Stress urinary incontinence (SUI) is the unintentional leakage of urine when pressure in the abdomen increases, such as during coughing, sneezing, laughing, exercise or lifting. It is common and can range from a few drops of urine to leakage that affects daily activities.

Some women also experience a sudden urge to pass urine, frequent toilet visits, difficulty emptying the bladder or other urinary symptoms. An assessment helps identify the type of incontinence and the treatment options that may be suitable.

At SGH, women with urinary leakage can be assessed by the Urology team. SGH manages up to 400 cases of stress urinary incontinence (SUI) each year, making it one of the leading centres in Singapore for the assessment and treatment of this condition. Care may include pelvic floor rehabilitation, symptom-management support, diagnostic tests, urethral bulking injections or continence surgery, depending on the diagnosis, general health and treatment preferences.

The bladder stores urine, which leaves the body through a tube called the urethra. The pelvic floor muscles and surrounding tissues help keep the urethra closed. Stress urinary incontinence can occur when these structures do not provide enough support, or when the urethra does not close tightly enough during movement or physical effort.

The pattern and severity of leakage vary. Some women leak only during strenuous exercise, while others leak with everyday movements such as coughing or standing up. Treatment depends on the type of leakage, how much it affects daily life, previous treatment and what matters to the patient.

SUI may cause one or more of the following:

• Leakage when coughing, sneezing or laughing.
• Leakage during running, jumping, exercise or sport.
• Leakage when lifting, bending, standing up or making a sudden movement.
• Leakage during sexual activity.
• The need to use pads or change clothing because of leakage.
• Avoiding exercise, travel, work or social activities because of concern about leakage.

Urinary leakage is common, but it does not have to be accepted as an unavoidable part of ageing, pregnancy or childbirth. An assessment can clarify the cause, identify factors that may be treated and help you compare non-surgical and surgical options.

The most suitable treatment is not the same for everyone. Your doctor will consider the pattern of leakage, pelvic floor function, previous pelvic or continence procedures, other urinary symptoms, general health and your treatment goals.

SUI may be linked to weakening or injury of the pelvic floor and urethral support. Contributing factors can include:

• Pregnancy and vaginal childbirth.
• Ageing and changes around menopause.
• Previous pelvic, gynaecological or continence surgery.
• Chronic coughing, including cough related to smoking or lung disease.
• Constipation and repeated straining.
• Being overweight, which can increase pressure on the pelvic floor.
• Regular high-impact exercise or repeated heavy lifting.
• Conditions that affect pelvic floor muscles, nerves or connective tissues.

Diagnosis usually begins with your symptoms, medical history and a physical examination. The doctor will also check whether the leakage may be related to urgency, infection, incomplete bladder emptying, pelvic organ prolapse or another condition.

What to expect if additional tests are recommended

Your care team will explain why the test is being considered, how to prepare and what the results may show. Additional tests can include urodynamics, which measures how the bladder stores and passes urine, or cystoscopy, which uses a small telescope to examine the urethra and bladder, or imaging in selected cases.

Treatment depends on the severity and type of leakage, pelvic floor function, general health, previous procedures and personal preferences. Many women begin with non-surgical treatment. A procedure or operation may be considered when symptoms remain bothersome or conservative treatment has not provided enough improvement.

Lifestyle and pelvic floor care

Supervised pelvic floor muscle training is usually the first-line treatment for SUI. A trained healthcare professional can check that the correct muscles are being used and guide a programme, often over at least three months. Lifestyle measures may also reduce pressure on the pelvic floor or improve related bladder symptoms.

• Practise pelvic floor exercises as advised and continue them regularly.
• Treat constipation and avoid repeated straining.
• Seek help for a chronic cough and stop smoking where applicable.
• Work towards a healthy weight if advised.
• Adjust high-impact exercise or heavy lifting if these clearly trigger leakage.
• Use bladder training when urgency or mixed symptoms are also present, if recommended.
   

Medicines and symptom-management products

Medicines are not usually the main treatment for SUI. Your doctor may discuss treatment for related symptoms or contributing conditions. For some postmenopausal women with vaginal dryness or urinary discomfort, local vaginal oestrogen may be considered after an individual assessment. Pads, protective underwear and other continence products can help manage leakage but do not correct the underlying cause.

Non-surgical treatment

Non-surgical care can be used alone or before a procedure. The aim is to improve pelvic floor support, reduce triggers and help you manage symptoms safely.

Procedures and surgery, if needed

If SUI remains bothersome, your urologist will discuss suitable procedures, expected recovery, possible benefits, limitations and risks. Shared decision-making is important because less invasive options may have a lower chance of complete dryness, while more invasive operations may involve longer recovery or implant-related considerations.

If a procedure or surgery is recommended, the care team will explain why it is being considered, the alternatives and what recovery may involve. Instructions vary according to the treatment, anaesthesia and individual health needs.

