Frequently Asked Questions

When I sneeze or cough, I’ll sometimes accidentally leak a little urine. Many times I have trouble making it to the bathroom without leaking a little urine.  Is this incontinence?
Yes, leaking urine when you sneeze, cough or even when you run or jog are all symptoms of incontinence. And, if you’re experiencing any of these “little accidents,” you’re not alone. Nearly 12 million people have urinary incontinence. The good news is that there are many treatment options available to help control your symptoms and even cure your condition.

What are the different types of incontinence and how will I know which I have?
Any involuntary loss of urine is considered urinary incontinence. Accidental leaking of urine at the wrong time and place is termed urge incontinence. When urine leaks out due to pressure on your bladder – some causes include exercise, coughing, sneezing, or laughing — you may have stress incontinence.

What is urge incontinence?
Incontinence has a variety of causes. Urge incontinence, sometimes referred to as an “overactive bladder,” occurs when your bladder muscle spasms or contracts. Spasms can stem from a variety of causes including: bladder nerves damaged by stroke, Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, a brain tumor or aneurysm and spinal cord injuries. Other spasms can be caused by eating foods or drinking beverages that contain chemicals that irritate the bladder, an infection, lack of estrogen in the genital tissues or bladder, kidney stones, diabetes mellitus, chronic constipation, or drinking too much liquid or not enough.

What is stress incontinence?
Stress incontinence is caused by weak pelvic muscles and poor ligament support of the bladder and urethra, or a defect in the tube connecting the bladder to the urethra. Some experts believe incontinence can be caused by extreme stress on the pelvic muscles during childbirth. Multiple pregnancies, long pushing times and large babies, as well as activities such as chronic lifting of heavy items, chronic coughing and some sports activities, may increase your risk of incontinence.

Can constipation cause incontinence?
Constipation and urge incontinence can be related and urge incontinence will often improve when we chronic constipation is treated. Natural dietary changes to treat constipation, including increasing daily fiber to 20-35 through foods and supplements, have been found to be effective in many cases. (A half-cup of All Bran cereal has almost 10 grams of fiber. One cup Raisin Bran has about 8 grams of fiber.)

What are my options for treatment?
Options for treatment of urinary incontinence can vary depending on the individual. Nearly 80 percent of patients are able to find improvement with simple changes in the diet and by doing pelvic exercises, known as Kegel exercises. Medication, painless electrical stimulation and surgery are utilized in those 20 percent of patients where additional treatment is needed.

I’ve read that dehydration can cause incontinence. Is that true?
Yes, dehydration can cause incontinence. You can gauge whether you’re dehydrated or not by looking at your urine – pale yellow means you’re adequately hydrated. The amount of fluids a person needs is different for everyone and depends on level of activity as well as how much fluid you’re getting from the solid foods you eat. Your doctor can help you determine how much fluid you should be getting.

Can the foods I eat affect incontinence?
Absolutely, food or drinks with high acid content, such as citrus, as well as carbonated drinks, spicy foods, milk and milk products and even smoking and alcohol can cause incontinence.  Lifestyle changes such as avoiding caffine and refraining from drinking in the evening can help avoid frequent trips to the bathroom at night.

Can pelvic exercises really improve my incontinence problem?
The good news is that Kegel exercises are among the most effective, non-invasive treatments for incontinence. Because these simple exercises (you can even do them while waiting for a stoplight to change) help strengthen and tone the pelvic muscles, they can make a significant difference. Though it may take as long as six weeks to notice any improvement with Kegel exercises, the results will be worth the effort.

Are there medications that I can take for incontinence?
Certain medications can help with incontinence by contracting and tightening muscles to prevent urine leakage. In many women, small amounts of estrogen cream applied to the vagina or hormone replacement therapy (HRT) can help as well.

My doctor suggested that electrical stimulation might be the best treatment option. It sounds frightening. Will it hurt?
Though electrical stimulation sounds scary, it does not hurt and isn’t even uncomfortable.  But, it can be very effective in controlling their bladder function. With electrical stimulation, a small instrument is inserted into the vagina to deliver tiny electrical pulses. These pulses cause your muscles to contract and become stronger to effectively treat involuntary leaking of urine.

I have tried dietary changes, Kegel exercises and electrical stimulation without success.  What are my next options?
If exercise, diet and other conservative treatments haven’t provided the improvement, surgery may be an option. There are a variety of surgeries that can help control incontinence. Most are minimally invasive and most patients achieve full recovery in as little as four to six weeks.

Is incontinence a problem for women only or do men suffer too?
Both men and women can suffer from incontinence. Frequently, men who have been treated for prostate cancer find that incontinence is a side-affect. However, through advanced technologies and surgical techniques, male incontinence can be successfully treated.

