• What is a Urogynecologist?
• Bladder Problems
• Pelvic Organ Prolapse
• Prevention of Urinary Incontinence and Prolapse

Urinary Incontinence
Urine leakage is an embarrassing problem that can lead to depression and social isolation. The two main types of urinary incontinence in women are urge incontinence and stress incontinence. Urge incontinence occurs when a woman has a strong urge to get to the bathroom but leaks before doing so, which may happen during the day, at night or both. Stress incontinence occurs with coughing, laughing , exercise, or sneezing, among other activities. Although less common, other types of incontinence exist and can be discussed and treated.

Urinary Urgency and Frequency and Urge Incontinence
A typical woman will urinate up to eight times during a twenty-four hour period including once during sleeping hours. If a person is urinating more often than that, she is said to have urinary frequency. Sometimes, frequency is worse during certain times of day. When a woman has an uncomfortably strong need to void that arises quickly this is called urinary urgency. If she urinates more than once a night and her sleep is being disrupted, this is called nocturia. Women with urgency, frequency, and/or nocturia with or without leakage have overactive bladder symptoms.

Urge urinary incontinence is urine leakage that occurs before a woman can get to the bathroom in response to an urge to urinate. This is usually due to uncontrolled spasms or contractions of the bladder muscle (the detrusor). Various causes of urge urinary incontience exist. Typically, no specific illness is identified. Various treatment options exist.

Stress Urinary Incontinence
Stress urinary incontinence (SUI) occurs with periods of increased abdominal pressure, such as with laughing, coughing, sneezing, lifting, bending, or exercising. SUI is related to loss of support and loss of function of the bladder neck and uretha. These structures act as a valve to keep urine from leaking out when abdominal pressure increases. Loss of this support is often related to childbirth, smoking, repetitive physically-strenuous work, accidental pelvic injuries, or inherited tissue weakness. Sometimes SUI is accompanied by the loss of pelvic organ support, known as pelvic organ prolapse. In these cases, a woman may note a "dropped uterus," pelvic pressure or discomfort, or a vaginal bulge, among other symptoms.

The amount of leakage and associated activities vary. Some leak only with certain specific activites, while others leak with most activities. The volume of urine leakage also varies. Women with more constant or severe leakage or who have had previous bladder or prolapse surgeries may have intrinsic sphincter deficiency (ISD), a severe form of SUI.

Can SUI be treated?
Yes! Multiple treatment options are available depending on the causes and severity.
Non-surgical Options
Pelvic floor therapy, biofeedback, coping strategies and exercises (Kegels) are available to strengthen your pelvic muscles. Biofeedback helps improve pelvic floor muscle control by letting you see or hear when you are using the pelvic muscles correctly.
Surgical Options
A variety of surgical repairs exist to support the urethra and/or "bladder neck." Choosing among the different surgical techniques depends on the experience and training of your urogynecologist and the exact nature of your problem. You and your urogynecologist must decide on the specific surgery together.
Support Devices
Several kinds of support devices exist including pessaries, urethral devices and tampons.
Some women find a tampon provides effective support for the urethra, thus improving bladder control.
Urethral devices are placed in the urethra like a cork or plug.
Pessaries for urinary incontinene are silicone rubber devices that are placed in the vagina to support the bladder neck. Most women can learn to care for their pessaries themselves.
Your Options
You and your Urogynecologist must work together to plan your treatment. Many women choose to try non-surgical options first. When these prove unsatisfactory, surgical options can be explored. Remember, you are not the only one with this problem and that you do not have to "just live with it!"
Will I ever be dry again?
No treatment option is perfect. While most patients can get substantial improvement, some continue to leak but markedly less so. About 75-80% of patients are still satisfied with surgical results 5 years later. Many will continue to do well thereafter. The 5 year mark is a convenient research point. Longer-term studies show the majority of women followed 10 to 20 years are still satisfied.

Dysuria
Dysuria is a pain that occurs while urinating, often due to a urinary tract infection (UTI). Other causes include infection of the urethra (urethritis), herpes, and painful bladder syndrome/interstitial cystitis (PBS/IC).

Voiding Dysfunction
Some when have trouble starting urination (hesitancy) and/or difficulty emptying the bladder. Urinary control and emptying involve complex interactions of the brain, spinal cord, bladder, urethra, pelvic floor muscles, and connective tissues. Medications can affect control and emptying. Pelvic floor surgery is also a common cause.

Patients who cannot empty may eventually start to leak urine due to overflow incontinence. Patients may have a feeling of lower abdominal or pelvic fullness or bladder pain possibly with frequent, small volume urination as well as leakage.