Caring for yourself after a continence procedure or surgery

Your discharge instructions take priority because aftercare differs between a urethral bulking injection and continence surgery. Contact the care team if you are unsure what is expected during recovery.

• Take prescribed medicines as directed.
• Drink and pass urine according to the instructions given by your care team.
• Follow catheter-care advice if a temporary urinary catheter is required.
• Avoid heavy lifting, strenuous exercise and sexual activity until the care team advises that it is safe.
• Monitor urine flow, pain, bleeding, fever and other new symptoms.
• Attend follow-up so that symptom improvement, bladder emptying and any side effects can be reviewed.

SUI can improve, remain stable or return after treatment. Long-term symptom control is supported by regular pelvic floor care and management of factors that increase pressure on the pelvic floor.

• Continue pelvic floor exercises as advised, including after improvement.
• Manage constipation and avoid repeated straining.
• Seek treatment for a persistent cough.
• Maintain a healthy weight where possible.
• Build up exercise gradually and modify activities that repeatedly trigger leakage.
• Arrange review if symptoms return, change in pattern or begin to affect daily life again.

Leakage with coughing or activity suggests SUI, but urgency, pain, recurrent infection, poor flow, incomplete emptying or continuous dribbling may indicate mixed incontinence or another urinary condition.

Blood in the urine, persistent pelvic pain, fever, new neurological symptoms or a sudden inability to pass urine require medical assessment. Your doctor may recommend additional tests or referral to another service depending on the findings.

SGH’s Urology team assesses female urinary incontinence, including symptoms that are persistent, recurrent or have continued after previous treatment. The treatment plan is based on the type of leakage, individual health needs and informed discussion of the available options.

Patients may benefit from:

• Specialist urology assessment for stress, urgency and mixed urinary symptoms.
• Access to pelvic floor rehabilitation and diagnostic testing where clinically appropriate.
• A range of conservative, injectable and surgical treatment options for selected patients.
• Assessment of recurrent or complex incontinence after previous pelvic or continence procedures.
• Follow-up focused on symptom improvement, bladder emptying, recovery and the need for further treatment.

To help your doctor assess your symptoms, bring or prepare the following where available:

• A description of when leakage happens, how often it occurs and how much urine is lost.
• Details of urgency, toilet frequency, night-time urination, pain, blood in the urine, infections or difficulty emptying the bladder.
• A completed bladder diary, if you have been asked to keep one.
• Current medicines, supplements, allergies and medicines that affect blood clotting.
• Details of pregnancies, childbirth, pelvic surgery and previous continence treatment.
• Previous urine tests, bladder tests, scans, cystoscopy or operation reports.
• Questions about treatment choices, expected improvement, recovery, work, travel, exercise and sexual activity.

The cost of SUI care depends on the consultation, tests, pelvic floor therapy, procedure or surgery, anaesthesia, day-surgery or ward arrangements, subsidies and insurance coverage. The care team and financial counselling team can explain the expected charges and available support after a treatment plan is recommended.

For the most up-to-date cost estimates and subsidy information, please visit the MOH website.

Can stress urinary incontinence improve without surgery?

Yes. Supervised pelvic floor muscle training is usually the first treatment and can reduce leakage for many women. Managing constipation, chronic cough, excess weight and activity-related triggers may also help. A procedure or surgery can be considered if symptoms remain bothersome.

Is stress urinary incontinence the same as an overactive bladder?

No. SUI causes leakage with coughing, sneezing, exercise or other physical effort. Overactive bladder involves urgency and usually increased toilet frequency, with or without urgency leakage. Some women have both patterns, which is called mixed urinary incontinence.

Do I need urodynamic testing before treatment?

Not always. It is not routinely required for every patient with straightforward SUI. It may be recommended when the diagnosis is unclear, symptoms are mixed, bladder emptying is difficult, pelvic organ prolapse is present, there has been previous continence surgery or the result may change treatment planning.

What is a urethral bulking injection?

A small telescope is passed through the urethra, and a soft bulking material is injected into the urethral wall. The material creates cushions that help the urethra close more firmly when abdominal pressure rises.

What is a Bulkamid procedure?

Bulkamid procedure is a urethral bulking procedure. Bulkamid is composed of a non-degradable, homogenous polyacrylamide gel, which distinguishes it from older urethral bulking agents. Bulkamid procedure technology includes a short urethroscope with a special needle guide.

Does a urethral bulking injection use surgical mesh?

No. The injection does not use surgical mesh and does not require an incision. It is less invasive than continence surgery, but it may be less likely to result in complete dryness and repeat treatment may be needed.

Will treatment make me completely dry?

Complete dryness cannot be guaranteed with any treatment. The likelihood and degree of improvement depend on the type and severity of leakage, the treatment chosen and individual factors. Your urologist will discuss realistic goals and alternatives.

Medically reviewed date: 17 September 2026