What exactly is a “Kegel” Exercise and how do I do it?
Exercising your pelvic floor muscles with Kegel exercises, for just 5 minutes, three times a day can make a big difference to your bladder control. You can locate these muscles by stopping and starting your urine when you use the toilet. The good news is that you can do your Kegel exercises whether sitting at a desk, standing in a checkout line or lying on your back. A combination of all three positions will yield the most effective results. To begin, simply pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Work up to 10 to 15 repeats

 

URINARY INCONTINENCE

What is Urogynecology?
A subspecialty within Obstetrics and Gynecology, urogynecolgy focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence and constipation. Urogynecologists complete a residency in Obstetrics and Gynecology, followed by fellowship training where they spend several years focusing only on these disorders.

Does urinary incontinence affect a lot of women?
The most important thing to know is that, while millions of women experience involuntary loss of urine or urinary incontinence, it is not normal and there’s no reason anyone should suffer needlessly from it. While some women may lose a few drops of urine while running or coughing, others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Symptoms can range from mildly bothersome to totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.

 

PELVIC ORGAN PROLAPSE

What does "prolapse" mean?
Pelvic organ prolapse (POP) may be considered a type of “hernia” in which the pelvic organs descend or shift within the pelvis, and in some cases, protrude outside the vagina. As many as 50% of women who have given birth one or more times have some degree of genital prolapse, but only 10 to 20% experience symptoms. Approximately half of all women over age 50 complain of symptoms associated with prolapse.

What symptoms are caused by my prolapse?
Symptoms can vary based on the type of prolapse and how long you have had it. Many women don’t seek treatment until later stages. The first signs of prolapse, such as pain during intercourse or an inability to keep a tampon inside the vagina, are often dismissed by women. With time, as the condition worsens, some women will experience uncomfortable bulging or a heavy sensation in the vagina. Bowel movements will often cause increased discomfort or heaviness. In extreme cases of prolapse, women may have to manually push stool out of the rectum by placing their fingers into the vagina during bowel movements.

What causes a prolapse?
Prolapse can be caused by a variety of factors and most can not be controlled or prevented. A few of the contributing factors that we know of are: a family history, vaginal childbirth, obesity, repeated heavy lifting, pelvic tumors and chronic constipation.

Is surgery the only treatment option for prolapse?
Though advancements in surgery have made it a popular treatment option, there are other treatments available. One of the most popular non-surgical treatment options is called a pessary. It is a device that is worn in the vagina like a diaphragm to support the prolapsed pelvic organs.

Am I more prone to vaginal infections if I wear a pessary?
To avoid infections, a pessary can be inserted daily and removed at night for cleaning. Another option is for the pessary to be inserted in a more permanent manner. About every four to six times a year, the patient would return to her physician’s office for a routine cleaning and examination. In either case, vaginal infections, due to pessaries, are rare.

If I choose not to get treatment will anything happen?
In rare cases, when pelvic organ prolapse is untreated, it can cause urinary retention and ultimately kidney infection or damage. In nearly all cases, when left untreated, pelvic organ prolapse will usually get worse. However, treatment of prolapse should be based on your symptoms and the patient should be able to decide when it’s time to have their prolapse treated.

I think that my best treatment option is surgery – what can I expect?
Depending on the type and extent of your surgery, a hospital stay of between one and four days. In many cases, urination following surgery is difficult and a catheter will be necessary for 3 – 7 days after. Prescription strength pain medicine may be necessary and patients are encouraged to restrict activity (no heavy lifting, no intercourse and no heavy exercise) for up to 12 weeks to allow proper healing.

Will this permanently repair my problem or will I need to have my surgery repeated in the future?
Continence or pelvic reconstructive surgery is generally permanent and, in most cases, will not need to be repeated. However, none of these procedures are successful 100% of the time.  Should additional repair be necessary, successful results can be achieved with pessary use, or surgery that is much less extensive than the original surgery. Chances for permanent and sustained success are improved when patients follow the recommended recovery period of 12 weeks.

I am scheduled to have surgery to repair my prolapse but I’m not having  trouble with urinary incontinence. Do I really need to have bladder tests prior to surgery?
Yes, bladder testing is always required prior to prolapse surgery. In many cases of prolapse, the vagina may have fallen against the urethra and is preventing urine leakage – or masking the effects of urinary incontinence. A bladder test or urodynamic test will temporarily reposition the prolapse in its normal position so that your doctor can determine if an incontinence procedure is needed at the same time.

Will I still be able to have sex following treatment for my prolapse?
If you choose to treat your prolapse with a pessary, you’ll simply need to remove it prior to intercourse. If you choose to have surgery to correct the prolapse, we recommend that you wait at least 12 weeks before engaging in intercourse. In severe cases of prolapse, patients may want to consider a surgical option known as a colpocleisis or colpectomy. Though less invasive than reconstructive surgery, this procedure makes intercourse impossible. Only patients who are absolutely certain they will not want to be sexually active should consider this option. So it is only appropriate for patients who are ABSOLUTELY sure that they never want to be sexually active again.