Stress Urinary Incontinence

What is Stress Incontinence?  Stress urinary incontinence (SUI) is the leaking of urine that typically occurs with “coughing, sneezing, laughing, and exercise”… any activity that increases pressure in your abdomen and leads to leaking of urine.  SUI is very common, affecting more than 25 million Americans!  The leaking is involuntary, and can often cause anxiety and embarrassment.  Incontinence is absolutely NOT a normal part of being a woman or of the aging process and it does not need to be tolerated.  If fact, delaying treatment can actually worsen the condition.  Help is available!

These diagrams will help you to better understand what happens to our bodies when we have stress incontinence.

Your body BEFORE stress incontinence
The muscles and ligaments of the pelvic area support the bladder and urethra in their normal positions. They also provide proper muscle control, alternately constricting the urethra to store urine or constricting the bladder to remove urine from the body.

 

Your body WITH stress urinary incontinence
When the pelvic floor muscles and ring of muscles that surround the urethra (urinary sphincter) have been weakened or damaged by pregnancy, childbirth, menopause, or other causes, the urethra may relax from its normal position and be unable to close completely. So, if a woman coughs, sneezes, or laughs, the sudden pressure she places on her bladder may be too much for her weakened muscles to handle, and she may experience an embarrassing momentary loss of bladder control known as stress urinary incontinence.

How Do We Evaluate Stress Incontinence?

First, we establish the cause for your incontinence.  This is accomplished through a pelvic exam, a sample of your urine to rule out other causes of leaking, and often urodynamic testing.

Urodynamics refers to a series of diagnostic tests to evaluate the performance and health of the bladder and urethra.  These diagnostic tests are done right here in the office by the nursing team.

What do I need to do to prepare for Urodynamic testing? You can use the bathroom up to 3 hours before your test, which takes only about 30 minutes.  Your bladder should be full, but not so much that you are feeling a strong urge to urinate.  Of course, do not force yourself NOT to urinate if you need to.  Drink bottled water on the way to your appointment to bring your bladder back to a full level.

What will happen during the test?  When you come in, you will be asked to empty your bladder into a special toilet-type device called a uroflowometer.  This device measures the strength of your urine flow.  When you have emptied your bladder, an ultra-thin, smooth and flexible tube called a catheter will be gently inserted into your bladder.  This may sting just a little for a second or you may not have any discomfort at all.  The catheter is used to both fill your bladder with water and measure the pressure on it as it fills up with water and is then emptied.  During the next phase, a very small measuring tube will be inserted into your vagina.  Chances are you will not even feel the tube inside your body.  This tube will measure pressure in your abdomen when you laugh, flex your abdominal muscles, or cough.

After that, two electrodes will be placed on your buttocks near your rectum.  These electrodes will monitor the muscles and nerve responses during urination.  You may feel minor discomfort when the electrodes are removed due to the adhesive used to hold them in place.  This is much like removing an adhesive bandage.  Our staff will explain each step of the test.  A computer will record all findings, which will be analyzed by our physicians.

Getting the test done is your first step toward achieving a more normal life without worrying about a leaky or overactive bladder.

What are the treatment options for Urinary Stress Incontinence?

Once the cause is determined, we will work with you to find the best treatment option for you.  Treatments may include exploring behavioral or drug therapy, minimal surgical procedures, and the O shot.

The reality for many women is that drug therapy causes unwanted side effects (constipation and dry mouth) and behavioral therapy (limiting caffeine and fluid intake), Kegel exercises, pelvic physical therapy, are often not enough to stop the embarrassing leaking.  Two alternative options we have had extreme success with in our practice are the urethral sling and O shot.

  • Urethral sling: During a sling procedure, your surgeon uses strips of synthetic mesh to create a sling or “hammock” under your urethra.  The sling supports the urethra and helps keep it closed, so that you don’t leak urine.  This procedure requires anesthesia, but is usually performed in a matter of minutes and requires only one, small 1.5 cm vaginal incision.  Most patients do not require pain medications and are back to work the next day.
  • O-Shot®: As the name Orgasm Shot® implies, this revolutionary procedure is also used to improve a woman’s clitoral sensitivity and orgasm, but based on the location of the injection beneath the urethra, also treats stress incontinence.  How Does This Procedure Work?
    First, a small amount of blood is drawn from your arm.  Using a centrifuge, one of our doctors isolates platelets from that blood (platelet rich plasma, or PRP), all within about 15 minutes in the office.  The platelets are then “activated” to release at least eight growth factors that would normally be used to heal injured tissue.  These growth factors work like magic to cause increased collagen and new blood flow.

