Urogynecology

Urinary incontinence (UI) is a common condition in women that involves the involuntary loss of urine. When UI occurs while laughing, coughing, sneezing, jogging, or other physical activity, it is known as stress incontinence. When it manifests as a strong urge to urinate without enough time to reach a bathroom, it is known as urge incontinence. There are also other less common causes of UI. While these conditions are usually not life threatening, they can be embarrassing and have a significant impact on your daily life.

UI can affect people of all ages, but women are especially susceptible after pregnancy and later in life. UI is sometimes caused by a urinary tract, or bladder, infection. Other common causes include a loss of supporting connective tissue and muscles in the urinary tract, or bladder spasms. These weaknesses may prevent you from closing off the urethra while doing certain activities. UI may also be a sign of underlying medical disorders.

Symptoms alone often do not indicate which of these causes are responsible for this sometimes debilitating problem. An evaluation may uncover other abnormalities such as cystocele, rectocele, enterocele, and uterine prolapse. We offer a comprehensive workup of female urinary incontinence including a detailed history, a focused physical exam, and the convenience of in-office cystometrics.

Certain exercises, such as pelvic floor or Kegel exercises, can strengthen pelvic muscles that can be used to close off the urethra. Losing weight can also help to control accidents. Changing your diet and adjusting medication dosage can help as well. Behavior modification such as training your bladder and setting a urination schedule are sometimes effective in treating urinary incontinence.

When these conservative methods are unsuccessful, anticholinergic medications, which relax the bladder and increase bladder capacity, may be prescribed for you. A device called a pessary, inserted into the vagina to help retain urine, can be helpful in some instances. Surgery may be required for patients who do not respond to other treatments. Our doctors can help you decide which treatment option is best for you.

Cystometrics is a procedure that tests your bladder for incontinence.

What to Expect: 

Please come to this visit with a full bladder. When you arrive, you will be asked to empty your bladder into a commode in order to measure the speed of your urine flow. Next, a small tube will be placed in your urethra and vagina or rectum. Your bladder will be filled slowly while the pressure is measured. You will be asked to cough and bear down in order to observe any leakage that might occur. Finally, you will be asked to void into the commode again with the tubes in place. This is not typically a painful procedure. You may experience some cramping and pressure with an urge to urinate during this study.

Pre-procedure: 

You do NOT have to drink a large amount of fluid prior to the procedure. However, it is preferable to come to your appointment with a slightly full bladder. Please try to hold your urine if you feel that you have to empty your bladder an hour or more before the test.

This procedure may be cancelled if you have recently started your period.

Post-procedure: 

You may experience a slight burning sensation for not more than 24 hours after the procedure. You should call our office if you experience prolonged burning with urination, blood in the urine, severe pain, a fever greater than 100.5 F, or if you have any questions.

Surgery for Urinary Incontinence and Pelvic Organ Prolapse: 

Surgery for UI and pelvic organ prolapse is undergoing rapid evolution. Urogynecologic surgeries can help patients regain some or all pelvic floor function and enjoy relief from pain or discomfort. Surgery can improve or correct urinary and fecal incontinence and pelvic organ prolapse (including uterine prolapse, cystocele, rectocele and enterocele). Some surgeries, such as tension-free vaginal tape (TVT), can be performed on an outpatient basis. Others require a hospital stay of anywhere from two to four days. Regardless of the type of procedure, we encourage patients to rest for 12 weeks after surgery (no heavy lifting, no strenuous exercise, and no intercourse) so they can fully heal and minimize the chance of developing complications.