We provide contemporary incontinence care that covers the entire treatment spectrum, beginning with non-surgical options and progressing to surgical management where desired.
You have probably heard or read about the potential for surgical complications related to anti-incontinence surgery.
We also see a lot of women who come to us for second opinions after not being offered conservative therapy first.
Please know that we adhere to best practice guidelines for treatment of urinary incontinence. That means you will first be offered non-surgical treatment options, such as physical therapy, to improve pelvic floor muscle function.
We also offer other advanced nonsurgical treatment options, such as InTone, which we have had fantastic results with.
However, if surgical therapy is desired, the mid-urethral sling (also called bladder sling) is a highly effective and long lasting treatment option.
Another option is urethral bulking agents, which have minimal recovery time. You can go to the gym the day after a urethral bulking with minimal disruption of your daily routines.
What to Expect
At your initial visit, we’ll take a thorough history and exam to make sure no other problems, such as prolapse or pelvic floor muscle issues, need to be addressed.
We’ll review with you the available treatments for stress incontinence that typically begin with improving pelvic muscle function through physical therapy, biofeedback and/or InTone.
You will also complete a voiding diary (journal where you record what you drink and urinate for 48 hours); this helps us to identify possible holistic treatment options, such as simple behavioral modification.
If a procedure or surgery is desired, we’ll then proceed with urodynamic testing to see how your bladder functions before finalizing a surgery decision.
For the best results, we believe it is important to maximize your pelvic floor muscle function prior to any surgical procedure.
Stress incontinence is urinary incontinence/leakage with activity. Some common symptoms are: leaking with coughing, leaking with laughing, leaking with sneezing, leaking with exercise
Urethral bulking agent
Urethral bulking is a technique to thicken the lining of the urethra and narrow the inner diameter to prevent urinary leakage from stress urinary incontinence.
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Incontinence can happen at all ages - young girls, adolescents, during adulthood, and with aging and menopause.
Leakage is not normal; it's very embarrassing and corrosive to self-esteem and body image.
If not treated, leakage can lead to a variety of chronic health issues; it is often the first domino to fall in the chain of leakage, less exercise, weight gain, diabetes, heart disease and depression. Incontinence is linked to all these conditions, so it's important to find strategies to manage your plumbing so you can stay healthy and avoid chronic health conditions.
Leakage also impacts your relationships—from something as simple as picking up your cat, to playing a sport, to intimacy and sharing your body with your lover. You may feel inhibited about doing any of these things since you're concerned about leaking, while those around you don't realize why you are holding back.
How much counts as 'leakage'?
Any unwanted and unplanned leakage can be an issue—if it's a bother to you then it's something you should address.
What causes leakage?
Urinary leakage can happen with a variety of causes.
It can happen for temporary reasons, such as a bad cold with a lot of coughing or a bladder infection. Your leakage will improve after your cold or UTI is resolved.
Urine leakage can also be caused by pregnancy, vaginal deliveries, gravity, aging, time or a change in hormones...it's a long list!
What kinds of treatments are available?
Treatments for bladder leakage may include:
- A Kegel program and a visit with a pelvic health physical therapist to teach you how to do them properly (most of us have a hard time easily localizing the pelvic/vaginal muscles)
- A "pessary" which is a plastic ring you can place in your vagina to provide support
- Surgical procedures that can bulk or lift to get you completely dry.
Would treatments be covered by most insurances?
This is the reason many women defer treatment – thinking it's not covered by insurance. Incontinence treatments are always covered by insurance.
Who do I talk with about incontinence?
Is this something I can bring up during my yearly checkup, or do I need to specifically talk to a GYN or other specialist?
You can do either...your gynecologist or a pelvic health specialist can counsel you about your options. Depending on your primary provider, you may get some counseling about first steps for treatment or a referral to a specialist.
I'm having lots of UTIs and leakage around them; should I be treating the leakage or the UTIs?
UTIs are a little problem that can create a big hassle. With an infection in your bladder, the tissues get inflamed and nothing works down there until the infection is cleared up!
Often it takes more than antibiotics to get the tissues completely healed and during this interval, you are at risk of another infection and more inflammation that can drive leakage, pain and irritation.
UTIs and bladder leakage are linked and one can cause the other. It’s best to be seen by a specialist to help sort out which is the chicken and which is the egg.
What kind of specialist should I see? Do I need a referral, or can I make an appointment myself?
Specialists who treat urinary incontinence are either in gynecology, urology or a combined specialty called "urogynecology." At our urogynecology practice, we specialize in treating women with pelvic health problems such as bladder, bowel or sexual problems.
Most women will get a referral from their primary care provider to see a urogynecologist, but check with your insurance to see if a referral is needed or if you can self-refer.
Self-referral is often easier for women who aren’t comfortable bring up pelvic health or sexual health issues during their annual exam.
Can drinking too much water cause leakage?
Drinking too much water can definitely drive urinary frequency, urgency and leakage.
A normal amount to drink is enough to keep your urine light yellow to clear, usually about 40-60 ounces a day, depending on your activity level.
Does it make a difference what type of fluid I drink?
Water is the best drink. The more dilute urine it produces, the larger volume you're able to hold.
Acidic drinks such as coffee, black tea, anything with bubbles and citric juices will be more irritating to your bladder and cause you to feel like you need to urinate before your bladder is at full capacity.
Can menopause cause incontinence?
The pelvic tissues that line and support your vagina and bladder are all hormone sensitive, so dryness and irritative bladder symptoms like frequency, urgency, burning and leakage can all occur with menopause.
Sometimes a little hormone cream applied to your vaginal area is all that's needed for significant improvement, sometimes menopause is the tipping point that unveils an underlying issue with poor support that leads to incontinence