The time to treat your incontinence is now, before symptoms progress and necessitate a more invasive approach.  We would be happy to see you for an individual consultation and discussion of your needs.  Feel free to make an appointment today!

 Over Active Bladder (Urge Incontinence)

  • Are you experiencing a sudden urge to urinate and sometimes do not make it to the bathroom?
  • Are you struggling with lack of normal bladder control?

These symptoms may indicate an Over Active Bladder, or OAB.

OAB is NOT a normal part of aging.  OAB is also not your fault.  It is a common condition experienced by many women and often leads to avoidance of work and social functions due to fear of embarrassing leaking.  There are several factors that contribute to a woman developing OAB, including pregnancy, childbirth, obesity, weakening of the pelvic muscles with aging, and neurological misfires.  High calcium levels and inactivity can also increase your risk for developing OAB.

Part of our work-up for OAB often includes Urodynamic testing.  Urodynamics refers to a series of diagnostic tests to evaluate the performance and health of the bladder and urethra.  These diagnostic tests are done right here in the office by the nursing team.

What do I need to do to prepare for Urodynamic testing? You can use the bathroom up to 3 hours before your test, which takes only about 30 minutes.  Your bladder should be full, but not so much that you are feeling a strong urge to urinate.  Of course, do not force yourself NOT to urinate if you need to.  Drink bottled water on the way to your appointment to bring your bladder back to a full level.

What will happen during the test?  When you come in, you will be asked to empty your bladder into a special toilet-type device called a uroflowmeter.  This device measures the strength of your urine flow.  When you have emptied your bladder, an ultra-thin, smooth and flexible tube called a catheter will be gently inserted into your bladder.  This may sting just a little for a second or you may not have any discomfort at all.  The catheter is used to both fill your bladder with water and measure the pressure on it as it fills up with water and is then emptied.

During the next phase, a very small measuring tube will be inserted into your vagina.  Chances are you will not even feel the tube inside your body.  This tube will measure pressure in your abdomen when you laugh, flex your abdominal muscles, or cough.  After that, two electrodes will be placed on your buttocks near your rectum.  These electrodes will monitor the muscles and nerve responses during urination.  You may feel minor discomfort when the electrodes are removed due to the adhesive used to hold them in place.  This is much like removing an adhesive bandage.

Our nursing staff will explain each step of the test.  A computer will record all of the findings, which will be analyzed by our physicians to develop the best treatment plan for you.

Getting the test done is your first step toward achieving a more normal life without worrying about a leaky or overactive bladder.

What are some of the latest options for treating Over Active Bladder?

  • Behavior modification and physical re-training:  sometimes by changing what you eat and drink, and when, timed voiding (urinating at frequent and timed intervals) and by doing Kegel exercises to strengthen your pelvic muscles, you can significantly improve your OAB symptoms.
  • Medication: certain medications can reduce the frequency and severity of OAB.  Unfortunately, many of these medications cause frequent unwanted side effects, such as constipation and dry mouth.
  • Urgent PC:  offers bladder control without drugs or surgery.  A small acupuncture-like needle electrode is placed at the ankle, patients sit comfortably while the device delivers percutaneous tibial nerve stimulation.  30-minute weekly sessions for 12 weeks are recommended.  Studies suggest up to 80% of patients improve with Urgent PC treatment.
  • Neurostimulation:  InterStim, a revolutionary treatment option made by the same trusted company, Medtronic, that developed the pacemaker.  InterStim uses neurostimulation, a treatment that involves the minor surgical implantation of a small device that uses mild electrical impulses to stimulate the sacral nerves, which are located near the tail bone.  If functioning normally, the sacral nerves tell the brain the bladder is full, and the brain in turn tells the pelvic muscles to contract to empty the bladder.  InterStim corrects the sacral nerve impulses and thus many OAB symptoms.  It’s also a reversible treatment should you and your provider decide it would be best removed at a future time.  As with any surgical procedure, there are minor risks, which we can discuss in depth during your consultation.

You don’t need to suffer in silence with Over Active Bladder.  You don’t need to decline social invitations anymore or spend hours planning an outing to make sure you are always near a rest room.

Get your life back on track and get back to feeling like your old self without worrying about urinary leaks or bladder control problems!

We encourage you schedule an appointment with one of our physicians or nurse practitioners to discuss your specific concerns and decide on a treatment that is best for you and your lifestyle.

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