dr Wu.

Other factors include injury to the urethral sphincter, ageing and low female hormone levels, obesity, constipation and chronic cough. In men, stress urinary incontinence is common in those who have undergone treatment for prostate cancer.

While not life-threatening, the condition can severely affect patient’s quality of life.

Dr Joe Lee, a consultant at NUH’s department of urology, has seen individuals with the condition become socially withdrawn or limit their lifestyles.

About 3 per cent of men who have undergone prostate cancer treatment may have severe incontinence that cannot be managed using pelvic floor exercises, said Dr Lee, who is also the director of andrology and male reproductive medicine at NUH. For this group, constant urine leakage is an everyday reality. 

Some patients resort to DIY solutions to manage their symptoms when frequent diaper changes become too costly. Dr Lee once encountered a patient who resorted to tying a plastic bag around the tip of the penis to collect leakage.

“Because of this, the tip of his penis was constantly soaked in urine. The rubber band affected blood flow, and the patient ended up with issues like urine infection and the skin also became unhealthy,” said Dr Lee.

While pelvic floor exercises are helpful for milder cases, surgery is usually recommended for more severe incontinence, said the NUH doctors.

However, there is currently low awareness that surgical treatments such as the artificial urinary sphincter implant are available for severe incontinence in men, said Dr Lee. The implanted device helps to control the flow of urine out of the bladder mechanically.

The cure rate for women who undergo surgery for stress incontinence is between 75 and 90 per cent but surgery has its inherent risks and complications, said Dr Wu.

A detailed discussion between the patient and doctor is important to establish a good treatment plan, she added.