Breaking the Silence on Female Incontinence: Modern Urogynaecology Offers New Hope

This article was contributed by Dr Albert Tan Chao Chiet, Consultant Obstetrics & Gynaecology (O&G) - Urogynaecology at Pantai Hospital Cheras. To book an appointment or learn more about Dr Albert Tan Chao Chiet and his clinic, click here

By Dr. Albert Tan Chao Chiet, Consultant Obstetrician, Gynaecologist & Urogynaecologist 

Urinary incontinence — the involuntary leakage of urine — affects countless women across Malaysia, yet many continue to suffer silently. Often dismissed as a normal consequence of childbirth, ageing, or menopause, incontinence is not something women have to “tahan sahaja”. It is a medical condition with effective, proven treatments. 

Women frequently describe how incontinence affects their social life, work, exercise, and confidence. Many avoid travel, restrict fluids, or live in constant fear of leakage. With proper assessment and treatment, most women can regain full control of their bladder — and their lives. 

When to Seek Assessment — It Could Be More Serious Than You Think 

Not all urinary leakage is benign. Sometimes, incontinence may be linked to an underlying pelvic mass or even a dangerous uterine tumour compressing the bladder, especially if symptoms develop suddenly or worsen rapidly. 

Women should seek prompt evaluation if they experience: 

• Leakage with effort, coughing, or sneezing 
• Sudden urge to urinate and inability to hold 
• Frequent daytime or nighttime urination 
• Pelvic pressure or bloating 
• Difficulty emptying the bladder 
• New urinary symptoms after menopause 
• Rapid change in bladder habits 

Early diagnosis ensures that treatable problems are not overlooked — and that serious conditions are detected early. 

Pelvic Organ Prolapse: A Common but Overlooked Cause of Incontinence

Pelvic Organ Prolapse (POP) occurs when the bladder, womb, or bowels slips down due to weakened pelvic floor muscles — often after childbirth, difficult deliveries, menopause, or chronic coughing. Many women do not realise that prolapse and urinary incontinence often occur together.

Prolapse can cause

• Urine leakage on exertion
• Difficulty emptying the bladder
• Frequent urination
• Feeling of vaginal bulging or heaviness
• Recurrent urinary infections

When prolapse is present, treating incontinence alone is often ineffective. Both conditions must be assessed and managed together, using a holistic pelvic floor approach. 

This is precisely why urogynaecologists — specialists trained in both gynaecology and female pelvic floor disorders — are the most appropriate experts to diagnose and treat female incontinence. Unlike urologists, whose training focuses primarily on the urinary tract, urogynaecologists are specifically trained to evaluate how the uterus, vagina, pelvic floor muscles, and bladder interact — a crucial factor when managing conditions unique to women. 

A Unique Expertise in Malaysia: Laparoscopic Burch Colposuspension

Stress urinary incontinence (SUI)—urine leakage during coughing, laughing, or physical activity— is one of the most common forms of female incontinence. When pelvic floor exercises or medications do not provide sufficient relief, surgical treatment may be indicated. 

I am currently the only known urogynaecologist in Malaysia who routinely performs Laparoscopic Burch Colposuspension with consistently positive clinical outcomes. This minimally invasive, mesh-free procedure uses sutures to restore the bladder’s natural support, and is backed by decades of international evidence demonstrating its safety, durability, and long-term success. 

For women who prefer to avoid synthetic mesh, or those who have experienced complications from prior mesh surgery, laparoscopic Burch colposuspension provides a reliable, effective, and proven alternative. 

Why Not Use Mesh? Understanding the Risks

In the past, synthetic mesh slings were widely used to treat stress incontinence because they were quick to insert and initially effective. However, over the years, many countries have reported serious complications from mesh, including: 

• Chronic pelvic pain 
• Mesh erosion into the bladder or urethra
• Painful intercourse (dyspareunia) 
• Recurrent infections 
• The need for multiple corrective surgeries 

Several nations, including the UK and New Zealand, have imposed strict regulations or temporary bans on mesh for incontinence due to these adverse outcomes. 

For women who prefer to avoid mesh, or those who have had complications from previous mesh procedures, laparoscopic Burch colposuspension offers a safe and effective alternative with a long history of success — without introducing foreign material into the body. 

Modern Urogynaecology Can Transform Lives

Female incontinence impacts self-esteem, relationships, and daily activities. But with targeted assessment, conservative therapy, and advanced surgical options like laparoscopic Burch colposuspension, women can regain normal function and confidence. 

If you or someone you know experiences urinary leakage, do not ignore the symptoms. Help is available, and you do not have to live with incontinence. 

For further information or to arrange a consultation, you may reach out to my affiliated clinics or book an appointment at Pantai Hospital Cheras.

Mesh erosion in the urethra on cystourethroscopy.
Source: Han, Ji-Yeon. (2019). Recurrent Urinary Tract Infection from Urethral Mesh Erosion after
Midurethral Mesh Sling Surgery. Urogenital Tract Infection. 14. 60. 10.14777/uti.2019.14.2.60.